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Episode 10 - Measuring Economic Burden or Value Against Clinical Outcomes
While discussing the factors that managed care professionals review when assessing a pharmaceutical product’s cost versus its overall benefit, the panelists explain that the process is often challenging.
Oncologists and other health care providers, along with the FDA, must assess several factors, most importantly a drug’s risk-benefit ratio, before deciding how to approve it. And in the United States, there is no current threshold for what constitutes a reasonable price on drug therapy or helps determine what necessary approaches can help pay for expensive therapy, clarifies Michael Kolodziej, MD.
Because the money that is being spent to help pay for expensive therapy comes through insurance agencies, from taxpayers’ dollars, reminds Dr Kolodziej, the decision about how to pay for expensive treatments such as immunotherapy should be a societal decision.
The panelists agree that as our country shifts toward a value-based insurance design, the consumer will have to become more active in the economic decision-making process.
Daniel J. George, MD, explains that the decision-making process will rely heavily on providers, as they will need to supply the information important to patients so that they can make valued decisions.
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Specialty Drug Users to Gain Relief Under Medicare Reforms
May 16th 2025A new analysis looked at estimated out-of-pocket costs for etanercept, ustekinumab, and ibrutinib, specialty drugs that often represent a significant cost burden for Medicare Part D beneficiaries and which were selected for 2026 drug price negotiation under the Inflation Reduction Act.
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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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Navigation and Clinician Payment Investments Enhance Colorectal Cancer Screening Benefits
May 15th 2025Investing in patient navigation and clinician incentives ensures colorectal cancer screening completion, improves early detection, reduces disparities, achieves cost savings, and advances population health for all stakeholders.
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