Health Care Cost

The Employer Playbook on Biosimilars highlights strategies employers can use to navigate challenges around ensuring employee access to biosimilars at the pharmacy, as well as how to respond to pharmacy benefit managers who aren’t making biosimilars available on the formulary, said Margaret Rehayem, vice president, National Alliance of Healthcare Purchaser Coalitions.

Autism is being diagnosed more often in girls; cancer medication shortages mean some patients may die before receiving treatment; new CMS policies aim to reach underserved populations.

Many gene therapies promise life-changing effects, but without long-term data it remains to be seen how long the benefits last.

A new report from AHIP indicates that biosimilars have the potential to garner savings of $180 billion over 5 years, but there needs to be a review of the approval process for interchangeability to encourage more approvals.

A federal ruling could undermine the framework of FDA drug approvals; Florida’s warning on COVID-19 vaccines omits key data; uninsured patients with cancer struggle to find care.

Sashi Naidu, MD, is director of research at Carolina Blood and Cancer Care Associates, where the No One Left Alone (NOLA) initiative is working to break down cancer health disparities among its patients and prevent care fragmentation.

With the global market for biologics estimated at $382 billion just last year, and a projected global drug spend of close to $1.5 trillion by 2027, the landscape is ripe for biosimilars to help decrease the health care system’s cost burden.

CMS finalizes plans to decrease overpayments to Medicare Advantage insurers; an experimental respiratory syncytial virus (RSV) vaccine is highly effective in infants when given to pregnant women; obesity may be influenced by different brain factors between men and women.

The National Cancer Plan is being implemented as part of the Cancer Moonshot aims; inflation and higher spending are driving up monthly plan premiums under the Affordable Care Act; millions of people may lose Medicaid coverage after pandemic protections end.

Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.

Rates for reimbursement cuts will be lower than expected within Medicare Advantage plans; financial safety nets, in the form of Social Security and Medicare, are likely to be unable pay full benefits; CDC teams experience symptoms similar to East Palestine, Ohio, residents following train derailment

The Protocol AC study analyzed visual acuity gains and cost if patients with diabetic macular edema started on bevacizumab, which costs less, and switched to aflibercept later, explained Jennifer K. Sun, MD, MPH, associate professor of ophthalmology and chief of the Center for Clinical Eye Research and Trials, Harvard Medical School; and chair, DRCR Retina Network.

The province of Newfoundland and Labrador and the territory of Yukon both announced biosimilar switching policies, bringing Canada to a total of 10 out of 13 jurisdictions have a policy in place.

For employers, keeping members engaged with their health care is one of the key factors that leads to better outcomes, said Jeremy Wigginton, MD, vice president of health quality and innovation at Blue Cross and Blue Shield of Louisiana.

Panelists at the Value-Based Insurance Design Summit discussed research and reforms to address the high cost of medications and the impact it has on equitable access to treatment.

Implementing a strategy that focuses on dose rounding for chemotherapies can have a 3-fold impact of decreasing drug costs, minimizing drug waste, and improving treatment efficiency. This strategy and its benefits were explored in a session on day 2 of AMCP 2023.

Some challenges linking medication adherence to medical cost offsets include the potential of reverse causality, omitted variable bias, how adherence is measured between studies, and the outdated nature of some of the most-cited literature, said Ben Urick, PharmD, PhD, principal health outcomes researcher at Prime Therapeutics.

On the first full day of conference activity at AMCP 2023, a morning session examined prior authorization (PA) through a lens of refining the current process and the potential role of clinical trial data in PA criteria.

Minnesota looks to create abortion refuge for patients and providers; Moderna’s expected price single dose of COVID-19 sits at $130; FDA staff sees a "clinical benefit" in Biogen’s ALS drug.

Gov. Mark Gordon sings a ban on the use of abortion pills in Wyoming; a new study shows that Affordable Care Act has reduced racial disparities in health care; California Gov. Gavin Newsom announces a contract to make affordable insulin.

A substantial proportion of families of privately insured children with sickle cell anemia pay more than $100 for essential stroke screenings, a high-value service.

Preventing tobacco use has saved Californians billions, according to recent research.

Biosimilars may not be perfect, but they are, at the very minimum, helping to make cancer therapies a little bit more accessible, said Andre D. Harvin, PharmD, MS, executive director of pharmacy, oncology, Cone Health.

The high court in North Dakota voted to protect abortion in that state; an outside panel of FDA expert advisors voted to support a full approval for Paxlovid; Sanofi follows competitors' price caps for insulin.

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.