Insurance

Ben Urick, PharmD, PhD, of Prime Therapeutics, compares the value of medically integrated specialty pharmacies with that of mail order pharmacies.

Biosimilars are becoming more common as more launch on the market in the United States, but patient and provider education can help speed uptake of these products, explained Bincy Abraham, MD, Houston Methodist – Weill Cornell.

According to the National Cancer Institute, in the year following a cancer diagnosis, the average cost of medical care plus medication exceeds $42,000, with some treatments having a price tag of more than $1 million.

Medicare Part A and B premiums are set to increase by $9.80 next year; 20 experts from various specialties and institutions have developed updated brain death guidelines; many Black patients are strongly affected by multiple COVID-19 infections due to a lack of health insurance and health care access.

In this analysis of more than 97 million commercially insured individuals, investigators found that the COVID-19 pandemic induced a spending shock in 2020 and that health care spending did not recover to baseline until mid-2021.

Patients with Medicare were 5.08 times more likely than patients with private insurance, and 2.81 times more likely than patients with Medicaid, to face a financial barrier to obtaining varenicline and combination nicotine replacement therapy.

Cigna will pay $172 million to resolve allegations that it submitted inaccurate diagnosis codes for Medicare Advantage plan enrollees in order to increase payments from Medicare.

Providers have to know how to manage patients who are hesitant to switch to a biosimilar and payers who have specific preferences about which biosimilar to use.

FDA is investigating fraudulent schemes trafficking counterfeit semaglutide (Ozempic); Moderna plans to begin a late-stage trial of its combined COVID-19 and flu vaccine later this year; CMS will begin restricting predictive software used by insurance companies next year.

The researchers noted that their findings suggest clinicians and policy makers should encourage hepatitis C virus (HCV) treatment in those with unhealthy alcohol consumption or alcohol use disorder (AUD) rather than create barriers to it.

Among Latino men who have sex with men (MSM), access to and use of pre-exposure prophylaxis (PrEP) remain at suboptimal levels, despite this population of individuals having disproportionately high rates of diagnosed HIV in the United States.

Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.

The cohort study focused on annual incidence, prevalence, and mortality linked to a number of cardiovascular conditions between 2015 and 2019.

ViiV Healthcare is developing a self-injectable HIV drug similar to Cabenuva; HHS met with insurance companies to resolve COVID-19 vaccine coverage issues; the FDA has greenlit drugmaker Novo Nordisk to add reports of ileus, or intestinal blockage, to its Ozempic label.

A survey of gastroenterologists, dermatologists, and rheumatologists found Amjevita had the most recognition, followed by Cyltezo, the only interchangeable biosimilar on the US market.

Medicare Advantage enrollment was higher among immigrants compared with US-born residents, but the highest enrollment was found among immigrants with limited English proficiency.

While regional variations were identified in rates of breast reconstruction, complications, and cost for patients with breast cancer, these differences did not seem to be associated with any implicit bias.

The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.

Enrollment in managed care among Medicaid enrollees presents challenges to classifying Medicaid coverage in cancer registries.

The playbook includes resources for purchasers to help in their dealings with pharmacy benefit managers (PBMs), including best practice checklists, sample questionnaires for choosing consultants, and recommendations for contracting language.

The Medicare Shared Savings Program (MSSP) generated its second highest annual savings since the program began more than a decade ago.

Physicians have been facing increasing workloads making it difficult to practice medicine as they were trained, but an accountable care organization might provide an opportunity for real change to deliver high-value, compassionate care.

Patients and physicians are publicly shaming insurance companies on social media for the troublesome prior authorization process; HHS has awarded $1.4 billion in grants for the creation of new technologies and tools to prevent COVID-19 infection; Novo Nordisk has increased lobbying efforts to allow Medicare coverage of weight loss drugs.

Clinicians and nurses who treat patients with hemophilia with a gene therapy identified important factors and considerations needed in a potential shared decision making tool.

A new CMS proposal would authorize Medicare payments to cover family caregiver training; US list prices for popular weight loss drugs are higher than those of other wealthy nations; Midwestern cities declare themselves sanctuary cities despite anti-LGBT state laws passed.

Data on 10 social determinants of health (SDOH) were analyzed to determine their distribution among low-income patients hospitalized for heart failure (HF) at a safety-net hospital.

The program, which scales an accountable care organization (ACO) model across all major payers in Vermont, reduced Medicare spending and hospitalizations while improving patient care.

Novo Nordisk continues to limit starter doses of popular weight-loss drug Wegovy in the US; veterans and survivors received an error message when submitting PACT Act claims shortly before the deadline; insurance companies are failing to inform patients of their eligibility for free preventative services.

The Red Cross’s inclusive assessment will determine blood donation eligibility; Wegovy reduces the risk of cardiovascular events; the first postpartum depression pill sparks pricing questions.

A record low of 7.7% of Americans had no health insurance at the start of 2023; the American Academy of Pediatrics renewed its backing of gender care for children while requesting a research review; 2 lots of an oral contraceptive were recalled for possible reduction in effectiveness.