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Anti-PD-1 Agents as Frontline Therapy
Richard W. Joseph, MD, notes that current treatment guidelines for melanoma recommend anti-PD-1 agents as front line therapy and discusses payer coverage for first-line use of these agents.
Although neither pembrolizumab nor nivolumab have FDA approval for the front line therapy indication, guidelines from the National Comprehensive Cancer Network recommended an anti-PD-1 agent as a preferred initial regimen, says Dr Joseph.
Unfortunately, he remarks, healthcare professionals and patients need to worry about whether front line use of these agents will be covered by payers. Currently, coverage of first-line anti-PD-1 therapy is mixed, Dr Joseph adds. While some payers cover anti-PD-1 therapy as front line treatment, others do not.
Front line use of anti-PD-1 therapy has the potential to save payers money, notes Dr Joseph, as these agents are more effective and less toxic than other options.
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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A Focus on MAHA, Lasting Changes to Health Care Programs for Trump’s Second Term
March 13th 2025The second Trump administration is expected to bring changes to Medicaid, Medicare Advantage, and the health insurance exchanges, as well as highlight the Make America Healthy Again (MAHA) movement, speakers at the Value-Based Insurance Design Summit said.
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VBID, Heading Into a Third Decade, Looks to Promote Personalization and Access
March 12th 2025Speakers at the 2025 Value-Based Insurance Design summit recapped the accomplishments made over the past 20 years in designing insurance benefits with value in mind and looked ahead to iterations to come.
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