Peter Wehrwein, Managing Editor

Vanderbilt’s Stacie Dusetzina and colleagues explain how the ‘copay adjustment’ programs work in this week’s JAMA Internal Medicine and also shed light on third strategy used by insurers and pharmaceutical benefit managers, the alternative payment program.

The Biden-McCarthy leaves $5 billion intact for coronavirus vaccine and treatment research, according to multiple media reports.

The company said 21% of its Medicare Advantage members are in plans with 2023 ratings of 4.0 or above, a steep decline from the 2023 star ratings.

The announcement mentions the growth in Medicare Advantage during his five-year tenure.

Results reported in JAMA comparing Black and White populations show a narrowing and then leveling off of excess mortality and potential years of life lost before the difference widened again in 2020.

Medicaid redetermination may result in a favorable payer mix for some providers if people switch to ACA and employer-based coverage that has higher payer rates. But that is a pretty big if.

Coverage of Ozempic, Wegovy; eliminating hepatitis C, $100,000 bonsues for nurses

Audits and following prevention “bundles” were among the steps infection control leaders took at the Sparrow Health System long-term acute-care hospital in Lansing, Michigan.

Oxygen supplementation may be necessary, especially for newborns born prematurely. But the oxygen free radicals associated with high levels can be harmful, causing conditions such as retinopathy of prematurity, which can result in blindness. A review article discusses how researchers and clinicians have found the right balance between high and low oxygen supplementation for newborns.

Over 7,000 people attended the meeting in Las Vegas this week.

Ed Paiewonsky, Director, Medical Outcomes Science Liaison at Alnylam Pharmaceuticals, discussed results of the Alnylam Rare Disease Trend report at this year's Asembia Specialty Pharmacy Summit.

But payers may be putting undue emphasis on interchangeability, said a panelist at session on biosimilars at the 2023 Asembia Specialty Pharmacy Summit.

Adam Fein, Ph.D., talked about some surprising trends in specialty pharmacy and healthcare at the 2023 Asembia Specialty Pharmacy Summit. The number of specialty pharmacy locations may be peaking. And that "gross-to-net bubble" in drug prices that Fein has written about so much — well, it may be shrinking.

“It was like, we’re going to take off your head, we are going to come after you,” said Seema Verma, the Centers for Medicare and Medicaid Administrator in the Trump administration, during an on-stage interview at the 2023 Asembia Specialty Pharmacy Summit.

A relatively small number of cell and gene therapies have become a clinical reality. But now the specialty pharmacy industry, and healthcare more generally, is bracing for a wave of cell and gene therapies that will force change and adaption. And, yes, the new therapies will be extremely costly.

A little-known provision of the Inflation Reduction Act will allow people with Part D coverage to "smooth out" their annual out-of-pocket costs as an average payment over months.

Daybue (trofinetide) is the first treatment for Rett syndrome. The pivotal trial for treatment for a lifelong condition was only 12 weeks long.

More PBM legislation, Medicaid work requirements are a hot topic, low-value care's main culprits

Biden's bid for re-election, AHIP takes on Pharma and the digital health's equity problems

The Senate Finance Committee released a framework for legislation this week, and the leaders of the “big three” PBMs are scheduled to be witnesses at another committee's hearing about insulin prices on May 10.

CDC researchers estimate an almost 50% decrease in those with uncovered costs associated with HIV preexposure prophylaxis (PrEP). More people who are PrEP eligible have insurance and the cost of PrEP has declined.

Medicare Advantage plans have been associated with increased screening rates. But managed care tactics and narrow networks may be a disadvantage for people needing care.

Researchers compared cardiac effects of waking people up every hour to limiting them to five hours of sleep.

The National Sleep Foundation published a position statement about disparities last year. Earlier this year, researchers reported findings showing that White patients with a diagnosis of insomnia are more likely to be prescribed an FDA-approved medication than Black patients.

A bibliometric analysis shows the annual number of published studies has increased from a handful to more than 60. Most studied are the sleep tracking apps.

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.