Briana Contreras

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.

A legislation was signed today banning transgender minors from receiving gender-affirming care in Tennessee by Gov. Bill Lee. The bill prohibits the minors from receiving altering surgeries and hormone treatments.

Briana Contreras, an editor of Managed Healthcare Executive, chats with Bronwyn Spira, CEO and founder of Force Therapeutics, in this week's episode about CMS' new CPT codes that were introduced in 2022.

Pfizer could soon be the first to offer an RSV vaccine to adults ages 60 and older if the vaccine is fully approved by the Food Drug and Administration and the Centers for Disease Control and Prevention.

Amazon has officially acquired One Medical several months after the merger was first announced in July 2022. Together, the organization will work to help more people get better care, when and how they need it.

Mark Cuban Cost Plus Drug, Cost Plus Drugs, company has recently partnered with Diathrive Health in the initiative to improve healthcare access, lowering costs and improving outcomes for those living with diabetes and other chronic diseases.

Pfizer's COVID-19 vaccine, Comirnaty, dominated in 2022 with forecast sales of $37 billion. The vaccine is expected to maintain these sales going into the future, with with sales forecasts up by 16%.

When it comes to the human papillomavirus (HPV) vaccine, organizations like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend protection with the vaccine in different doses.

Up to half of patients infected with SARS-CoV-2 may experience symptoms lasting beyond three months post-infection, including severe fatigue, organ system-based symptoms and other persistent symptoms.

Rich Priore, Sc.D., M.H.A., a clinical associate professor in the Department of Health Policy and Management at Tulane University addresses how hospitals will be affected on the cost and revenue side after the COVID-19 Public Health Emergency expires May 11.

Under the Consolidated Appropriations Act of 2023, some Medicare telehealth flexibilities will extend until December 31, 2024, though significant questions remain for the future of telehealth, especially in the Medicare program.

Rich Priore, Sc.D., M.H.A., a clinical associate professor in the Department of Health Policy and Management at Tulane University, said if Americans invested in health prevention and wellness, fewer would be in hospitals and the cost of care would lower.

Our guest on this month’s episode of the “What's on Your Mind” podcast is Margaret Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of Managed Healthcare Executive® editorial advisory board. Murray is an expert on Medicaid and healthcare policies that affect people with low incomes. In the interview with Managing Editor of MHE, Peter Wehrwein, she discusses ACAP’s growth and its legislative wins, Medicaid redetermination, “junk insurance,” and state Medicaid programs carving out pharmacy benefits.

Healthcare leaders are urging the public in a new public service announcement to make sure they are up-to-date on their COVID-19 vaccines, including the updated bivalent booster dose when eligible.

Founder and managing partner of Third Culture Capital (3CC), Julien Pham, expressed that funding for telehealth is on the decline and will only continue on this path. Pham explained why this is happening and shared alternative routes of care organizations can take to address disparities and improve access to care.

The MSK AI model will automatically identify and measure tendons of specific anatomical sites including the foot, ankle and knee using artificial intelligence with the Clarius L7 HD3 and Clarius L15 HD3 high-frequency ultrasound scanners.