Insurance

This study analyzes the current coverage designs for hepatitis C virus drugs by Medicare Part D plans.

What we're reading, May 3, 2016: low-quality, low-cost hospitals received bonuses from Medicare; Brigham and Women's Hospital is publicizing its mistakes; and Tenet expects other insurers will fill the void when UnitedHealth leaves the exchanges.

What we're reading, May 2, 2016: new discoveries about why people struggle to keep off weight; first Zika-related death in the US; and Medicare Advantage needs more competition.

Oral anticancer agents are being launched at significantly higher prices compared with a decade ago, which can prove a barrier to patient access, according to a new analysis published in JAMA Oncology.

This sweeping proposal is the biggest step yet in shifting reimbursement from a volume-based to a value-based system. Stakeholders offered mixed opinions this week.

One leading expert called the proposal the most substantive change in decades, but some feared CMS is once again hastening the demise of the independent physician.

A company in Canada, Biolyse Pharma, has offered to manufacture a generic version of enzalutamide at a significantly lower price than what CMS paid in 2014.

Flatiron Health has announced the development of a cloud-based electronic health record and an analytics tool to support reporting requirements for those clinics that will be selected to participate in the Oncology Care Model.

According to Avalere Health, physicians who prescribe lower cost drugs would be reimbursed at a higher rate than those who use more expensive drugs, under the proposed Medicare Part B demo model.

The American Hospital Association is among those asking for a rating system that reflects socioeconomic differences in hospital populations.

Coverage of sessions held at Cancerscape, the Association of Community Cancer Center’s 42nd annual meeting on policy, value, and quality, held March 2-4, 2016, in Washington, DC.

The National Quality Forum’s Measure Applications Partnership recently released guidelines on measures for the new Merit-Based Incentive Payment System and on cross-cutting issues for all federal healthcare programs.

Drug prices are rising faster than any other area of healthcare, but solutions aren't so simple. Easing barriers to competition, promoting approval of generic drugs, and increased transparency would help.

The biggest challenge facing oncologists in 2016 is the Medicare Part B demonstration that CMS announced, Lucio Gordan, MD, of Florida Cancer Specialists, said at the Community Oncology Alliance's 2016 Community Oncology Conference.

Everyone in healthcare is currently grappling with what payment reform will look like in the coming years, and oncology is no exception. Payers, providers, and health policy experts reviewed ongoing changes in the healthcare system and shared their vision on what the future would look like.

From the focus on prevention to the possibilities of telehealth, the annual meeting presented by The American Journal of Managed Care and Joslin Diabetes Center showed where care is heading.

Patients encountering high deductibles regarding medication in their Affordable Care Act plans can seek assistance from drug manufacturers by using copay programs, said Daniel J. Klein, president and CEO of the Patient Access Network Foundation.

Updates to Medicare Advantage and the Part D Prescription Drug program will improve programs for health plans that provide care for vulnerable enrollees.

On the first day of The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, oncologists discussed how their practices are coping with the transition toward quality- and value-based reimbursement.

The expansion follows an early demonstration project that showed that what happens between visits is critical for patients with chronic conditions.

Sachin Jain, MD, MBA, has been named as successor to lead CareMore Health System when President Leeba Lessin retires on April 15. Dr Jain is an editorial board member of The American Journal of Managed Care and current chief medical officer of CareMore.

With the news that Medicare will soon pay for diabetes prevention, the 2016 edition of Patient-Centered Diabetes Care, presented by The American Journal of Managed Care, offered up-to-the-minute news on how technology will change the prevention and clinical care models, why ending stigma is key to treating obesity, and what’s ahead in insulin therapy.

CMS' plan to pay for the National Diabetes Prevention Program is an important step toward payer coverage of technology-based diabetes care. But reimbursement for telehealth to treat type 2 diabetes remains challenging.

The lawsuit, brought in 2005, took a turn in 2014 when a federal judge ordered the state to reach an agreement with the plaintiffs after finding the Florida failed to provide adequate healthcare to poor children.

The move to value-based payment is going well, but the real work has to be done on the care transformation side, Farzad Mostashari, MD, co-founder and chief executive of Aledade.

The study, commissioned by the Community Oncology Alliance, has found that overall costs for Medicare and commercial health plan enrollees have been increasing at the same rate as the cost of treating patients with cancer. This contradicts the popular notion that cancer care costs have far outpaced overall healthcare spending.

Four panelists and 2 moderators discussed the issues surrounding cancer and healthcare in the lead-up to the 2016 presidential election during the National Comprehensive Cancer Network 21st Annual Conference.

What we're reading, April 1, 2016: Federal Trade Commission files lawsuit to stop pay-to-delay deals; CMS' bundled payment initiative for joint replacement takes effect; and scientists confirm link between Zika virus and microcephaly.

The Society for Research on Nicotine and Tobacco and the Association for the Treatment of Tobacco Use and Dependence have developed a position statement recommending access to smoking cessation interventions for smokers in the high-risk group who undergo a lung cancer screen.

This week's top managed care stories include a lawsuit between Anthem and Express Scripts, trouble with Medicare's bidding program for diabetes test strips, and the cost of reporting quality measurements.