GAO Finds CMS Still Falls Short in Screening Potentially Fraudulent Medicare Providers
July 22nd 2015Since the adoption of the Affordable Care Act, CMS has removed 28,000 questionable providers from Medicare. But the Government Accountability Office found more needs to be done to verify addresses and weed out those who have lost their licenses.
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New ICER Program Analyzes Budget Impact of New Drugs
July 22nd 2015A new program from the Institute for Clinical and Economic Review will produce public reports that include a full analysis of the comparative effectiveness, the cost-effectiveness, and the potential budget impact of new drugs.
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ASCO Calls for Developing Oncology Trials for Geriatric Patients
July 20th 2015The American Society of Clinical Oncology has issued a position statement in the Journal of Clinical Oncology, calling for federal agencies and the cancer research community to broaden clinical trials to include older adults.
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CMS Testing Concurrent Coverage of Palliative, Curative Care
July 20th 2015Instead of making patients suffering from life-limiting illnesses choose between hospice care and curative care, CMS will test coverage that allows individuals to receive palliative and curative treatment concurrently.
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Researchers Use Precision Medicine in Common Type of Lymphoma
July 20th 2015In the first clinical study to demonstrate the importance of precision medicine in lymphomas, researchers determined that patients with a specific molecular subtype of diffuse large B-cell lymphoma responded better to ibrutinib than patients with a different molecular subtype.
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New Enrollees on Exchanges May Reduce Drug Costs
July 20th 2015The Exchange Pulse Report published by Express Scripts predicts that compared with 2014, the year 2015 will see a greater number of younger enrollees signing up on healthcare exchanges, which could potentially drive down drug costs for specialty medications.
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This Week in Managed Care: July 18, 2015
July 18th 2015The top story was Marilyn Tavenner became the nation's top healthcare lobbyist when she was named the new president and CEO of America's Health Insurance Plans, plus the controversial new guidelines that called for more Americans to take statins were validated, according to the results of a new study.
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The Challenge of Providing Care to Complex Medicare Patients
July 17th 2015Approximately 9 million Medicare beneficiaries are considered "complex care" and they often incur high out-of-pocket costs. As lifespans lengthen, it becomes important for Medicare to adapt to serve these complex care beneficiaries.
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Most Americans Would Keep Medicare, Medicaid Intact, Poll Finds
July 17th 2015Nearly 50 years after President Johnson signed the law that created them, Medicare and Medicaid have become part of the fabric of the US healthcare system. A Kaiser Family Foundation poll finds little support for proposals to alter the basic structure of the programs.
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Annual Report on the Status of Cancer in the United States Released
July 16th 2015The Annual Report to the Nation on Status of Cancer, product of a collaboration between The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries, has been published.
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Will the Lack of Long-Term Safety Data Hurt PCSK9 Repatha and Praluent Reimbursement?
July 16th 2015As Amgen's Repatha (evolocumab) and Sanofi/Regeneron's Praluent (alirocumab) get closer to market, the safety question is one of the remaining pieces of the puzzle that unfortunately can't be solved immediately until real-world data starts to become available. However, as payers assess the risk-benefit of Repatha and Praluent vs the gold standard statins, there are questions that CAN be answered immediately.
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Study Highlights Need for Improved Diagnostic Tests to Identify Pneumonia
July 16th 2015Viruses, not bacteria, are the most commonly detected pathogen in US adults hospitalized with pneumonia; however, neither viruses nor bacteria were detected in the majority of these patients despite current diagnostic tests.
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GAO Finds Bogus Applicants Not Only Enroll in ACA Marketplace, but Get Coverage Renewed
July 16th 2015The Government Accountability Office received notices of inconsistent information, but it wasn't enough for CMS to cancel coverage for the phony beneficiaries. A key flaw revealed is the ability of phony applicants to use the telephone to bypass online controls.
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CDC Report Examines Racial Disparities in Healthcare Access in 2014
July 15th 2015Although Hispanic adults were more likely to have a consistent place of care in 2014 compared with 2013, they were still more likely to experience difficulty in accessing and utilizing care than the non-Hispanic population.
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