Deborah Abrams Kaplan

Commercial plans haven’t traditionally covered hearing aids.

This part of the month's cover story series features private equity and how it's coming for primary care. Jane Zhu, M.D., M.P.P., of Oregon Health & Science University shares that private equity takes advantage of economies of scale to make things more streamlined, then move onto the next market or specialty. This months cover story shines a light on the companies, trends and ideas that are shaking things up and reshaping the contour of how healthcare is paid for and delivered.

Repositories of donated drugs in 13 states are redistributing oncology medications to those in need.

Andrew Shadid and Genesis Orthopedics & Sports Medicine applied some of the principles of reverse innovation to make the practice successful.

More practices are directly dispensing oral cancer drugs, bypassing specialty pharmacies. What does this trend mean for patients and healthcare?

Insulin, albuterol, epinephrine, glucagon and naloxone are on the list.

Drug manufacturers are rejecting the program’s blanket discounts involving contract pharmacies. A flurry of litigation has ensued.

The Big Three all set up group purchasing organizations recently, but some industry observers question the timing of the move and who will benefit.

A Kaiser Family Foundation survey found that all the responding programs had at least one initiative to expand behavioral health services.

The company is expanding the reach of Amazon Care and partnering with health systems and senior living companies to support at-home care.

The agency has been in the spotlight because of the pandemic, questions about its independence and the approval of Aduhelm. The stakes are high and the politics, fraught.

Copays and formulary tiers involve financial incentives to use certain drugs. But is Cigna’s offer of a $500 debit card in a different category?

Government regulations are designed to encourage data fluidity in healthcare, which could "radically empower" consumers, said Kim Diehl-Boyd, CoverMyMeds vice president of industry relations and government affairs, at the 2021 Annual National Conference of the Pharmacy Benefit Management Institute.

FDA approval of Lumakras was contingent on a trial testing lower doses. It could usher in a new era of optimal dosing instead of the maximum tolerated dosing.

Low prices and some gaming of regulations can drive out competitors and create monopolies that allow generic makers to jack up their prices. Experience has shown that it often takes multiple generics to achieve the promised-for downward pressure on prices.

Predictions that the company would make a major move to dominate American healthcare have not come to pass. So far.

Providers are moving toward acceptance; the rules are here to stay. Payers recognize that people need to know prices.

Governments are the only buyers so far, and the amounts they are paying varies.

Having specialty pharmacies fill prescriptions may lower costs, but critics of the practice see safety issues and other drawbacks.

William Trombatt and James Adams of AllianceRx Walgreens Prime discussed specialty pharmacy for people with MS at PBMI Specialty Rx Forum last week. The need for "higher touch" programs is important for people with MS, said Adams.

Can data mined from EHRs match that from the gold standard, randomized clinical trials?

Whether the online giant has larger healthcare ambitions is unclear.

Where some see bloat and trendiness, others see nimbleness and responsiveness.

Companies are using rewards and ‘gamification’ to encourage patients to take their pills as prescribed.

Early studies from China suggested that CT scans of the lungs could be used to diagnose the disease. But as PCR tests became available, radiology groups said CT scans should be used more sparingly and in confirmed cases.

Early detection of low blood oxygen levels may detect ‘silent hypoxia’ seen in some patients with COVID-19. But the American Lung Association advises against buying a pulse oximeter unnecessarily.

By almost any measure, these are good times for Medicare Advantage. Enrollment is growing, the number of insurers in the market is increasing, and gross margins are higher than in other health insurance markets.

Here are four programs making a difference.

There are a variety of ways, but a multi-pronged approach is best.