Health Care Cost

The Supreme Court has ruled that HHS' decision to lower reimbursement rates to hospitals so that those in the 340B program received reduced rates because they received discounted drugs was unlawful.

Using biosimilar rituximab to replace the reference in a common combination regimen to treat diffuse large B-cell lymphoma (DLBCL) results in similar outcomes.

The analysis of adults with low income enrolled in Medicare Advantage (MA) or traditional Medicare (TM) indicates that increasing enrollment in MA may not advance health equity in the Medicare program.

Ashok Subramanian, MBA, founder and chief executive officer, Centivo, speaks on the limitations of traditional employer-based health benefit plans in the pursuit of value-based care and what employers should consider in designing these incentives on a community level.

The Federal Trade Commission (FTC) launched an inquiry into the practices of pharmacy benefit managers; FDA advisers overwhelmingly support approval of Novavax, a new COVID-19 vaccine; drug prices soar to 20% annual inflation.

Identifying patients with spinal muscular atrophy (SMA) early and before the onset of symptoms can yield financial savings and improve quality of life (QOL) for these individuals and their families.

A study found that patients in the Comprehensive End-Stage Renal Disease (ESRD) Care Model saw a decrease in hospitalizations and readmissions compared with the accountable care organization (ACO) model.

As more treatments continue to enter the market for multiple myeloma (MM), the cost of associated treatments is expected to continue climbing, with the researchers of the study emphasizing the need for more effective and options to help mitigate costs.

The year that full benefits will stop for Medicare and Social Security is now a year later than previously estimated; diagnostic companies are racing to develop tests for monkeypox as cases surge; the rate of firearm suicides increased by 15% in youth aged between ages 10 and 24.

Alignment of incentives in the United States do not always support the use of biosimilars or other lower-cost alternatives, said Sonia T. Oskouei, PharmD, BCMAS, DPLA, vice president of biosimilars at Cardinal Health.

As biosimilar competition heats up in the United States, payers have more tools at their disposal to manage these agents.

The findings highlight the significant financial burden of sickle cell disease.

United States birth rate rises from last year but is still lower than pre-pandemic; a drug plant closure in California could affect availability of 5 essential medications; the No Surprises Act prevented 2 million potential surprise bills in first 2 months of 2022, report says.

Dupilumab was associated with reductions in exacerbations and oral corticosteroids (OCS) dosage, as well as improved lung function, in patients with OCS-dependent asthma with and without comorbid chronic rhinosinusitis with nasal polyps.

Chargemaster lists may encourage patients to shop around for services, but the authors of this report said the implications of this change for dermatology are not well-defined.

Across commercial insurance, Medicare, and Medicaid populations, oncology is the top category of spend, and the drug pipeline has increasing specific and complex therapies.

Today, health plans are shifting dollars to more value-based contracts along with investments in population health management. Digitizing lab results across all care settings and unlocking the potential of lab values can help health plans reach the Triple Aim of improving the patient experience, improving the health of populations, and reducing the per-member cost of health care.

The report details totals paid to hospitals by private insurers and providers and compares the sums with a Medicare benchmark.

Significantly greater persistence, adherence, and time on monotherapy was achieved with the use of ixekizumab vs the biologics adalimumab, etanercept, secukinumab, and ustekinumab, in the treatment of moderate to severe psoriasis.

Gene therapies in the pipeline to treat hemophilia will be very expensive, but they also seem to be very efficacious, and multiple could hit the market between now and 2024, said Ray Tancredi, RPh, MBA, CSP, divisional vice president, specialty pharmacy development and brand Rx/vaccine purchasing, Walgreens.

While CMS has started making changes to address health equity through policy and payment models, commercial plans are waiting to see the outcomes before they follow suit, said Jayson Slotnik, partner, Health Policy Strategies, Inc.

This study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.

Biosimilar adoption can be accelerated or stymied depending on actions taken by the managed care space, explained Sonia Oskouei, PharmD, vice president, biosimilars, Cardinal Health, during a session at Asembia’s Specialty Pharmacy Summit.

The impact that the adalimumab biosimilars will have in 2023 is going to depend on when they all get to market, said Doug Long, MBA, vice president, industry relations, IQVIA.

US Senate to vote this week on legislation seeking to codify abortion rights into law; hospitals aiming to raise treatment prices in response to increasing nurse salaries; shortage of infant formula worsening nationwide.

UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.

Future quality conversations must recognize what the pandemic has illustrated over the past 2 years—that patients who were in the most dire need of health care, including those with multiple chronic conditions, had the least amount of access, said Jonathan Blum, MPP, the principal deputy administrator and chief operating officer of CMS.

Coverage, equity, and value-based payments are critical areas of focus for the Biden administration’s health care agenda leading up to the midterm elections, according to 3 experts from Avalere.

Limited evidence from a literature review suggests that co-pay assistance was associated with improved treatment persistence/adherence across various diseases, with indirect evidence suggesting improvements in clinical outcomes.

At the Pharmacy Quality Alliance (PQA) 2022 Annual Meeting Wednesday, participants heard about some unexpected insights arising from a workshop held this week between patients and pharmacists who are creating a patient-centered outcomes research agenda focused on addressing social determinants of health (SDOH) in the community pharmacy setting.