Podcast Q&A: HEOR for Medical Technologies for the US Healthcare System
This podcast segment features the Q&A from Alira Health's December 14, 2022 webinar and features Deepak Sahu, MBA, MPH [...]
Humana and TriWest Nets $136 Billion in Tricare Contracts
Humana Military and Triwest have been awarded two Tricare managed care contracts totalling $136 billion. The contract for the East Region went to Humana to the tune of $70.9 billion, while TriWest nabbed the West Region contract for $65.1 billion.
STAT News: 8 Points to Note About Aduhelm Congressional Investigation
With the release of the US congressional report about the US Food and Drug Administration’s approval of Biogen’s ill-fated Alzheimer's drug Aduhelm, STAT News has published and article detailing 8 points to keep in mind going forward. The first is that the agency’s officials didn’t document communications with the manufacturer as required.
Becker’s Payers Issues: Humana in 2022
A newly released article in Becker’s Payers Issues revisits their biggest stories of 2022 about the payer giant Humana. In May, they covered the partnership they made with the Welsh, Carson, Anderson, & Stowe to expand its value-based primary care clinic offerings. In July, Humana announced it would split, with the company divided into an insurance provider and Centerwell.
FDA Faces Pressure Over Aduhelm Approval
A US congressional report released this week noted that the Food and Drug Administration (FDA) failed to heed its own advice when approving Aduhelm, a controversial treatment for Alzheimer’s disease. The report blamed the agency for overlooking key issues with data surrounding the drug’s actual clinical efficacy. In addition, it lambasted Biogen, the drug’s manufacturer, for the exorbitant price tag.
South Korea’s HIRA Leaves Australia Off Drug Pricing Reference List
South Korea’s Health Insurance and Assessment Service (HIRA) has released its “detailed evaluation criteria for drugs subject to negotiation,” and Australia has been left off the list of countries used for reference pricing. The agency was considering it for inclusion into its’ A7 list, which includes Germany, Switzerland, Japan, Italy, France, the UK, and the US.
Report Finds Medicare Part B Lab Test Spending Jumped $1.3 Billion in 2021
A newly released report by the Office of the Inspector General (OIG) found that Medicare Part B spending on lab testing jumped by $1.3 billion in 2021 from 2020. This 17% increase brought the total spending on laboratory tests to $9.3 billion. A key driver of the spike comes from mass utilization of COVID-19 testing.
An Arm and a Leg Podcast: 2022 in Review
The past year has been a tumultuous in pharma, with high drug prices sitting squarely in the forefront of the public’s attention. In the newest episode of the “An Arm and a Leg” podcast by Kaiser Health News, listen as hosts take a look back at 2022 and the ups and downs it brought to the pharma and biotech industries.
Democrats Cautiously Optimistic About Drug Pricing Reform in 2023
Despite a split Congress beginning next year, US Democrats are cautiously hopeful about their drug pricing efforts in the coming years. This is because of the provision in the Inflation Reduction Act that will give Medicare the ability to negotiate some drug prices over the next ten years. If negotiations with Medicare go well, some Democrats expect this might act as a useful slippery slope to give private payers the power to negotiate too.
Managed Healthcare Executive Top PBM Articles of 2022
Managed Healthcare Executive has covered pharmacy benefit managers (PBMs) extensively over the past year, as the industry and its practices face increasing scrutiny. In a new compilation, the Managed Healthcare Executive staff share their most viewed articles about PBMs in 2022. The first is about the 3 titans in the industry.
Bettering Health Outcomes for Older People Through Real-World Data
Older adults account for a sizeable portion of Medicare Advantage (MA) beneficiaries, but healthcare is only one determinant of health. Non-medical benefits could help address other lifestyle and social determinants of health (SDoH). However, more data is needed to identify and address these factors. Real-world data (RWD) may be an avenue to do just that.
Physician Calls for $800,000 Pay Cap for Hospital CEOs
CEOs of hospital systems often make orders of magnitude higher than the actual clinicians delivering care to patients, a practice that has drawn scrutiny. In a new article published in Becker’s Hospital Review, learn about Dr. Kenneth Frisof’s argument that CEOs’ pay should be capped at $800,000, still far higher than MD-level specialists.
Hitting the Books: Exploring Education Status as a Key Social Determinants of Health
Educational status is being increasingly recognized as a pivotal social determinant of health (SDoH) a social factor that affects health outcomes. In a new primer by Sara Heath, learn more about education as an SDoH and how it interacts with other key SDoH like race, ethnicity, etc.
