Clinical Role - Payer

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Adoption of digital and focus on value set to transform current prior authorization processes.
 
Affordable Care Act
A recent study published in CANCER indicates that for patients with both HIV and cancer, implementation of the Patient Protection and Affordable Care Act (ACA) improved insurance coverage, both in states that expanded Medicaid coverage and in states that did not.1
Informed by the newly released NCPA 2019 Digest, members of community pharmacy organizations elaborate on the ongoing discussion of value-based care and reimbursement for community pharmacists.
Texas oncologist Stephen Hahn, MD, is expected to receive the Trump administration’s nomination for the role of FDA Commissioner, a move that had been anticipated by federal insiders.
Medical Bills
The high cost of treating blood cancer may contribute to delayed initiation of active treatment in newly-diagnosed Medicare beneficiaries.
 
PUTT: Pharmacists United for Truth and Transparency
Community Pharmacy Consultant Bruce Kneeland talks with independent pharmacy owner Teresa Dickinson, RPh, about the work of Pharmacists United for Truth and Transparency.
Nine widely-used medications have experienced substantial price growth since 2016, adding $5.1 billion to overall drug spending.
 
Multicolored pills atop a spoon
In the wake of California’s drug transparency law, an analysis by state health officials on pricing trends found that drug companies raised the whole acquisition cost dramatically for many drugs.
A report by the Institute for Clinical and Economic Review lists the top drugs with the greatest price increases not supported by new clinical evidence.
 
Study finds health-related quality of life is often not collected for novel cancer drugs when they are submitted for reimbursement.
Drug
A new study by Prime Therapeutics LLC has shown a sharp increase in the number of drug "super spenders," defined by the researchers as members with pharmacy and medical drug therapy claims of $250,000 or more annually.
Value assessment frameworks are expected to play a more pivotal role in decisions that affect future patient choice and access.