Providers Bill for End-of-Life Talks
In the first year that providers could bill Medicare for end-of-life discussions, nearly 575,000 beneficiaries had such conversations. According to Kaiser Health News, the use was much higher than expected and 23,000 providers submitted more than $43 million in covered charges. The American Medical Association had predicted that just 300,000 people would take part in end-of-life discussions in the first year. The benefit pays $86 for the first 30-minute office visit and $75 for additional sessions.
Not Enough Patients in Cancer Clinical Trials
With science racing ahead, there are too many experimental cancer drugs and not enough patients to take part in their clinical trials. The New York Times reported that part of the issue is that these new revolutionary treatments, such as immunotherapies, are only effective in select patients. There are now more than 1000 immunotherapy trials underway, and cancer centers worry that these trials don’t always address new questions—instead, the drug companies are simply trying to get proprietary drugs approved.
Maine to Consider Medicaid Expansion
In November, Maine residents will vote on a ballot question that requires the state to apply for Medicaid expansion. The state’s expansion of Medicaid is expected to cost $54 million each year, according to AP. Proponents say the move will reduce the number of uninsured and create jobs, but opponents want any Medicaid expansion to include work requirements and worry it will lead to unexpected enrollment and budget shortfalls.
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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STEER Data Open Door to SMA Gene Therapy for Wider Age Range of Children
March 19th 2025Delivery of onasemnogene abeparvovec into the intrathecal space was safe and effective for children with spinal muscular atrophy (SMA) aged 2 to 17 years, who had previously been shut out of receiving gene therapy.
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EMBARK Data Show Continued Improvements With DMD Gene Therapy
March 19th 2025Data from the EMBARK trial of delandistrogene moxeparvovec in patients with Duchenne muscular dystrophy (DMD) show that benefits in functional outcomes, gene expression, and muscle imaging persist 2 years after receiving the gene therapy.
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How Access to SMA Treatment Varies Globally and by Insurance Type
March 18th 2025Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.
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