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Takeaways from Senate Hearing on Semaglutide PricingNovo Nordisk said it’s open to discussions with PBMs based on their commitments that a lower semgalutide list price would not impact formulary coverage.
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Unlocking the Hidden Potential of Modern Care ManagementHealth plans must embrace real-time member awareness, timely clinical context and actionable insights to realize the benefits of care management.
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FDA Grants Accelerated Approval For Targeted Drug for Rare Brain TumorModeyso is the first drug to treat patients with diffuse midline glioma with an H3 K27M mutation, an ultra-rare and aggressive brain tumor.
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Pressure on Patient Assistance Programs | Predictions for 2025Predictions for 2025 by Tracy Baroni Allmon, J.D., vice president of Market Access and Policy at Magnolia Market Access.
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Closing Insights: The Future of Cemiplimab in NSCLC and BeyondPanelists discuss how, as new data on cemiplimab and other checkpoint inhibitors emerge, the treatment pathway for cancers like non-small cell lung cancer (NSCLC) is expected to evolve toward more personalized, targeted approaches. This will enhance survival outcomes, refine patient selection and optimize therapy regimens.
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Digital Transformation is the Revolutionary Change Healthcare NeedsDue to one of the most challenging global crises in living memory and one that presented an acute challenge for the medical community, healthcare providers find themselves operating within an uncertain landscape. They are still managing the fallout of COVID-19 while also planning for the future.
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Precision Medicine vs Trial and Error: Why Pharmacogenomics is Increasingly RelevantPharmacogenomics looks at how genetic influences affect an individual’s response to therapeutic medications.
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Closing the Gap With Virtual Care Services: Reimagining the Delivery of HealthcareThe delivery of care model needs to scale across the community settings while servicing the unique needs of each patient.
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CMS’s RADV Strategy Will Reverberate Throughout Health Plan OperationsTo prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.
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Study: Medicaid Coverage Uneven for Gene TherapiesRecent study finds that Medicaid coverage for some of the first gene and cell therapies was at times delayed and not consistent with federal requirements.
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Digital Patient Engagement: Helping Uninsured Americans Gain Access to CareIdentifying the right payer before a healthcare service is provided and billing on time, reduces costs, prevents bad debt and maximizes reimbursements and revenue.
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Acute Hospital-at-Home Holds Promise for Hospitals Facing Staffing ShortagesOrganizations setting up hospital-at-home programs need to be aware of the associated risks and mitigation best practices.
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Reimagining healthcare payer operations: the power of process intelligenceHow AI-powered technology and its data-driven insights improve payer operations and reimburse providers faster.
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Getting Real About Health EquityCMS and state officials are using payment incentives, data collection and program requirements to start edging the lofty ideals of health equity toward reality.
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Collaborating to Support Better Outcomes Through Value-Based CareEngaging with payers in collaborative arrangements is critical for achieving quality outcomes at lower cost, while ensuring financial health for providers during good times and bad.
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Why Timing Matters When It Comes to PBM ContractingPlan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
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Health Plans Are Managing More Data Than Ever Before. How to Ensure It’s Usable.Health plans need to consider regulations and keep healthcare data secure to take full advantage of its enormous potential to broaden and reshape timely, effective delivery of care.
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The Future of the Growing Medication Adherence MarketPatients with chronic conditions like asthma, diabetes, and cardiovascular disease often require emergency attention and hospitalization due to non-adherence, resulting in higher treatment costs.
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Clinical Decision Support Can Help Identify Common Drugs Linked with Increased Arrhythmia and Sudden Death RiskResearch has linked many drugs to QT prolongation and decision support tools could alert clinicians to the risk and guide prescribing decisions to safer alternatives.
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Pharma: Striding Towards the Digital-only Reality with AIAs industries across the board move towards a digital-only world, pharma companies must account for the different technologies that are transforming the R&D process.
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Why Timing Matters When It Comes to PBM ContractingPlan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
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Value-Based Decision-Making in Metastatic Breast CancerIn this Managed Healthcare Executive® KCast, Ian Krop, M.D., Ph.D., oncologist and associate professor of medicine at Dana-Farber Cancer Institute in Boston, and Debra Patt, M.D., Ph.D., MBA, executive vice president at Texas Oncology in Austin, provide key insights into the value-based care model for patients with HER2-positive metastatic breast cancer (mBC). This article summarizes the highlights of the discussion.
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2025 Digital Healthcare Outlook: Compliance, Security and CollaborationSome regulatory changes are already set to happen this year, but reduced regulation under the new administration could have a ripple effects in healthcare. Meanwhile, artificial intelligence is likely to have pronounced impact on nonclinical workflows in 2025.
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How to Recognize, Capitalize on the Benefits of Price Transparency in HealthcareHospital leaders who have historically viewed price transparency as potentially disastrous can tap into these three tips to leave that mindset behind and capitalize on the opportunities that price transparency provides.
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Accelerating Value-Based Care Transformation Today and Post COVID-19One year into the COVID-19 pandemic and healthcare leaders are taking a hard look at all operations – especially innovative reimbursement models that best meet the needs of their business, providers and patients. No doubt these leaders are finally paying closer attention to value-based care.
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Using Real-World Evidence in Managed Care Frameworks for the Adoption of Bispecific Antibodies in Multiple MyelomaAn expert discusses the growing importance of real-world evidence in informing payer decisions and value-based care strategies for bispecific therapies in relapsed/refractory multiple myeloma (R/R MM), highlighting the need to validate clinical trial outcomes, assess economic impact, and ensure equitable integration into treatment pathways.
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Exploring the Critical First Step in Adding and Paying CBOs in Value-based ContractsThe transition from treating patients at a provider’s site to delivering care in the home and community requires two things: an ability to incorporate social determinants of health into the care coordination process and the inclusion of value-based care and community-based organizations as compensated care delivery partners in VBC networks.
