Health Technology Assessment (HTA) agencies consider a wide range of evidence when evaluating drugs for reimbursement, but their appraisals do not indicate the weight or importance of individual evidence sources. Using Scottish Medicines Consortium (SMC) as a case study, we compared positive vs. […]
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Evidence Review Groups are independent academic organizations commissioned by NICE to act objectively, but how much influence do they have on reimbursement decisions and cost-effectiveness assessments? Listen to this recorded webinar, Do Evidence Review Groups Bias NICE Decisions? here. (Source: […]
Although the field of oncology has seen enormous innovation of late, the average monthly cost for an oncology drug has doubled over the last 10 years (to approx. $10,000 today) and 1,500 people in the U.S. die from cancer each day. To make sure patients are getting the most appropriate […]
Sponsors of Medicare Advantage plans and stand-alone Prescription Drug Plans have an abundance of significant proposed changes to sift through as a result of CMS’s complex “45-day notice” and preliminary 2016 Call Letter. The potential pay changes alone are tough to measure since they will vary […]
Health insurers are now developing coverage options for their large-employer clients’ 2016 benefits programs. New regulatory and market challenges are weighing heavily on purchasers, and carriers are devising ways to help them keep costs down — tiered networks, narrow networks, private exchange […]
Although an approval pathway for biosimilars has been available since the Affordable Care Act passed in 2010, the U.S. has only recently seen the FDA approve a drug through this process, Sandoz’s Zarxio. The agency also has been working with other companies that are hoping to gain approval for and […]
Expectations remain high that single-carrier and multi-carrier private insurance exchanges will ultimately attract thousands of employers and millions of consumers. But as with the launch of any revolutionary enterprise of this magnitude, most health insurers had mixed results (at best) in the early […]
Boeing has partnered with two leading health care systems in the Puget Sound region — Providence-Swedish Health Alliance and UW Medicine Accountable Care Network — to change the way health care is delivered. This new arrangement is called the Preferred Partnership and is among the past year’s most […]
Innovation Health, the Northern Virginia health plan owned 50-50 by Aetna Inc. and Inova Health System, represents a great example of an “alignment” structure, with the new health plan allowing the provider and carrier to tap into each other’s expertise to lower costs, grow market share and move to […]
New CMS rules and guidance usually mean more restrictions for health insurers. But in its December 2014 guidance, the agency took an entirely opposite tack on rewards and incentives for Medicare Advantage members, and the result is an opportunity — which can translate into higher star-rating bonuses […]
A whopping 60% of Medicaid members now receive benefits through a managed care company. On May 26, CMS proposed the most significant overhaul to the Medicaid program in more than a decade, with new rules to modernize the program and significantly alter the way it regulates participating health […]
Zenefits — the start-up human resources platform valued at $4.5 billion — is the talk of the benefits industry. With $500 million in venture capital funding in its latest financing round, the Silicon Valley darling has traditional brokers and health insurers pondering what its impact will be in the […]
The Holy Grail on pharmaceutical usage by Medicare Advantage plan members — a program that improves patient outcomes and boosts star ratings — may have been found. The joint SCAN Health Plan-Express Scripts demonstration program so far is showing impressive results in areas such as reducing […]