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Episode 6 - Recommended Guidelines and Payer Challenges
Treatment guidelines are now recognizing and suggesting immunotherapy for the treatment of several types of cancer.
However, Jeffrey Weber, MD, PhD, explains that the unspoken issue in regard to immunotherapies is that most are investigational. With respect to a payer covering treatment, in different states throughout the country, some will cover research-related costs and some will not.
As the panelists discuss how coverage inconsistencies, or the lack of coverage altogether, challenges providers to offer treatment as suggested by important NCCN guidelines, Daniel J. George, MD, concludes that there is no real way to develop a standard policy without reviewing each case individually.
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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