Health Care Cost

Spending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.

A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.

The Biden administration released the list of 27 Medicare Part B drugs that are subject to rebates back to the government for having price increases that rose faster than inflation as well as the removal of out-of-pocket costs for some vaccines covered under Part D.

The authors analyzed cost and utilization changes for sepsis and pneumonia non–COVID-19 episodes prior to and during the pandemic, and during the pandemic for patients with and without COVID-19.

Optimizing utilization of sacubitril/valsartan for treatment of heart failure could improve provider performance in the Bundled Payments for Care Improvement initiative and the Medicare Shared Savings Program.

With the rapid decline in average sales price of reference pegfilgrastim products due to biosimilar competition, health care institutions and payers may grapple with coverage of Neulasta Onpro.

A session at the Association of Community Cancer Centers (ACCC) 2023 Annual Meeting and Cancer Center Business Summit highlighted ongoing issues in oncology policy and payment, from the Cures 2.0 Act to 340B drug reimbursement.

Jeff Hunnicutt, CEO of Highlands Oncology Group, explains the 2 risk options provided under the Enhancing Oncology Model (EOM) and why the mandatory downside risk might give pause to practices that saw some success in the Oncology Care Model.

Panelists at the keynote session of the Value-Based Insurance Design Summit highlighted what their organizations are doing in health equity.

A new resource from the National Alliance of Healthcare Purchaser Coalitions aims to help plan sponsors adopt biosimilars into their pharmacy benefit plans.

Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care, spoke on financial toxicity, heterogeneity of cancer, and other complex factors in oncology care systems that may perpetuate disparities in health care outcomes and delivery among patients.

Cyber attacks on health care are raising cyber insurance costs; Democrats and Republicans clash over what constitutes a cut vs a reform; rural hospitals begin conversion under a new federal payment program.

A roundup of the latest biosimilar news from The Center for Biosimilars®.

Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology, discusses the present state of value-based oncology care and what the future may bring when the Enhancing Oncology Model kicks off on July 1.

The FDA approved the first drug for the rare disease Friedreich’s ataxia; House Republicans seek information from pharmacy benefit managers (PBMs); FDA panel narrowly supports respiratory syncytial virus (RSV) vaccine for older adults.

David A. Eagle, MD, New York Cancer & Blood Specialists, discusses the present state of treatment for cancer, which often sees patient financial concerns outweighed by the cost of treatment.

A Cardinal Health report reviewed the potential impact biosimilars will have in rheumatology, gastroenterology, dermatology, and ophthalmology.

Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.

There are 2 ranibizumab biosimilars approved in the United States, and with more ranibizumab and the first aflibercept biosimilars on the horizon, gaps in knowledge among retinal physicians should be addressed.

An increased risk of hospitalization for more than 6 days due to community-acquired infections was associated with male sex and admittance to the Pulmonology or Surgery department, with risk shown to differ according to pathogen.

Social Security and Medicare spending could double by 2023; FDA panel experts want naloxone to be available over the counter after the drug information is revised; Moderna announced its COVID-19 vaccines will stay free, and the Biden administration might keep tests and treatments free for the uninsured.

Unrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.

This study investigated the impact atopic dermatitis (AD) has on out-of-pocket (OOP) costs for caregivers of pediatric patients with the chronic skin condition.

Some communities will use COVID relief money to pay medical debt; residents living near train car derailment site in Ohio are worried about toxic chemical health effects; following medical guidelines point by point would create impossibly long workdays for providers, studies are pointing out.

Targeting everyday chronic conditions to rare diseases that require costly, sometimes 1-time treatments, CMS Tuesday announced an intent to test 3 new models in an effort to lower drug prices and widen access to expensive, life-changing therapies for patients in Medicare and Medicaid.

Implications of these findings include a more clear understanding of the burden imposed by heart failure (HF), which encompasses the cost of care and adverse health outcomes.

Congress has no solution for out-of-network ambulance rides; teenagers going to an emergency department in a mental health crisis don't receive necessary follow-up care; Medicaid explores nutritional benefits of food as medicine spending in some states.

The Biden administration released 2 sets of guidance documents for pharmaceutical manufacturers about how it plans to implement the new Medicare Prescription Drug Inflation Rebate Program as required under the Inflation Reduction Act, and said some beneficiaries could see lower coinsurance for some Part B drugs as soon as April 1.

Jessica Allegretti, MD, MPH, medical director of the Crohn's and Colitis Center, Brigham and Women's Hospital, discussed how the FDA’s approval of Rebyota for the prevention of recurrent Clostridioides difficile infection (CDI) may promote cost effective management of CDI for patients and health systems.

The findings emphasize a need for policies that may offset the impact of direct and indirect costs for patients with breast cancer.