Peter Wehrwein has been the lead editor of Managed Healthcare Executive since February 2020.
Optum Rx Picks Hyrimoz and Cyltezo for Its Formulary
The Sandoz's and Boehinger Ingelheim's Humira biosimilars will join Amgen's Amjevita on the formulary of UnitedHealth Group's PBM. Cyltezo may have a marketing edge because of its interchangeability designation.
A Step Forward, Perhaps, for Safe Step Act and Exemptions from Step Therapy
Legislation designed to smooth the path to exemptions from step therapy has been incorporated into the Pharmacy Benefit Reform Act, one of several bills targeting pharmacy benefit managers that is making legislative headway in the Senate.
What to Look For in the Pipeline, Misconceptions of Drug Approvals and More of ‘What’s on the Mind’ of Jeffrey Casberg
Briana Contreras, an editor with Managed Healthcare Executive, and Peter Wehrwein, managing editor of MHE, got to chatting with the newest editorial advisory board member, Jeffrey Casberg, who is vice president of Clinical Pharmacy at IPD Analytics.
What Happens When NICUs Affiliate With Physician Management Companies?
Research results reported by Cornell researchers show price increases when neonatal intensive care units (NICUs) affiliated with practice management companies, but quality indicators largely hold steady.
CMS Will Cover Alzheimer’s Drugs Leqembi, Donanemab — With Strings Attached
The drugs must have full “traditional” FDA approval and patients need to be enrolled in a registry that collects post-approval data efficacy and safety when the drugs are used in clinical practice.
UnitedHealth Ditches Controversial Prior Authorization for GI Procedures for ‘Advance Notification Process’
The head of a gastroenterologist group criticizes the company for having a "slapdash approach."
Another Dispatch From the Accumulator-Maximizer Wars
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.
No Medicaid Work Requirements, COVID-19 Funds Clawed Back: The Debt-Ceiling Deal
The Biden-McCarthy leaves $5 billion intact for coronavirus vaccine and treatment research, according to multiple media reports.
CVS Health’s 2024 Operating Income Reduced by up to $1 Billion Because of Low MA Star Ratings
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.
AHIP CEO Matthew Eyles Moving On
The announcement mentions the growth in Medicare Advantage during his five-year tenure.
Some Years of Progress in Narrowing Black-White Mortality Differences. Then COVID-19 Happened
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, Sanders' Healthcare $$$ Plans & AI for Mental Health | The AM News Cycle
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.
News Round-up: May 15
Coverage of Ozempic, Wegovy; eliminating hepatitis C, $100,000 bonsues for nurses
How One LTACH Reduced Its Central-Line Associated Bloodstream Infections to Zero
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 for Newborns: When There Is Too Much of a Necessary Thing
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.
Inflation Reduction Act, Cell and Gene Therapy Were Hot Topics at Asembia Meeting | 2023 Asembia Specialty Pharmacy Summit
Over 7,000 people attended the meeting in Las Vegas this week.
The Latest Trends and Potential Implications in Rare Disease, Orphan Drug Management | Asembia Specialty Pharmacy Summit
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.
Biosimilars, Once Dubious, Looking Like a Surer Thing | 2023 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.
The Healthcare World According to Fein | 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.
Verma Talks About the ‘Pretty Toxic’ Environment of Trump Administration | 2023 Asembia Specialty Pharmacy Summit
“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.
The Future Has Arrived and Is Knocking. Getting Ready for the Arrival of Cell and Gene Therapy | 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.
Inflation Reduction Act Has a 'Smoothing' Effect on Beneficiaries | 2023 Asembia Specialty Pharmacy Summit
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.
New Rett Syndrome Treatment Heralded But With Some Concerns | Asembia Specialty Pharmacy Summit
Daybue (trofinetide) is the first treatment for Rett syndrome. The pivotal trial for treatment for a lifelong condition was only 12 weeks long.
AM News Cycle: April 26
More PBM legislation, Medicaid work requirements are a hot topic, low-value care's main culprits
AM News Cycle: April 25
Biden's bid for re-election, AHIP takes on Pharma and the digital health's equity problems
PBMs in the D.C. Hotseat
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.
Financial Barriers to PrEP Remain But They Are Lower
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.
Is Medicare Advantage a Disadvantage For Patients With Cancer?
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.
Sleep Restriction is More Stressful Than Sleep Fragmentation
Researchers compared cardiac effects of waking people up every hour to limiting them to five hours of sleep.
Sleep Health Through the Disparities Lens
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.
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