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High Drug Prices Skewing Payouts to Some Physicians
Ophthalmologists are among Medicare's highest paid specialists-a finding already drawing scrutiny from policymakers and watchdogs worried about waste and overuse.
Ophthalmologists are among Medicare's highest paid specialists—a finding already drawing scrutiny from policymakers and watchdogs worried about waste and overuse. But doctors' advocates say the data shouldn't be interpreted as eye doctors getting rich off the government's senior citizen healthcare program.
A closer inspection of the data reveals that many of the highest-paying codes for eye doctors relate to the use of Lucentis, a branded injectible drug for macular degeneration that costs $2,000 a dose.
Medicare rules let doctors mark up the price of drugs delivered in their offices by 6% over the manufacturer's average sale price. The additional fee was designed to help physicians defray the cost of running their facilities.
Read the full story here: http://bit.ly/1eoqoy9
Source: Modern Healthcare
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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Neurologists Share Tips for Securing Patient Access to Gene Therapies
March 19th 2025Tenacious efforts at every level, from the individual clinician to the hospital to the state to Congress, will be needed to make sure patients can access life-saving gene therapies for neuromuscular diseases.
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The Impact of Cost Sharing on High-Value Care
March 14th 2025Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.
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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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