Insurance

There is a right way and a wrong way to inform a patient about a switch from the reference product to a biosimilar, explained Laura Wingate, executive vice president, Education, Support, & Advocacy, Crohn's & Colitis Foundation.

Debra Patt, MD, PhD, MBA, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."

Some of the many barriers patients with hidradenitis suppurativa (HS) face include accessing knowledgeable providers, insurance coverage of treatment, and the way the health care system is set up, said Haley Naik, MD, FAAD, associate professor of dermatology, University of California, San Francisco, School of Medicine.

The proposed fee schedule for 2024 would reduce payments by 3.4%. Most responses were swift and negative.

Residence in a more disadvantaged neighborhood was associated with higher likelihood of being a high-cost utilizer among older adults and lower likelihood among younger adults.

Off-marketplace plans are widely available, and individuals with higher incomes can obtain silver plans with low premiums off-marketplace.

An online survey identified that documentation requirements and communication issues with health plans are associated with providers modifying clinical decisions to avoid medication prior authorization.

Medication formulary policies represent a key determinant of access to medication and can be leveraged to advance pharmacoequity and health equity writ large.

In March 2023, national telehealth utilization rose 1.8%, up from 5.5% of medical claim lines in February, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker.

At the 2023 Greater Philadelphia Business Coalition on Health annual conference, a panel of employers shared their advice on incorporating the principles of value into health benefits.

The FDA approved Pfizer’s respiratory syncytial virus (RSV) vaccine Wednesday; Medicare announced plans to largely cover a new class of expensive Alzheimer drugs; more states are extending postpartum coverage under Medicaid.

Insurance is by far the most important factor of whether patients followed up with treatment after getting screened for glaucoma, said Byron L. Lam, MD, professor of ophthalmology, University of Miami Miller School of Medicine's Bascom Palmer Eye Institute.

At the 2023 Greater Philadelphia Business Coalition on Health, panelists described the ways their organizations are promoting access to primary care in hopes that it can be part of the progress toward achieving the Quadruple Aim of lower costs, better outcomes, patient satisfaction, and clinician experience.

Kicking off the 2023 Greater Philadelphia Business Coalition on Health annual conference, Mark Fendrick, MD, of the University of Michigan, delivered a keynote exhorting the audience of employers and payers to implement the principles of value-based insurance design (VBID) in order to improve individual and population health and drive toward equity.

Although acne and rosacea treatment are widely covered, treatment for other types of skin conditions are not covered at all, a new report shows.

Medicare Part D low-income subsidies alone are insufficient to improve the uptake and equitable use of high-cost, orally administered antimyeloma therapy.

If approved by the FDA, sotatercept would be the first therapy that acts directly against the cause of the disease.

Although commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.

Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.

Gene therapy has the promise of being one and done, but it isn’t always that way for all patients, which leaves questions about where these therapies fit in the commercial landscape, said Charles C. Wykoff, MD, PhD, of Retina Consultants of Texas and the Blanton Eye Institute at Houston Methodist Hospital.

A study assessing factors that may determine a commercial health plan’s likelihood of covering a biosimilar found that biosimilars that are cancer therapies, used to treat children, indicated for highly prevalent conditions, or only competing against the originator were more likely to have coverage restrictions.

This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.

Estimated rates of lung cancer screening with low-dose CT were extremely low among eligible patients across insurance types in 2017, with rates varying between patient demographics.

Payment models that align financial incentives of payers, providers, and patients can mitigate spending growth in thoughtful ways, but the details of the models matter.

Equity has to be made front and center in conversations about value assessment, otherwise all stakeholders will continue waiting for someone else to make the first move, said one panelist at the Value-Based Insurance Design Summit.

A ruling by District Judge Reed O’Connor on March 30 called the future of preventive care access into question.

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.

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.

Panelists at the Value-Based Insurance Design Summit discussed ways their organizations are looking to create a better benefit design to promote health equity and address known disparities.

Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.