Peter Wehrwein, Managing Editor

A study in this month's Health Affairs shows that Medicare Advantage penetration has a ripple effect on the patterns of postacute care usage among those in traditional Medicare. As Medicare Advantage penetration increased, use of postacute care services by beneficiaries in traditional Medicare decreased.

Former CEO Corey McCann, M.D., Ph.D., pointed a finger at payers.

A Senate Finance Committee hearing yesterday was the latest in a series of hearings and announcements featuring sharp condemnation of the business practices of the large pharmacy benefit managers.

Specialty drugs are expected to comprise 80% of the FDA approvals this year. Among them are gene therapies for hemophilia A and Duchenne muscular dystrophy priced at between $2 million and $3 million.

Coverage decisions about prescription digital therapeutics may take payers out of their comfort zones and require new processes and subject matter experts, according to members of a panel at the AMCP annual meeting. But P&T committees are likely to still be central to the process.

They are the trendy way to lose weight and payers have been noticing an increase in GLP-1 claims. An analysis of the pharmacy and healthcare claims of a small commercial health plan in Texas documents the growth in the off-label usage of the GLP-1s, such as Ozempic, for weight loss.

The IQVIA vice president sees trouble for generics manufacturers, but painted a bright picture for biosimilars during his keynote address at the annual meeting of the Academy of Managed Care Pharmacy (AMCP).

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.

The co-anchor of Good Morning America spoke about her experience when she was diagnosed with myelodysplastic syndrome.

Costs have always figured into drug coverage decisions, but value assessments have become a separate and more formalized part of the process at payer organizations, said members of a panel on value frameworks at the 2023 AMCP annual meeting. The Institute for Clinical and Economic Review (ICER) came up often during the discussion.

A pavilion devoted to prescription digital therapeutics and an educational track devoted to biosimilars are new this year.

This part of the month's cover story series features Suzanne Delbanco, Ph.D., M.P.H., executive director of the Catalyst for Payment Reform, who has the provocative suggestion of flipping physician payment so primary care physicians are paid more, not less, than specialists. “We spend so much more on specialists than we do on primary care. While a specialist can help people who are already ill, primary care doctors can help people from becoming ill,” she says.

Findings from a mouse model suggest that encapsulating anandamide, an endocannabinoid, could be a way to make it an effective treatment for cutaneous lupus erythematosus (CLE).

The researchers say their findings argue for dermatologists embracing TikTok and promoting more high-quality content on it and other social media platforms.

Erik Jaklitsch of the University of Pittsburgh School of Medicine presented findings today at the annual meeting of the American Academy of Dermatology that suggest that teledermatology might be useful for shortening the time to treatment for melanoma patients.

Monica Li, M.D., clinical instructor in Department of Dermatology and Skin Science at University of British Columbia, led a session on advances in microneedling today at the annual meeting of the American Academy of Dermatology in New Orleans.

This part of the month's cover story series features Ivan Jarry, CEO of Obviohealth. According to Jarry, companies like his that run decentralized clinical trials can solve many of the problems that bedevil clinical trials, making them cheaper, faster and more inclusive and their results more reliable. 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.

Diabetes management may lend itself to digital health interventions for a whole set reasons. DarioHealth reported good results recently, and a meta-analysis published in Lancet Digital Health this month showed that smartphone applications and SMS-based interventions are associated with effective management of type 2 diabetes in adults.

Patient groups and lawmakers such as Sen. Bernie Sanders want Sanofi and Novo Nordisk to follow Eli Lilly's example and reduce the prices of their insulin products. Both companies said they already have programs that bring down the cost.

Program reached the Marshallese workers who have moved from the island nation in the central Pacific Ocean to work in the poultry and meatpacking industry in northwest Arkansas.

The new factor VIII product is part of a surge of research and drug development for hemophilia.

As with the controversial drug Aduhelm, coverage is limited to people enrolled in clinical trials. The Alzheimer’s Association had petitioned for a change.

Rituximab is cheaper and just as effective as the other monoclonal antibodies used to treat MS, says an ICER report that came out today.

A 72-year-old man developed worsening myalgia while taking Paxlovid. The FDA and authors of a case report in JAMA Internal Medicine today says patients who would benefit from Paxlovid should be advised to temporarily stop taking statins and other drugs with potentially serious drug-drug interactions with Paxlovid.

Leaders of the Digital Therapeutics Alliance hope to get a Congressional Budget Office score on the legislation that would extend Medicare coverage so members of Congress can weigh budget implications.

Senators and witnesses said at a Commerce Committee hearing today that pharmacy benefit managers are putting independent pharmacies out of business and siphoning money from the drug supply chain. A University of Chicago economist and the industry trade association pushed backed, saying they bargain to save payers and patients money.

At a placeholder price of $19,000, resmetirom would produce cost savings, says the drug evaluation group. Obeticholic acid’s price would need to be slashed to meet a commonly used cost-effectiveness threshold.

Cuban, of "Shark Tank' fame and owner of the Dallas Mavericks, called drugs prices ‘insane’ and used some profanity when talking pharmacy benefit managers at the annual meeting of the Association for Accessible Medicines yesterday. Cuban has co-founded an online pharmacy that he says will make drug prices lower and transparent.