The exponential spending growth in oncology has resulted in myriad utilization management strategies by both payers and providers to control costs, especially drug costs. Precision’s Julianna Kula, Bruce Edelen, Ronald Schleif, Jeffrey Becker, Mark Urban, and Elizabeth Oyekan explore current and emerging drug utilization management strategies being employed to help curtail oncology costs without adversely impacting patient quality and outcomes.
More pushback against copay programs likely on the horizon: Precision’s Ryan Cox and Reta Mourad, PharmD, FNTP discuss why a federal court’s decision striking down a CMS rule that would have narrowed the exclusions from Medicaid best price for manufacturer-provided patient-assistance programs, as well as a recent pharma lawsuit against a maximizer company, could spur more states to take action of their own.
Orphan drugs for rare diseases are now frequently found in big pharma pipelines. Payers have had an eye on the potential flood of gene therapies for rare diseases brewing in the pipeline. Precision’s Phil Cyr and Erin Lopata weigh in on new ways to pay for them.
A federal court recently struck down a CMS rule that would have narrowed the exclusions from Medicaid best price for manufacturer-provided patient-assistance programs. Precision’s Ryan Cox and Reta Mourad weigh in on why the decision may spur more pushback against these copay programs.
The COVID-19 pandemic served as a catalyst for the expansion and uptake of telehealth and virtual care for office visits and outpatient care, which rose from less than 1% utilization in 2019 to more than 50% at the height of the pandemic in 2020. Now, as the pandemic stabilizes, virtual care visits have declined significantly and have largely stabilized at about 10% of health care visits. Precision’s Elizabeth Oyekan and Reta Mourad discuss three reasons that virtual care and telehealth care are here to stay.
A federal court recently struck down a CMS final rule slated to take effect in 2023 which would have required pharmaceutical manufacturers to ensure that financial assistance provided to patients goes only to patients and not to payers under their copay accumulator and maximizer programs. Despite the ruling, Precision’s Ryan Cox and Reta Mourad discuss how the renewed attention to these programs could spur more states to take action of their own against them.
Many pharmaceutical and medical device companies have made commitments to address health inequities as they exist in the realm of clinical trials. Precision’s Alice Pressman co-authors this article discussing some of the obstacles, solutions, and implications for widespread efforts to improve health equity throughout the clinical research cycle.
Diabetes deaths in the United States continue to surge well above pre-pandemic levels with over 100,000 Americans dying from diabetes in 2021. Increasing deaths from diabetes is a clear call to action for new solutions. Historically, diabetes has been treated as a chronic disease, managed with a lifetime of medications. However, a new line of thinking about diabetes remission permeates the literature.
A rule slated to take effect January 1, 2023 would reverse CMS’ long held position that manufacturer-provided assistance given to patients is excluded from best price and average manufacturer price calculation for prescription drugs. The rule change could potentially result in increased patient out-of-pocket costs for drugs and pharma companies being on the hook for ensuring they know exactly where their assistance is going.