- Center on Health Equity & Access
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- Value-Based Care
Episode 9 - The Payer Approach to Immunotherapy
In this segment, the panelists explain how coverage policies vary by payer, and explore the factors that affect the costs associated with different immunotherapy agents.
Michael Kolodziej, MD, discusses how Aetna reviews evidence and takes several factors into account when making payer decisions about supporting cancer research, and explains that different organizations have different processes. Jeffrey Weber, MD, PhD, continues the conversation with an explanation of how different immunotherapy agents have different dosage and administration requirements, which affect overall costs.
Addressing cost differentials and coverage policy inconsistencies is important because what is covered by payers directly impacts the types of treatments that are recommended to patients. As concluded by Daniel J. George, MD, providers want to be able to recommend a clinical trial or other treatment modality in situations where standard therapy is not likely to be effective for the patient.
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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