Peter Wehrwein, Managing Editor

A new Health Care Cost Instittue report finds prices, not utilization, drove spending growth in employer coverage from 2019 to 2023, echoing the group's very first report — and the title of Uwe Reinhardt's famous article.

This is a written summary of the conversation between Kirk Campbell, M.D., and Howard Trachtman, M.D., about FSGS, the DUPLEX trial, and sparsentan, sold under the brand name Filspari.

The Health Care Cost Institute’s annual healthcare cost and utilization report on healthcare spending by those with employer-based health insurance shows that price increases, not utilization, account for soaring cost increases. HCCI CEO Katie Martin says employers should focus on bringing down hospital prices.

Real-world research using the PEDISTAD registry makes up for the gap left by relatively low enrollment of children with skin of color in the pivotal trials of Dupixent (dupilumab).

The research results suggest that exposure to smoke may possibly tip the balance and trigger the onset of hidradenitis suppurativa in some children and adolescents

The purchase comes as the "big 3" drug wholesalers are coming under scrutiny for their market dominance and the possible perils of vertical integration.

High prices and cutbacks in ACA and Medicaid coverage leave many patients unable to medical bills.

Rand researchers identify standardizing supplemental benefits, limiting the number of plans an insurer can market and reforming broker commissions as policy proposals that would benefit beneficiaries while not harming the government or the plans.

Bill Kerr of Avalon Healthcare Solutions says incorporating Z codes into CPT coding for lab and genetic testing would add needed specificity, reduce waste and possibly head off fraud.

Some predicted that drugmakers might boost launch prices to make up for Medicare drug negotiations shrinking profits. Harvard researchers find no evidence of that happening so far.

Philip Mease, M.D., of the Swedish Medical Center, Providence St. Joseph Health in Seattle, and Saakshi Khattri, M.D., of the Icahn School of Medicine at Mount Sinai in New York, discussed the Be Bold trial.

Dunn of NeosRx says a 340B shift from discounts to rebates likely won't affect rebate erosion affecting plan sponsors.

Steering claims away from 340B-eligible pharmacies is one option but also the most disruptive, said Jeff Dunn, Pharm.D., MBA, of NeosRx.

340B discounts preclude rebates paid to pharmacy benefit managers for their payer clients. Dunn says new transparency and cost pressures have created awareness of “340B rebate erosion.”

Christine Poh, M.D., of the City of Hope Los Angeles, discusses follicular lymphoma treatment.

Sova, a clinical advisor for Employers Health, expects more employers to exclude GLP-1s for obesity but urges a look at coverage for specific cardiometabolic conditions.

Employers Health’s Alexis Sova says employers excluding GLP-1s now lean on weight management programs and direct-to-employer deals, not a hard cutoff.

Approximately two-thirds of Employers Health clients now exclude GLP-1s for obesity, up from a roughly even split at launch as cost drives coverage decisions.

The vice president said an additional 419,000 enrollees are being investigated as possibly being ineligible.

A study with three years of follow-up shows that the drug stays effective and safe for most, although 16% stopped getting treated with Dupixent, mainly because it was ineffective or caused side effects.

National Alliance names Jenny Goins interim CEO after former leader’s arrest; details emerge on charges, firing timeline, and impact on healthcare policy circles.

A review of randomized clinical trials, nonrandomized trials and case reports suggests that the inflammatory bowel disease risk from treatment with IL-17 inhibitors is low.

Elevated levels of immunoglobulin G (IgG) drive “inflammaging” processes that take a toll on skin tissue as people age, according to research results reported by Japanese researchers. Reducing IgG may mitigate the loss of collagen and elastin.

ProAct Chief Operating Offier Deborah Dempsey says plan sponsors still lack the data and visibility to know whether they were shorted on a 340B claim.

OrionRx's Don Anderson, Pharm.D., says a GLP-1 access model built around mandatory wellness coaching resulted in a six-point drop in body mass index and improved mental health.

Chronic inflammation may explain why people with hidradenitis suppurativa are more likely to develop lymphoma.

ProAct's Deborah Dempsey, Pharm.D., MBA, RPh, explains how 340B discounts to healthcare entities are in conflict with rebates that manufacturers pay to health plan sponsors.

Optum Rx's Anne Mall, M.H.A., says her company's AI is surfacing clinical details buried in providers' chart notes so clinicians can decide on therapy faster.

Optum Rx's PreCheck Prior Authorization tool automates 64% of approvals in under 30 seconds, getting patients onto therapy four days faster, Anne Mall, MHA, says.

OrionRx's Don Anderson, Pharm.D., outlines near-term and long-term fixes for the blind spots created when members buy medications outside their pharmacy benefit.