Health Care Cost

Panelists who have reviewed the Enhancing Oncology Model (EOM) say it puts additional requirements on practices with reduced monthly payments, and its risk modeling could put a small practice out of business.

Black and Latino Americans saw surges in health care insurance enrollment through the Affordable Care Act (ACA) between 2020 and 2022; Medicaid enrollment and spending is expected to slow in 2023; the Biden administration is preparing a national hepatitis C treatment plan.

Despite known racial disparities in access to advanced heart failure (HF) treatments, the reasons for this continue to require further exploration. In this new study, investigators searched for associations between ventricular assist device use and heart transplant and race (Black or White).

CDC advisory group votes to add COVID-19 vaccines to the pediatric immunization schedule; a new report says workplaces can be hazardous to the mental and physical health of Americans; drug makers are lobbying to ease the impact of the Inflation Reduction Act.

The goal of this new study was to gain more information on the disease burden, including costs, of patients living with chronic rhinosinusitis with nasal polyps (CRSwNP).

Black and Hispanic patients living with chronic inflammatory skin disease (CISD) have more barriers to care compared with White patients with CISD, according to a recent study.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members with support for rare, complex conditions.

The concluding keynote address at the Academy of Managed Care Pharmacy Nexus 2022 meeting discussed new and emerging oncology drugs in the pipeline and their potential impact on the treatment landscape as it pertains to managed care providers.

President Joe Biden is directing HHS, through an executive order, to use the Innovation Center to lower drug prices; the US extended the COVID-19 public health emergency for another 90 days; the CDC reported that 75% of teenagers experienced adverse childhood experiences in 2021, which worsened their mental health.

There have been many silver linings of the pandemic, including improvements in financial, operational, and clinical advancement efficiencies, as well as addressing the total cost of care in population health management, said Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute.

Integrated primary care services may offer better outcomes in patients living with severe chronic obstructive pulmonary disease (COPD) without increasing costs.

Two posters presented at AMCP Nexus 2022 addressed the cost-effectiveness of guideline-recommended integrase strand transfer inhibitor–based triple therapy in people living with HIV, as well as the efficacy of adjuvant lenacapavir in treatment-naïve patients.

New and emerging medications in the specialty drug pipeline were discussed during a keynote address at AMCP Nexus 2022 by Aimee Tharaldson, PhD, senior clinical pharmacist of emerging therapeutics at Express Scripts, with biosimilars, orphan drugs, and cell and gene therapies emerging as key trends to watch.

On this episode of Managed Care Cast, we speak with Matthew D. Eisenberg, PhD, lead author of a study published in the October issue of The American Journal of Managed Care® that investigated the use of high-deductible health plans and their impact on substance use disorder care and spending.

There are no FDA-approved therapies for nonalcoholic steatohepatitis (NASH), but there are many being developed. Resmetirom and obeticholic acid are both being reviewed by the FDA with decisions expected in 2023.

Investigators for this study analyzed outcomes among patients hospitalized with pulmonary arterial hypertension (PAH) who have higher risks of adverse health outcomes, in particular sepsis and septic shock.

With more and more biosimilars reaching market, there are considerations around whether to keep patients on their current biosimilar or switch them to another biosimilar as the market dictates, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Svante Pääbo was awarded the Nobel Prize in Physiology or Medicine for his discoveries in human evolution; the amyotrophic lateral sclerosis (ALA drug AMX0035 was priced at $158,000 per year or about $12,500 per 28-day prescription; more than 16,000 Americans died of combination cancer and COVID-19 in the first 10 months of the pandemic.

A new report finds despite reforms to the country’s health care system, many patients in China with lung cancer experience stress, and sometimes health consequences, on account of the disease’s financial burden.

The presentation focused on the Protocol AC trial, which considered whether step therapy had an impact on visual outcomes for patients starting on bevacizumab and switching to aflibercept later.

A recent study suggests that including a pharmacist in the hemophilia comprehensive care model may improve bleeding outcomes and medication access and adherence, and lead to cost savings.

A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.

Targeted therapies have improved outcomes for patients with lung cancer, but the goal needs to be tailoring the right therapy to the right patient, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

As health care shifts reimbursement models from fee-for-service to value-based care, new terms and phrases have been surfacing across the industry. Two of the terms emerging with increased usage are “patient engagement” and an “active patient.” But what do they mean? And why are they important?

On this episode of Managed Care Cast, we speak with 2 authors of an article in the September issue of The American Journal of Managed Care®, which focused on the results of their evaluation of an intensive, community-based care management program for dual-eligible Medicaid ACO high-risk patients.

With 6 pegfilgrastim biosimilars approved, and multiple administration options, a patient-centric model of pegfilgrastim administration should be possible for patients with cancer who require prophylaxis of febrile neutropenia.

Streamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.

A recent study found that 1 in 5 households were strapped with medical debt; hospitals and hospital systems in North Carolina proposed a way to expand Medicaid to hundreds of thousands of adults; the CDC reported that more adults sought mental health treatment in 2021 compared with 2019.

Nearly 30% of youths are affected with worsening mental health by the end of adolescence, with anxiety typically presenting in childhood and depression during the teenage years, but the problem is even more acute for Black and Latinx youth.