Custom Health Announces Medication Adherence Pilot with L.A. Care Plan
Custom Health has announced a partnership with L.A. Care Plan to help promote better health outcomes through medication adherence, which hovers around 50% in the US. This imperils health outcomes, which the partnership intends to address with an in-home drug dispensing device alongside remote access to support from a pharmacist.
New Drug Prices Top Records
The latest round of newly approved therapeutics are peppered with high costs in the US that peak in the millions of dollars, a growing trend in the industry. Many of these therapeutics are gene therapies or antibody-based treatments. These therapies are opening up new, powerful options to patients, but the high costs are often prohibitive.
Real-World Data Study Supports Half-Dose Phototherapy for Chronic Central Serous Chorioretinopathy
A retrospective real-world data (RWD) study has found that half-dose photodynamic therapy (PDT), which uses a photosensitizer and light source to generate bioactive oxygen in tissues, is an effective treatment for chronic central serous chorioretinopathy (CSCR). The results, taken from 125 eyes of 115 patients, support the current off-label use of half-dose PDT for the idiopathic eye condition.
Digital Health to Face Increased Scrutiny in 2023
Digital health solutions exploded over the past few years thanks to the COVID-19 pandemic and regulatory approval changes in many nations. However, concerns have grown regarding the evidence supporting the efficacy of many devices. As such, digital health companies are bracing for additional attention in the coming year.
CNBC: The State of Pharma in 2022
2022 has been a tumultuous year for pharma and biotech, with shifting market conditions, the Russian invasion of Ukraine, and US policy changes that spell an uncertain for the industry over the next few years. A newly published article by Ekta Batra reviews how the pharma industry performed in 2022, for better or worse.
AJMC Staffs 2022 Favorite American Journal of Accountable Care Papers
The AJMC staff have just published their top 5 favorite articles published in The Journal of Accountable Care (AJMC) this past year. These papers covered the cost-effectiveness of virtual healthcare, how employers can get the most from high-deductible health plans, value-based care at the end of life, and more.
2022 Retrospective: The Impact of US Health Policy Changes
2022 was loaded with US health policy debates and changes, with the reversal of abortion rights and drug pricing reform taking the center stage for much of the year. The Inflation Reduction Act, in addition to climate reform and other key Democratic platform items, will allow the federal government to negotiate Medicare prices for certain high-cost therapeutics.
AJMC View: Balancing Cancer Treatment Innovation and Economic Burden
At The American Journal of Managed Care’s Institute for Value-Based Medicine event that took place this past October, speakers discussed the high cost of new therapeutics. A balance must be struck, according to Kevin Cohen, MD, of Optum Care, using data analytics to optimize care quality and costs.
2023 Biopharma Predictions
Evaluate Vantage recently asked readers to anonymously provide their predictions for the upcoming year. The respondents, comprised of industry employees, investors, and bankers, speculated on everything from market conditions to M&A strategies. A key sticking point for many was the impending US drug pricing reforms implemented in the Inflation Reduction Act
AJMC View: PBM GER Fees Threaten Specialty Pharmacies
Many medically integrated specialty pharmacies (MIPs) take a hit when filling prescriptions due to PBM fees known as generic effective rate (GER). This can reduce patient access by disincentivizing the prescribing of these drugs. In a new AJMC View, authors Darrel L. Willyard, PharmD, and Alexis V. Fanshier, BA, explain how GERs impact specialty pharmacies and patient health outcomes.
NEJM Perspective: How Hospitals Can Act On Health Equity Data
In a recent announcement, the US Centers for Medicare and Medicaid Services (CMS) added three measures to the Hospital Inpatient Quality Reporting program that are intended to promote health equity efforts. These measures will rate hospitals on the degree to which they prioritize health equity, how they collect sociodemographic information and health-related social needs (HSRNs), the percentage of patients screened for HSRNs, and more.
India’s NPPA Updates Price Caps on 107 Scheduled Drug Formulations
India’s National Pharmaceutical Pricing Authority (NPPA) has announced it updated its ceiling price for 107 scheduled formulations, as per the drug (prices control) order, 2013 (NLEM 2022). This includes drugs like acetaminophen, risperidone, heparin, atorvastatin, levofloxacin, and more. The ceiling price update will cap the maximum price of drugs to retailers.
