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Russell Graney, Founder and CEO, Aidin, which helps patients find the best quality care after they leave the hospital while at the same time helping hospitals nationwide streamline the process of discharging patients, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Kyna Fong, Ph.D., CEO and co-founder, Elation Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In an interview with MHE, Fong shared a guilty pleasure of her's is Na Ya Dessert Cafe in San Francisco's Hayes Valley. In addition to a guilty pleasure, Fong also talked about a career turning point she experienced, and what book she recommends to healthcare professionals.

Mike Steelman, vice president, Managed Markets, Dexcom presented on the pathways to implement non-prescription digital therapeutics at the 2023 PBMI Annual National Conference in Orlando. In this interview with Managed Healthcare Executive, Steelman suggests that creating "certainty in an uncertain world" in the digital therapeutic space could potentially open up doors for further use of these tools.

Mike Baldzicki, chief commercial officer, Premier Pharmacy Services, shared some takeaways from his presentation on the rare-ultra orphan disease market and its therapies at the 2023 PBMI Annual National Conference in Orlando.

Research has shown that patients with inflammatory bowel disease, including ulcerative colitis, treated with TNF-alpha blockers have a lower antibody response and a shorter duration of immunity than those who receive integrin receptor antagonists, such as Entyvio (vedolizumab), or no medication at all.

There is a huge opportunity for savings from the recently launched Humira biosimilars and others expected to reach the market in the next few years. But plans and PBMs will need to step into the role that pharmaceutical manufacturers once did in supporting patients and prescribers.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark discusses how these new programs payers are using to control medication costs work, and shares how costs of the GLP-1s should be managed.

Ittai Dayan, M.D., M.P.H., co-founder and CEO of Rhino Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In this video interview, Dayan not only shares a good read for healthcare professionals, but also a turning point that changed his career trajectory and even a guilty pleasure of his — which involves finishing a scoop or more of his son's ice cream.

Ozempic (semaglutide) is second only to Humira (adalimumab) in sales, according to the IQVIA vice president of industry relations and a frequent speaker at conference. And for newly launched drugs, sales figures for Mounjaro (tirzepatide) are second only to what they were for Harvoni (ledipasvir and sofosbuvir), a hepatitis C antiviral, when the hepatitis C antivirals were new.

Kyna Fong, Ph.D., CEO and co-founder, Elation Health, the clinical-first technology platform for high-value primary care, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Payers are trying to figure out how to provide access to patients who would benefit from weight loss drugs such as semaglutide but also control costs.

As cell- and gene-based therapies become available for new and expanded indications with a higher incidence of patients, payers will be challenged to find ways to provide access to patients.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark shares the tools payers are using to control medication costs outside the traditional ones like utilization management. Feeney also talked about the new program that Highmark kickstarted in 2022 to help manage medication costs.

At this year's PBMI Annual National Conference in Orlando Ben Urick, principal health outcomes researcher at Prime Therapeutics, shared methods for medical cost savings through adherence improvement using integrated medical and pharmacy claims data.

Greg Baker, CEO of AffirmedRx, one of the many new, smaller pharmacy benefit managers (PBMs) challenging the status quo, listed the eight things that employers should know about their PBM. Baker planned to share six key points at the 2023 PBMI National Annual Conference in Orlando, but shared two more with conference goers.

Sampson Davis, M.D., an emergency medicine physician and best-selling author, says a tailored approach is needed.

Ittai Dayan, M.D., M.P.H., co-founder and CEO of Rhino Health, connecting the world’s disparate health data with federated computing, in order to unlock insight and create powerful artificial intelligence, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Case and care management can help health plans cope with seven-figure cell and gene therapies, according to panelists at the Pharmacy Benefit Management Institute’s annual meeting.

Alina M. Czekai, M.P.H., vice president, value-based care strategy, Cohere Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In this video interview, Czekai shares a turning point that changed her career trajectory, recommends a good read for healthcare professionals, and even spills her guilty pleasure: some time with the "Real Housewives" and a glass of red wine.

The keynote speaker for the three-day meeting in Orlando is Sampson Davis, M.D., an emergency medicine physician in New Jersey, an inspirational speaker and co-author of three best-selling books.

Alina Czekai, M.P.H., vice president of value-based care strategy at Cohere Health, a patient-centric, digital health company committed to streamlining the prior authorization process, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.

The FDA has approved Reblozyl as first-line treatment in MDS-related anemia and the first generics of ADHD drug Vyvanse. The agency also issued a CRL for bevacizumab to treat wet AMD. Additionally, two companies have submitted supplemental applications. These include Janssen, which is seeking full approval for Balversa for urothelial carcinoma, and AbbVie, which is seeking approval of Skyrizi for ulcerative colitis.

A special registration process could strike the right balance between increasing access to the drug used to treat opioid use disorder while limiting diversion and possible misuse, say an MHE editorial advisory board member and two co-authors.

Magellan Rx Management has begun providing a multi-state solution in which they negotiate with drug manufacturers for value-based contracts for high-cost gene and cell therapies.

In this opinion piece, Karen shares some of the critical issues related to re-enrolling members subject to Medicaid redetermination and covers some of the most important critical success factors for organizations seeking to optimize their response.