Insurance

Out-of-pocket costs required by Medicare prescription drug plans for drugs available through Walmart’s generic drug discount program have decreased from 2009 to 2017.

Today CMS announced the Part D Senior Savings Model, allowing Medicare Part D prescription drug plans to offer plan choices that provide a range of insulins to beneficiaries, at a maximum $35 copay per 30-day supply throughout the benefit year.

In comments on the CY 2021 Advance Notice, AMGA noted its concerns with the methodology for setting payment rates for patients with end stage renal disease (ESRD), who as of 2021 will have the option of enrolling in MA.

Nonadherence to essential chronic medications and mental health diagnosis were associated with higher hospitalizations and emergency department use among Medicare super-utilizers.

Implementing alternative payment models in oncology is a complicated process. The models are not perfect, especially the Centers for Medicare and Medicaid Services’ Oncology Care Model (OCM), although several panelists saw improvements in the proposed successor model, Oncology Care First (OCF).

How well patients say they are faring, both during and after cancer treatment, is more important than ever to payers. But measuring that feedback isn’t easy, and ensuring that measurement is fair to both patients and providers is harder still.

Medicare patients' health care utilization, including hospitalizations and emergency department visits, decreased after CAR T-cell therapy, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

While there are similarities to the Oncology Care Model, the new model has features “that could have a substantial impact on practices that choose to participate,” the authors write.

Out-of-network primary care may be associated with higher per-beneficiary spending in Medicare accountable care organizations (ACOs), reported a recent study published in Health Affairs.

A vascular surgeon in Florida allegedly stole $26 million from insurers and the government; a new report finds many rural areas are still at risk of an HIV outbreak; new disposable flavored vape pens have largely replaced Juul use among teens.

A federal watchdog will take on Medicare scams; Belviq, a weight loss drug, has been pulled from market; issues at Veterans Affairs have resulted in healthcare roadblocks.

Real-world discontinuation of hepatitis C drugs was low, but it was 3 times more likely than in clinical trials and varied by patient characteristics.

The evolution of data in healthcare in combination with policy advancements demonstrates how far the field has come but also brings up new challenges.

Medicare beneficiaries with untreated obstructive sleep apnea (OSA) have increased healthcare utilization (HCU) and costs across all points of service, according to results of a recent study published by the Journal of Clinical Sleep Medicine.

A group of 18 health plans announce they will manufacture generic drugs; President Trump hints at cutting Medicare funding; the Chinese government quarantines a city of 11 million in an effort to stop the spread of the coronavirus.

Reviews of apixaban in active cancer, Medicare costs after CAR T-cell therapy, and the need for financial assistance for novel therapies.

Along with weight loss, exercise, and nutrition, employers now target sleep improvements in employees; a Republican member of the FTC supports Medicare drug price negotiations; sepsis is likely responsible for 20% of deaths worldwide.

US Census data show the segment of the population over age 65 is growing faster than the group under age 65, highlighting the need for new healthcare delivery solutions.

Accountable care organization (ACO) participation in the Medicare Shared Savings Program (MSSP) remained flat this year, according to a press release from the National Association of Accountable Care Organizations issued Friday, January 10.

Avalere Health broadcasted its annual Healthcare Industry Outlook for 2020 on January 9. The hour-long discussion included insights on some of the top healthcare topics predicted to have an impact in 2020. Although Medicare and drug pricing took center stage, artificial intelligence, the future of the Affordable Care Act, and 2020 presidential campaign platforms were among the subjects discussed.

From linguistic dissonances of medical terminology to the generation of new care pathways for Medicare patients, the top 5 most-read articles of The American Journal of Accountable Care® spanned topics relevant to both patients and providers in 2019.

Patients with breast cancer who have government insurance face a higher risk of death, according to a retrospective study presented at the 2019 San Antonio Breast Cancer Symposium on December 13.

An article Schleicher co-wrote in JAMA Oncology, which appeared the day before the announcement of Oncology Care First, offered insights into the need for changes to the original OCM.

Kashyap Patel, MD, the chief executive officer of Carolina Blood and Cancer Care Associates—a leading OCM practice—and associate editor of Evidence-Based Oncology™ (EBO), said he’s optimistic about Oncology Care First.

The availability of biosimilars introduces competition based on price, offering a lower-cost alternative in the short term and helping to restrict—or even reverse—longer-term price growth.

A senior vice president of Archway Health discusses challenges and opportunities of the proposed Oncology Care First model.