Policy

Advances in medicine have produced breakthroughs in the treatment of a number of rare diseases, but these advances often come at a high cost. A multi-stakeholder panel at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting, in Baltimore, Maryland, addressed the question of how to define value in the always evolving and ever more expensive treatment landscape.

In a Monday panel convened at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 23rd Annual International Meeting in Baltimore, Maryland, stakeholders grappled with the role that value assessments play—or should play—in US private payer coverage and formulary decisions.

While incentives and penalties are effective at getting people to complete health risk assessments, the assessments do not lower costs or increase wellness.

At the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting, experts addressed the cost of treating patients with hemophilia and the importance of care coordination to ensure a more holistic approach toward caring for these patients.

Reimbursement models, novel gene therapy–based treatments, and price transparency: these were some of the topics covered by presenters and panelists at the annual meeting of the Community Oncology Alliance.

How are community practices coping with administering chimeric antigen receptor (CAR)-T treatments? At the 2018 Community Oncology Conference hosted by the Community Oncology Alliance, Houston Holmes, MD, MBA, FACP, Texas Oncology, shared his experience with administering CAR T-cells in a community cancer center–based setting.

CVS has announced the launch of CVS Pharmacy Rx Savings Finder, which will provide its 30,000 pharmacists the ability to find less expensive alternatives for their patients.

Nine in 10 people with non-group health insurance will continue buying coverage despite the repeal of the individual mandate and express worry over future availability and price of health coverage, according to a health tracking poll from Kaiser Family Foundation. The poll also found that for the uninsured, the main reason for not purchasing coverage is that it is too expensive.

The second day of the National Comprehensive Cancer Network (NCCN) 23rd Annual Conference in Orlando, Florida, opened with a dual keynote presentation on transforming cancer care in the United States.

Prior authorizations delay care, have a significant negative impact on clinical outcomes, and place a high burden on providers, according to a physician survey conducted by the American Medical Association (AMA).

In 2014, Maryland and CMS entered a 5-year agreement employing the All-Payer Hospital Model in the state to cut costs while improving quality. According to the year 3 performance data, Maryland has met or is on track to meet all model requirements, saving hundreds of millions of dollars as it lowers hospital readmissions and steers the state away from a volume-based system.

Currently, the FDA is evaluating 2 investigational drugs, both of which treat the underlying pathophysiology of hereditary transthyretin amyloidosis.

Discussing the integration of data from wearable technology into the electronic health record and utilizing telemedicine as a way to promote greater collaboration between the patient and their physician and health system with Jagmeet P. Singh, MD, PhD, FACC, deputy editor of JACC: Clinical Electrophysiology, and Fred Bove, MD, MACC, editor-in-chief of Cardiology magazine.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Estimating episodic target prices for each patient in the Oncology Care Model (OCM) can be challenging and time consuming. Applying that time to quality-focused care management tactics, based on observed utilization and patient outcomes, may wind up being more valuable, and help to reduce unnecessary spending.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

Using a large database created by a center for actuarial studies, a psychologist and researcher is positing that people with the worst cases of attention-deficit/hyperactivity disorder (ADHD) will see a 25-year reduction in life expectancy, according to a presentation made Saturday at the annual meeting of the American Professional Society of ADHD and Related Disorders.

When patients with rheumatoid arthritis experience failure of an anti–tumor necrosis factor (anti-TNF) therapy, clinical guidelines support either cycling to a different anti-TNF agent or switching to a treatment with a different method of action (MOA). However, payers often require cycling of anti-TNF options before they will reimburse for treatments with a different MOA.

Multiple studies have demonstrated that black Americans tend to receive more intensive, higher-cost care at the end of life, and have higher rates of hospitalization and lower rates of hospice enrollment. A new study sought to determine whether racial variation exists among hospice enrollees in rates of hospitalization and hospice disenrollment, and whether that variation could be explained by systematic differences in hospice provider patterns.

As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, the examples of practices participating in CMS’ Oncology Care Model can offer valuable insight into the most impactful workflow changes providers can implement as they strive to achieve cost and quality improvements.

A chief medical officer for a major payer outlines the challenges making sure that certain high-cost therapies are directed to the patients who need them.

US healthcare spending is on the rise, and is expected to comprise over 20% of the gross domestic product by 2025. Current expenditures are expected to double by 2060 if the pace of spending in the past decade continues. In this healthcare landscape, in vitro diagnostics (IVD) have increasingly become the subject of scrutiny, as IVDs are perceived as contributing to soaring costs.

Is transfusion dependence a barrier to hospice utilization among older patients with leukemia who are enrolled in Medicare?

With the increasing emergence of less expensive biologic alternatives, some health systems are making the switch. For a large healthcare system, the arrival of a cheaper alternative to filgrastim prompted the conversion to using tbo-filgrastim as the preferrred granulocyte-colony stimulating factor. The results were shared in a study published by the Journal of Managed Care & Specialty Pharmacy.

Authors of the study found that the mean total, chemotherapy, and physician costs were all lower in community settings compared with hospital-based settings for patients with breast, lung, and colorectal cancer. There were also fewer emergency department visits both 3 and 10 days following treatment.

A study published in JAMA analyzed 155 health conditions, 36 age and sex groups, and 6 types of care to determine the impact of population growth, population aging, disease prevalence or incidence, service utilizations, and service price and intensity on healthcare spending increases in the United States from 1996 to 2013.

Among the most anticipated sessions at the 2017 meeting of the American College of Rheumatology in San Diego, California was “The Great Debate: Biosimilars…to Switch, or Not to Switch? That Is the Question.”

The reform will adjust payment for drugs purchased through the program, relieve some burden for rural hospitals, and exempt rural sole community hospitals, certain cancer hospitals, and children's hospitals.

In addition to the cost, the excessive overuse of laboratory testing causes patient discomfort and can lead to hospital-acquired anemia, which results in additional testing, prolonged hospitalizations, unnecessary transfusions, and increased mortality for patients with cardiopulmonary diseases.