January 28th 2025
The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
Progress and Momentum to Improve Patient Access to Quality, Timely Cancer Care
September 13th 2024During the first fireside chat at the Patient-Centered Oncology Care® meeting, Alyssa Schatz, MSW, of National Comprehensive Cancer Network, discussed work being done to improve care for patients with cancer.
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Dr Dax Kurbegov on Gaps Between Payers, Health Systems, and Providers in Oncology
September 12th 2024Dax Kurbegov, MD, senior vice president of Sarah Cannon Cancer Network, discussed divides between payers, health systems, and oncology care providers, as well as the impacts these divides can have on patients.
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IRA Negotiated Drug Prices Can’t Come “On the Backs of Providers”
September 10th 2024There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.
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Payer Education Is Key to Early DMD Therapy Access
August 28th 2024The disease-modifying treatment landscape has expanded in recent years, but access to the latest approved Duchenne muscular dystrophy (DMD) treatments can be a challenge for patients and providers, Aravindhan Veerapandiyan, MD, a pediatric neuromuscular specialist at Arkansas Children’s Hospital, said.
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Aetna Announces Simplified Access to Fertility Services
August 27th 2024Aetna has become the first major US insurer to expand access to fertility services by covering intrauterine insemination as a medical benefit for all eligible plans, marking a significant move toward greater equity in family-building options for people of all backgrounds.
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Biosimilar Updates: Celltrion, Costco Partnership; Amgen Sues Samsung Bioepis; Denosumab Results
August 25th 2024Celltrion's adalimumab-aaty biosimilar is now accessible for all Costco members, while Amgen sues Samsung Bioepis over the latter’s denosumab biosimilar candidate, and GlycoNex progresses its denosumab biosimilar SPD8 to phase 3 trials.
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Access to Novel DMD Therapies Remains Challenging Despite Regulatory Approvals
August 5th 2024Aravindhan Veerapandiyan, MD, of the Division of Pediatric Neurology at the University of Arkansas for Medical Sciences, discussed the Duchenne muscular dystrophy (DMD) therapy landscape and barriers to treatment access.
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Understanding Coverage, Financing, and Future Trends of Gene Therapy in Employer Health Plans
July 21st 2024The Greater Philadelphia Business Coalition on Health webinar series provided an in-depth framework for the advantages of including cell and gene therapy coverage in employer health plans, as well as the challenges brought by manufacturing complexities and the need to address accessibility to treatment.
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CMS Unveils Proposed 2025 Physician Fee Schedule, Maternal Health Standards
July 11th 2024The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.
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The Impacts of Supplemental Benefits on Medicare Advantage Plan Composition
After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.
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Medicare Advantage Plans Provide No Substantial Cost Savings Over Traditional Medicare
June 24th 2024Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.
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Ali Khawar on Addressing the Mental Health Crisis Through Parity Law
June 13th 2024Ali Khawar, principal deputy assistant secretary with the Employee Benefits Security Administration (EBSA), US Department of Labor, explains how the Mental Health Parity and Addiction Equity Act (MHPAEA) aims to address the mental health crisis in the US.
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The Bundled Payments for Care Improvement program was associated with improved quality of skilled nursing facilities in hospital referral networks for patients undergoing surgery for joint replacement.
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This study quantified the trends over time in utilization of, spending on, and access to CT fractional flow reserve, the first artificial intelligence (AI)–enabled clinical software reimbursed by Medicare.
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