Expert Interviews

Sharon Jhawar, Chief Pharmacy Officer at SCAN Health Plan, said the organization researched their health plans to figure out what inequities existed in their members. What stood out was that their quality was lower for Black members and they weren't meeting their needs. They also saw in medication adherence, a significantly lower percentage of their Hispanic and Black members who were non-adherent. With the help of AI and cultural matching patients with physicians, they have noticed the improvement of adherence from their patients.

Jane F. Barlow, MD, MPH, MBA, chief clinical officer of Real Endpoints led a presentation at the annual AMCP meeting that can help align payers and their manufactures for success in value-based contracting. In this interview Barlow gives some insight on where we are now with value-based contracting compared to a few years ago and if it's gained some traction or if there are challenges that remain. She also touched what therapies are prime candidates for value-based contracting.

Melissa Andel of CommonHealth Solutions spoke at the AMCP annual meeting today in San Antonio about the ins and outs of the Inflation Reduction Act. She shared her discussion highlights the Act's plans of cost shifting in healthcare and the Medicare part-D benefit re-design. In this interview with Managed Healthcare Executive, Andel addressed the Eli Lilly $35 Insulin cap and how plans of price negotiation will resonate with the public. She also expressed what we may expect through Congress when it comes to repealing any provisions through the IRA, and what could be coming through inflation penalty rebates.

Ben Urick, PharmD, PhD, Health Outcomes Research Principal at Prime Therapeutics, LLC, discussed how non-adherence to medication has lead to medical cost offsets and shared solutions to improve adherence from patients and providers. In particular, Urick shared best data-collecting practices that can in-turn improve both adherence and cost. Urick led a discussion on the challenges leading to non-adherence and shared the efforts underway to remove them at the annual AMCP meeting in San Antonio.

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.

At the annual AMCP meeting, Summit Re's Vice President of Actuarial & Underwriting, Rick Lassow, FSA, MAAA, led a discussion on managing high-cost medications through reinsurance and stop-loss programs. In this interview with Managed Healthcare Executive Lassow addresses high-cost cell and gene therapies ran through reinsurance and how Medicaid can benefit the most from reinsurance programs.

Jennifer Roggenbuck, MS, LGC, and Laynie Dratch, ScM, CGC, discuss common genetic mutations associated with ALS.

Genetic testing for family members of patients diagnosed with ALS can provide opportunities for early awareness and disease intervention.

Kimberly Westrich, MA, Director of Value & Access Strategy at Xcenda/AmerisourceBergen kicks off AMCP's 2023 annual meeting in San Antonio with her discussion on value framework assessments. Westrich mentioned one of the obstacles payers come across when using value assessment frameworks in decision-making is either not having enough information or having the right kind of information.

In their final thoughts, Eugene McCray, M.D., and Steven Peskin, M.D., MBA, FACP, share insights into unmet needs surrounding HIV treatment management.

Drs McCray and Peskin provide an overview of the CAPELLA trial.

Sancy Leachman, M.D., Ph.D., professor and chair of the Department of Dermatology and director of the Melanoma Research Program at the Knight Cancer Institute at Oregon Health and Science University, discusses genetic testing for melanoma.

John E. Harris, M.D., Ph.D., of the UMass Chan Medical School in Worcester, Massachusetts, and director of a vitiligo clinic and research center there, discusses some of the insurance issues regarding Opzelura (ruxolitinib) cream.

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.

Eva R. Parker, MD, associate professor of dermatology at Vanderbilt University Medical Center and president of the Nashville Dermatologic Society, addressed how climate change is already increasing the incidence of some skin-related conditions at the annual meeting of the American Academy of Dermatology in New Orleans.

Emma Guttman-Yassky, M.D., Ph.D. of Icahn School of Medicine at Mount Sinai, New York discussed developments in atopic dermatitis treatment, more specifically with therapies like rocatinlimab and other anti-OX4 agents today at the annual American Academy of Dermatology meeting in New Orleans.

Haley Naik, M.D., associate professor of dermatology at the University of California, San Francisco, School of Medicine, led a discussion about hidradenitis suppurativa today at the annual American Academy of Dermatology meeting in New Orleans.

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.

Medical experts provide insights on the impact of delayed treatment interventions for patients diagnosed with ALS.

Key humanistic burdens, including stressors on patients and family members, are highlighted.

Laynie Dratch, ScM, CGC, discusses the prognosis associated ALS.

Treatment barriers inhibit optimal care for many patients diagnosed with HIV.

Dr. Peskin identifies the significance of payer support in the treatment landscape of MDR HIV.

Jennifer Roggenbuck, MS, LGC, opens a discussion on patient journeys with ALS.

Non–treatment-naïve patient considerations are explored by key opinion leaders.

Medical experts provide an overview of testing considerations for MDR HIV.

In this second part of a two-part video series, Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care.

Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes focus on musculoskeletal and respiratory conditions and the data collected from patients affected. According to Spira, these codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care.

Steven Peskin, M.D., MBA, FACP, discusses considerations for payers when identifying patients at risk for drug-resistant HIV.