- Center on Health Equity & Access
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- Value-Based Care
Appropriate, Value-Based Care in Immuno-Oncology
The idea of cost of care should be simple, but buying healthcare is incredibly complex, states Andrew L. Pecora, MD. Most individuals do not think about the potential for developing cancer when they make healthcare-related decisions.
Payers have to consider premium costs and risk pools, and generally have to look at their actuarial budgets over 3 to 5 years. In order to make actuarially sound reimbursement decisions, it is important to look at the total cost of care. If a drug is expensive, but changes the natural course of the disease, it provides value, explains Pecora.
There are ways for oncologists to assist patients in getting appropriate coverage for their prescribed regimen. For patients with limited insurance coverage, there are patient-assistance programs. It is important for oncology practices to communicate with payers about their treatment decisions in advance and to ensure these entities that the care is appropriate.
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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Reviving the Classics: The Role of Older Medications in Modern Dermatology
March 9th 2025Older, generic medications, including ones for cyclosporine, nicotinamide, and dapsone, can effectively treat patients with various dermatological conditions while helping to reduce insurance and cost barriers.
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Myasthenia Gravis Care Overlooks Speech and Swallowing Dysfunction
March 9th 2025Myasthenia gravis is a neuromuscular junction disorder with a hallmark of progressive muscle weakness and frequent manifestation of otolaryngologic dysfunction, such as difficulty swallowing and speech disorder.
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