News - Managed Healthcare Executive
WEBSep 9, 2009 · Semaglutide May Become Medicare Part D’s Most Expensive Drug. Logan Lutton. August 26th 2024. A recent study predicts a $34 to $145 billion annual cost for semaglutide due to Medicare’s decision to cover semaglutide for overweight patients with cardiovascular disease.
PBMs are Creating GPOs, and Stirring Debate as to Why
WEBJul 12, 2022 · PBMs are Creating GPOs, and Stirring Debate as to Why. The Big Three all set up group purchasing organizations recently, but some industry observers question the timing of the move and who will benefit. In 2019, Express Scripts PBM (pharmacy benefit manager) formed Ascent Health Services GPO (group …
How Capitation Contracts Benefit Providers, Payers and Patients
WEBMay 11, 2023 · Capitation contracts can benefit providers, payers, and patients. But they require thoughtful planning, careful alignment between PCPs and specialists, a commitment to optimizing the patient/member experience within a narrower network of providers, and a robust digital infrastructure. Lynn Carroll is the chief operating officer of HSBlox, an ...
AmeriChoice changes name to UnitedHealthcare Community Plan
WEBFeb 15, 2011 · The AmeriChoice Public Sector Health Plan in New York is now UnitedHealthcare Community Plan thank to a name change. The change is meant to unify AmeriChoice with other Medicaid health plans under the UnitedHealthcare banner. United acquired AmeriChoice in 2002. It has since expanded from four states to operate in 20 additional states and the ...
Digital Therapeutics Shaping the Future of Care
WEBDec 14, 2021 · In some cases, Dunn says, the digital therapeutics have been seen as extension of disease and care management for groups of employees who are vulnerable to certain health problems. There might be some supporting evidence, but they haven’t gone through an FDA approval process and the goal is typically health or wellness.
Understand the nuances of utilization review and utilization …
WEBJan 1, 2006 · Understand the nuances of utilization review and utilization mangement. Healthcare managers, administrators and doctors often confuse the phrases "utilization review" and "utilization management." The healthcare business uses the two interchangeably, however understanding their nuances helps clarify their meaning.
FDA Approves Hemgenix, $3.5 million Gene Therapy for …
WEBNov 23, 2022 · However, ICER cost effectiveness analysis arrived at a price of between $2.93 million and $2.96 million. A spokesman for CSL, the parent company of CSL Behring, the subsidiary marketing the drug, said in an email today that it will be commercializing Hemgenix as soon as possible in the United States at a list price of $3.5 million.
An Urgent Call to Reduce and Reuse Hospital Supplies for …
WEBJul 30, 2020 · Now is the time to take serious action to reform wasteful hospital practices and strengthen the healthcare supply chain. The high cost of American healthcare has topped headlines for years.
Beyond the Big Three PBMs - Managed Healthcare Executive
WEBDec 19, 2022 · But beyond the big three PBMs is a swarm of some 60 smaller, up-and-coming PBMs. Even if they are operating in a small slice of the pie relative to the towering dominance of the big three, the PBM pie is growing rapidly. The global PBM market is projected to increase from $495 billion in 2022 to $740 billion by 2029 (a 50% jump), according to a ...
Thinking of “Carving Out” Specialty Benefits? Your Questions …
WEBJun 10, 2021 · Payers know firsthand how much of their prescription drug spend is driven by specialty medications for complex, chronic conditions. CVS Health’s 2020 Drug Trend Report showed the outsized impact of specialty medications. Last year, 52% of money spent in the pharmacy benefit came from specialty medication even though only 2.5% of patients utilize them.