Novo Nordisk said it’s open to discussions with PBMs based on their commitments that a lower semgalutide list price would not impact formulary coverage.
Health plans must embrace real-time member awareness, timely clinical context and actionable insights to realize the benefits of care management.
In a study in mice, a wireless implant was able to release glucagon as an emergency treatment for hypoglycemia, a serious complication of Type 1 diabetes.
Predictions for 2025 by Tracy Baroni Allmon, J.D., vice president of Market Access and Policy at Magnolia Market Access.
Panelists 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.
Due 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.
Pharmacogenomics looks at how genetic influences affect an individual’s response to therapeutic medications.
The delivery of care model needs to scale across the community settings while servicing the unique needs of each patient.
To prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.
Recent study finds that Medicaid coverage for some of the first gene and cell therapies was at times delayed and not consistent with federal requirements.
Identifying the right payer before a healthcare service is provided and billing on time, reduces costs, prevents bad debt and maximizes reimbursements and revenue.
Organizations setting up hospital-at-home programs need to be aware of the associated risks and mitigation best practices.
How AI-powered technology and its data-driven insights improve payer operations and reimburse providers faster.
CMS and state officials are using payment incentives, data collection and program requirements to start edging the lofty ideals of health equity toward reality.
Engaging 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.
Plan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
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.
Patients with chronic conditions like asthma, diabetes, and cardiovascular disease often require emergency attention and hospitalization due to non-adherence, resulting in higher treatment costs.
Research has linked many drugs to QT prolongation and decision support tools could alert clinicians to the risk and guide prescribing decisions to safer alternatives.
As 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.
Plan sponsors should begin evaluation of PBM performance at least a year before the contract expires, say lawyers with expertise in PBM contracting.
In 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.
Some 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.
Hospital 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.
One 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.
An expert discusses the evolving role of BCMA-targeted therapies in relapsed/refractory multiple myeloma (R/R MM), comparing the efficacy, safety, and logistical considerations of CAR T-cell therapies, bispecific antibodies, and antibody-drug conjugates, and emphasizing the importance of individualized treatment selection and ongoing refinement of therapeutic sequencing.
The 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.