Briana Contreras

Kelsey Lang, principal of Avalere, breaks down the three provisions of the Inflation Reduction Act, which was discussed today at the annual Asembia Specialty Pharmacy Summit in Las Vegas.

Cate Lockhart, executive director of the Biologics and Biosimilars Collective Intelligence Consortium, shared results yesterday of a survey that look at biosimilars on the pharmacy benefit side of coverage versus medical benefit. The survey also shared how payers and those on the pharmaceutical side are anticipating the introduction of Adalimumab (Humira®), as well as what to look for in the future of the biosimilar pipeline.

Today at the annual Asembia Specialty Summit in Las Vegas, Sarah Marche, VP of Pharmacy at Highmark Health, spoke alongside other professionals from various stakeholders within the industry who are invested some way in digital therapeutics.

Today at Asembia 2023 Specialty Pharmacy Summit in Las Vegas, Alexander Pham, VP of Client Services & Strategy at Clearway Health, talked about their collaboration with safety net hospital, OU Health, alongside the Chief Administrative Officer of OU Health, Jigar Thakkar. In this interview, Pham talked about how the Clearway and OU Health partnership helped build a specialty pharmacy program, alleviate financial burden, and more.

The 2024 expansion includes 28 new health centers total to four states.

The average annual healthcare spending for people with employer-sponsored insurance spending increased to $6,467 in 2021 from $5,630 in 2020. Per person healthcare spending increased 15% in 2021, following a 4% decrease in 2020.

In 2019 there were roughly 183,000 deaths associated with poverty in the U.S. among people 15 years and older. This is a significant result as the data is from the year prior to the COVID-19 pandemic when death rates skyrocketed.

HHS released the data earlier this week, which makes it the first time anyone can review the information on the ownership of more than 6,000 hospices and 11,000 home health agencies.

In this final part of a two-part video series, Clay Wilemon, CEO of 4L Data Intelligence, shared how much in cost that fraud, waste and abuse has affected healthcare due to issues like overpayment; and how leveraging your artificial intelligence can help solve fraudulent issues. Clay added how much the industry can save using these solutions.

Clay Wilemon, CEO of 4L Data Intelligence addresses how fraud, waste and abuse in healthcare is an issue caused mainly by overbilling.

In a recent study, researchers investigated the ongoing argument of what causes cognitive deficits in obstructive sleep apnoea patients, the apneoa itself or associated comorbidities. Researchers compared cognitive performance in a group of 27 middle-aged male patients — ranging from 35 to 70 years-old — with untreated OSA and no comorbidities, to 7 healthy matched patients without OSA

The smartphone-based therapy was developed into an app adapted to Chinese culture for a clinical trial comparing sleep-educated patients to those who use the app, as more than 200 million people in China experience insomnia. Traditional in-person cognitive behavioral therapy for insomnia has become more inadequate due to the large group affected.

Researchers of the study investigated the determinants of COVID-19 vaccine fatigue because there is much more to learn on the issue, aside all the research on COVID-19 vaccine hesitancy.

Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.

Over 600 pregnant women and their newborns were analyzed to test the long-time assumption that has resulted in inconsistent data collected in past studies. For more clear results, researchers collected and evaluated pre-delivery maternal vaginal swabs and infant stool samples at 10-days and 3-months of life.

The ruling states insurers and employers who run plans for employees will have a choice over whether and how to cover certain routine screenings, exams and tests.

Health spending and medical care prices typically outpace growth over the overall economy, but as of mid-2022, inflation rates of the economy have reached a four-decade high.

Managing Directors of L.E.K. Consulting, Joe Johnson, Todd Clark and Brendan Mitchell introduce the innovations happening in pharmacy, more specifically disruptive innovations, and how they affect managed care. The team explained some of the innovations to be on the lookout for in the future, also.

Yoona Kim, PharmD, PhD, co-founder, CEO of Arine Inc., talked about the relationship between racial health disparities and medication non-adherence, and how artificial intelligence can help improve adherence between groups most affected such as Black, Latino and Asian populations.

Sharon Jhawar, Chief Pharmacy Officer at SCAN Health Plan, said the organization researched their health plans to figure out what inequities existed in their members. What stood out was that their quality was lower for Black members and they weren't meeting their needs. They also saw in medication adherence, a significantly lower percentage of their Hispanic and Black members who were non-adherent. With the help of AI and cultural matching patients with physicians, they have noticed the improvement of adherence from their patients.

Jane F. Barlow, MD, MPH, MBA, chief clinical officer of Real Endpoints led a presentation at the annual AMCP meeting that can help align payers and their manufactures for success in value-based contracting. In this interview Barlow gives some insight on where we are now with value-based contracting compared to a few years ago and if it's gained some traction or if there are challenges that remain. She also touched what therapies are prime candidates for value-based contracting.

Melissa Andel of CommonHealth Solutions spoke at the AMCP annual meeting today in San Antonio about the ins and outs of the Inflation Reduction Act. She shared her discussion highlights the Act's plans of cost shifting in healthcare and the Medicare part-D benefit re-design. In this interview with Managed Healthcare Executive, Andel addressed the Eli Lilly $35 Insulin cap and how plans of price negotiation will resonate with the public. She also expressed what we may expect through Congress when it comes to repealing any provisions through the IRA, and what could be coming through inflation penalty rebates.

Ben Urick, PharmD, PhD, Health Outcomes Research Principal at Prime Therapeutics, LLC, discussed how non-adherence to medication has lead to medical cost offsets and shared solutions to improve adherence from patients and providers. In particular, Urick shared best data-collecting practices that can in-turn improve both adherence and cost. Urick led a discussion on the challenges leading to non-adherence and shared the efforts underway to remove them at the annual AMCP meeting in San Antonio.

When asked for solutions in better managing expensive drug costs, Michelle Booth of Magellan suggests a "mortgage-like" payment that could help make these therapies, which are covered under medical benefits, more accessible and affordable. Because there aren't many gene therapies out there just yet in the market, there hasn't been much pressure in offering discounts through value-based contracts to patients. Though, more discussions on this initiative are happening, Andy Killpack also of Magellan, said in the second-part of a two part AMCP annual meeting video series.

Magellan's Michelle Booth and Andy Killpack presented today at the annual AMCP meeting in San Antonio to discuss equitable access to recombinant adeno-associated virus (rAAV) gene therapy as there are currently many barriers patients face toward treatment. Booth, senior director of specialty clinical solutions, claims though cost plays a significance in access, there are much more barriers from education to income that lead to inequities. Killpack and booth share solutions and other gene therapies expected to come to market.

At the annual AMCP meeting, Summit Re's Vice President of Actuarial & Underwriting, Rick Lassow, FSA, MAAA, led a discussion on managing high-cost medications through reinsurance and stop-loss programs. In this interview with Managed Healthcare Executive Lassow addresses high-cost cell and gene therapies ran through reinsurance and how Medicaid can benefit the most from reinsurance programs.

According to a study published in the British Medical Journal, results showed consistency across analyses reviewed that most estimates of symptom changes were close to zero and not significant.

Randy Forman will join the organization as chief commercial officer and Ryan Powers will take on the role as chief financial officer. Both have sparked high velocity growth for digital health leaders.

In this second part of a two-part video series, Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care.

Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes focus on musculoskeletal and respiratory conditions and the data collected from patients affected. According to Spira, these codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care.