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Managed Care

Mike Cantor
And health plans can't be caught flat-footed. They need to keep pace with the introduction of new treatments and be ready with strategies that address patient needs and manage costs. Using objective clinical data to guide dosing and working to redirect care to a patient's home is a place to start.
June 2017: Managed Care
Brooke Roeper, Eric Beck, Daniel Castillo, J Brent Myers, Brandy Sparkman, Jonathan Cox, Scott Bourn
One in five elderly patients returns to the hospital within 30 days of leaving. These rehospitalizations are a common and costly occurrence. A program developed to address problems in post-acute transitional care seems to be effective in reducing 30-day readmission rates for some Medicare fee-for-service beneficiaries.
June 2017: Managed Care
Thomas Morrow
Because it is given intravenously at the end of dialysis, Parsabiv could be the answer to the adherence problems posed by cinacalcet. Most patients are pretty adherent to dialysis. One study found that people missed only 7.1 episodes of dialysis per patient-year, which isn't perfect but it's certainly better than adherence to self-administered drugs.
June 2017: Managed Care
Jan Greene
Someone should check up on high-risk patients, make sure they are healing, taking their medications, and getting to their follow-up medical appointments. The question is, who? Health plans, hospitals, drug companies all have their methods. The result is too often confusion.
June 2017: Managed Care
Michael Schlosser, Ronald Chamberlain, Marcus Dortch
When new pharmaceutical products enter the market, the lack of real-world experience with these drugs creates quandaries for payers and providers alike. Often, all there is to go on is the minimum required for FDA approval-non-inferiority to a comparator product in terms of efficacy and safety. Here are a few promising strategies to end this ambiguity.
June 2017: Managed Care
Howard Wolinsky
Venture philanthropy and the move toward investment of not-for-profit dollars in for-profit companies started about 10 years ago. One expert argues that it's a little like calling someone an amateur-pro athlete. You can't be both. Proponents, however, point to some initially impressive results especially for niche diseases.
June 2017: Managed Care
(no author information available yet)
More than half (53%) of the 111 respondents to an online survey rated orphan drugs as having a major impact on rising drug costs, although there was also fairly wide (if mild) agreement that the 1983 Orphan Drug Act has been successful in creating incentives to develop remedies for rare diseases.
June 2017: Managed Care
Ed Silverman
Sales of orphan drugs are forecast to grow 11% over the next five years, to $209 billion. That growth rate is twice as fast as the expected increase in sales of all other prescription medicines. They may account for more than 21% of brand-name prescription drug sales by 2022.
June 2017: Managed Care
Krishna R Patel
In some respects, the 1983 Orphan Drug Act is a success story. But high prices and allegations that some drug companies have twisted the law to their advantage have made it controversial. Here are some of the main points in the debate.
June 2017: Managed Care
Joseph Burns
Sales hit the billion dollar mark as pharmaceutical companies apply creative approaches to increase earnings. For instance, "salami slicing": Dividing diseases into smaller and smaller categories based on genetic and biomarker differences so that the product can achieve the coveted orphan drug status.
June 2017: Managed Care
Thomas Reinke
The link between diabetes and cardiovascular disease has been clear for decades, but until 2015 no clinical trial had convincingly demonstrated a link between medications that lower blood glucose and cardiovascular risks. Enter SGKT2 inhibitors and GLP-1 agonists.
June 2017: Managed Care
Richard Mark Kirkner
Now it's the Senate's turn and there's a good chance that much of what the House put in the American Health Care Act will be left by the wayside. Keep an eye on some key players such as Sen. John Cornyn of Texas, who heads the Senate Health Care Working Group.
June 2017: Managed Care
Neil Minkoff
Regardless of your politics, the motivation behind a program designed to curtail cancer costs is clear. Cancer epidemiology (the old are disproportionately affected), coupled with 21st century demography (longer life expectancy, aging boomers), means cancer costs are going up.
May 2017: Managed Care
Jack McCain
Some are using the word "cure" for chimeric antigen receptor T cells. The modular nature of CAR T cells could provide novel strategies to combat resistance and convert more initial complete responses into lasting complete responses. Problems include: cytokine release syndrome, resistance, and finding ways to produce them more efficiently.
May 2017: Managed Care
Thomas Reinke
RWE is a relatively new kid on the block. How exactly it will fit into the complicated world of cancer drug testing, approval, regulation, and marketing is uncertain. The randomized clinical trial has been the gold standard in oncology research for decades and will remain so for the foreseeable future.
May 2017: Managed Care
Zachary Hafner
Building integrated cancer care programs is worth the effort. On the funding front, two key trends have particular relevance to the development: continued growth in the self-funded employer market, and booming expansion of Medicare Advantage. Both shift financial risk from traditional stakeholders to new ones.
May 2017: Managed Care
(no author information available yet)
Cancer screening may have its skeptics, but respondents to a Managed Care reader poll are not among them. Colorectal, cervical, breast, prostate, and lung care cancer screening were rated as highly beneficial by the 168 respondents to the online survey, although prostate and lung cancer screening were viewed somewhat less favorably than the other three.
May 2017: Managed Care
Timothy Kelley
To screen, or not to screen? For years, the question was rhetorical. Doctors screened, and health insurers anted up. The public still likes cancer screening, but some critics say that many tests have yet to show lifesaving benefit. The debate can get heated, as the mammography wars proved.
May 2017: Managed Care
Joseph Burns
Insurers point to what they believe to be a paucity of solid evidence that the bevy of tests are useful for making treatment decisions. Also, if they wait a few years, then it's Medicare's problem. Meanwhile, men with prostate cancer must pay about $3,000 out of pocket for genetic tests.
May 2017: Managed Care
Thomas Reinke
Approval of Merck's checkpoint inhibitor is further evidence that cancer treatment decisions are increasingly dependent on the PD-L1 biomarker and other molecular-level differences in tumor cells. But testing for PD-L1 is tricky, and variations in the concentration of PD-L1 cells in different regions of the sample can produce different test results.
May 2017: Managed Care
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