Payers

The Employer Playbook on Biosimilars highlights strategies employers can use to navigate challenges around ensuring employee access to biosimilars at the pharmacy, as well as how to respond to pharmacy benefit managers who aren’t making biosimilars available on the formulary, said Margaret Rehayem, vice president, National Alliance of Healthcare Purchaser Coalitions.

Many gene therapies promise life-changing effects, but without long-term data it remains to be seen how long the benefits last.

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.

Natalie S. Callander, MD, director of the University of Wisconsin Carbone Cancer Center Myeloma Clinical Program, reviewed the treatment landscape at the National Comprehensive Cancer Network (NCCN) 2023 Annual Conference.

The Protocol AC study analyzed visual acuity gains and cost if patients with diabetic macular edema started on bevacizumab, which costs less, and switched to aflibercept later, explained Jennifer K. Sun, MD, MPH, associate professor of ophthalmology and chief of the Center for Clinical Eye Research and Trials, Harvard Medical School; and chair, DRCR Retina Network.

The province of Newfoundland and Labrador and the territory of Yukon both announced biosimilar switching policies, bringing Canada to a total of 10 out of 13 jurisdictions have a policy in place.

Payers are looking to roll back on paperwork requirements for prior authorization (PA); CMS and Medicare Advantage (MA) insurers battle over new regulations; Johnson & Johnson (J&J) falls behind Pfizer and GSK for vaccine approval.

For employers, keeping members engaged with their health care is one of the key factors that leads to better outcomes, said Jeremy Wigginton, MD, vice president of health quality and innovation at Blue Cross and Blue Shield of Louisiana.

In this AMCP Market Insights session, panelists discussed best practices and challenges when it comes to prescribing antibody drug conjugates, from the payer, provider, and patient perspectives, based on survey findings.

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.

Ben Jones, vice president of Government Relations and Public Policy at the US Oncology Network, discussed the Enhancing Oncology Model (EOM), and why it's such an important topic at this year's conference.

On the first full day of conference activity at AMCP 2023, a morning session examined prior authorization (PA) through a lens of refining the current process and the potential role of clinical trial data in PA criteria.

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.

Growing bipartisan awareness of issues with the 340B drug pricing program will hopefully lead to reform, says Nicolas Ferreyros, BA, managing director of policy, advocacy, and communications at the Community Oncology Alliance.

CMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.

Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care, explained Thyme Care’s value-based care (VBC) system in oncology and the benefits of care navigation.

The findings, published in the Journal of the National Comprehensive Cancer Network, add to the evidence that the shift to precision medicine is built on data that have not included sufficient numbers of patients of color.

Panelists at the keynote session of the Value-Based Insurance Design Summit highlighted what their organizations are doing in health equity.

A new resource from the National Alliance of Healthcare Purchaser Coalitions aims to help plan sponsors adopt biosimilars into their pharmacy benefit plans.

Samyukta Mullangi, MD, MBA, oncology fellow at Memorial Sloan Kettering Cancer Center and incoming medical director at Thyme Care, spoke on financial toxicity, heterogeneity of cancer, and other complex factors in oncology care systems that may perpetuate disparities in health care outcomes and delivery among patients.

A Cardinal Health report reviewed the potential impact biosimilars will have in rheumatology, gastroenterology, dermatology, and ophthalmology.

Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.

Utilizing real-world evidence that applies to the specific care needs of certain patient populations can promote timely decision-making among payers and providers on the use of effective cancer therapies available on the market, said panelists at the 2022 Patient-Centered Oncology Care® (PCOC) meeting.