Managed Care Cast

Co-pay accumulator adjustment programs, or CAAPs, can help incentivize use of lower-cost generics by excluding drug manufacturer assistance from counting toward a patient’s out-of-pocket maximum. However, a rule finalized by HHS last year allows CAAPs to be applied even when no generic alternative is available. If patients are not informed about the implications of these programs, they may be forc...

On this episode of Managed Care Cast, we speak with Michael Abrams, managing partner at Numerof & Associates, on persistent barriers to entry for generics entering the pharmaceutical market, the impact of antitrust laws issued by the Biden administration, and further steps that are warranted to address anticompetitive tactics.

Today, we’re bringing you part 1 of a 2-part podcast series discussing multiple sclerosis, or MS. As part of the MS Stakeholder Summit, a panel of experts discusses tailoring treatments to patients with MS, payer considerations, and more.

Vizient recently released its Summer 2021 Pharmacy Market Outlook, which projects pharmaceutical spending for 2022 based on an analysis of its members' data, and on this episode of Managed Care Cast, we talk about some of their findings. The report, which delves into its members’ purchasing patterns, predicts a 3.1% increase in pharmaceutical spending next year, with oncology drugs accounting for...

August is National Psoriasis Awareness Month, and on this episode of Managed Care Cast, we bring you an excerpt of an interview conducted by Linda Stocum, assistant editor of Dermatology Times, for Medical World News, a new webcast from MJH Life Sciences. In it, Jerry Bagel, MD, MS, Windsor Dermatology, East Windsor, New Jersey, discusses how psoriasis is now understood to be an inflammatory disea...

Huntington disease is an incurable, progressive neurodegenerative condition that is ultimately fatal, and the field of research into this rare disease saw a setback a few months ago with the end of 2 clinical trials for a type of possible therapy from Roche and Wave Life Sciences. On this episode of Managed Care Cast, we bring you an excerpt of an interview, originally conducted by Matt Hoffman, s...

In this episode of Managed Care Cast, the lead author of an article in the July issue of The American Journal of Managed Care® describes the latest research that looks at the power of self-insured employers to negotiate hospital prices and the relationship between employer market power and hospital prices. Matthew Eisenberg, PhD, and coauthors used the US Census Bureau County Business Patterns dat...

In a recent paper published in JAMA Network Open, Charlie Wray, DO, MS, and colleagues examined experiences and opinions of nearly 150,000 Americans representing the 5 major forms of health insurance coverage. Specifically, the researchers used survey data from the 2016-2018 Behavioral Risk Factor Surveillance System and compared access to care, cost of care, and reported satisfaction among those...

Social distancing, vigilant sanitizing, and mask wearing required by COVID-19 did more than combat the pandemic—it cut down on flu cases as well as improved respiratory health for some patients. Some studies indicate that the measures also reduced Clostridium difficile, or C difficile, in hospitals and facilities. A recent set of interviews on Medical World News®, the 24-hour online news program f...

Today, we’re bringing you part 2 of the MS Stakeholder Summit series. During part 1, which first ran 2 weeks ago, a panel of experts discussed tailoring treatments to patients with multiple sclerosis, payer considerations, and more. In this second part of the series, the same panel of experts continues their talk on MS. They will discuss newer therapies, switching therapies, and more.

Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, discusses 2 reports on strengthening primary care after the COVID-19 pandemic: one from her own organization and the other from the National Academy of Medicine.

Diabetes care guidelines identify critical points in patients’ care when providers should refer them to diabetes self-management education, or DSME. However, it’s not known whether these clinical indicators of need actually increase the likelihood of receiving a referral. On this episode of Managed Care Cast, we’re talking with an author of an Original Research article published in our June 2021 i...

Gun violence is one of the most prominent public health issues facing America today, and accounted for over 43,500 deaths in 2020 alone—the highest number in decades. But a major driver of gun-related deaths in this country that often goes unmentioned is suicide. Research shows having access to a firearm significantly increases the risk of suicide via firearm, and during the pandemic, amid an unpr...

This month, the PwC Health Research Institute (HRI) released its annual Medical Cost Trend report for 2022. Reflecting the impact of the COVID-19 pandemic, the report predicts a 6.5% medical cost trend in 2022, slightly lower than the 7% medical cost trend in 2021 and slightly higher than it was between 2016 and 2020. On this episode of Managed Care Cast, we speak with Trina Tsouderos, who leads H...

In this episode of Managed Care Cast, we speak with a coauthor of an article in June’s Health Affairs examining the racial and ethnic composition of beneficiaries in Medicare Advantage plans and the potential implications as the program continues to grow.

On this episode of Managed Care Cast, a research scholar at the Marron Institute of Urban Management at New York University discusses the latest findings in the Health of the Air report, which was presented at the recent American Thoracic Society (ATS) 2021 International Conference.

The COVID-19 pandemic has led to an unprecedented boom in telehealth use, especially when it comes to services provided for mental health. With the combined toll of a global pandemic, economic hardships, and protracted grief, Americans’ mental health has jumped to the forefront of the national conversation. A recent analysis, published by Blue Cross Blue Shield of Massachusetts, illustrates this s...

An author of a study in the May 2021 issue of The American Journal of Managed Care® describes how the COVID-19 pandemic, the aging of America, and already-existing workforce shortages will further threaten the dual-eligible population unless policy makers reform scope-of-practice laws.

Vaccine hesitancy may be one of the contributing factors if the United States does not reach herd immunity to the virus that causes COVID-19. Such hesitancy presents itself in different ways and forms, ranging from outright refusal in conservative rural areas to fears in communities of color, to skepticism of science elsewhere. On this episode of Managed Care Cast, Patricia Salber, MD, MBA, of The...

This podcast is brought to you by Insulet. Today we are bringing you part 2 of a 2-part, sponsored podcast series discussing insulin delivery for patients with diabetes. In part 1, Mary Caffrey, associate editorial director of The American Journal of Managed Care, spoke with Greg Forlenza, MD, a pediatric endocrinologist at the Barbara Davis Center at the University of Colorado, about prepivotal d...

With unprecedented pauses in air pollution emissions seen around the world in the spring of 2020 and virus mitigation behaviors being implemented for over a year, the COVID-19 pandemic has presented a unique opportunity to better understand the impact of poor air quality on human health. In particular, exposure reduction due to mask-wearing and stay-at-home orders has contributed to anecdotal repo...

This podcast is brought to you by Insulet. Today, we are bringing you part 1 of a 2-part sponsored podcast series discussing insulin delivery for patients with diabetes. In part 1, Mary Caffrey, associate editorial director of The American Journal of Managed Care, speaks to Greg Forlenza, MD, a pediatric endocrinologist, about the evolution of diabetes care technology and standards for automated i...

This week, the top managed care news included COVID-19 vaccine eligibility opens to all adults nationwide; a spotlight on payment models and value-based care; barriers to mental health care for children and teenagers.

The United States is now 5 months into its national vaccine rollout. Although hundreds of millions of doses have been successfully administered, the process has hit several snags along the way, including, but not limited to, disparities in administration and a failure to collect racial data on nearly half of those vaccinated at the national level. But to achieve this feat, health systems have had...

The authors of a study in the April 2021 issue of The American Journal of Managed Care® discuss the possible reasons behind the link between care fragmentation and hospitalizations in veterans with diabetes, as well as potential opportunities to address disjointed care in the context of the widespread telehealth uptake seen during the COVID-19 pandemic.