The American journal of managed care
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Biosimilars provide an opportunity for a more sustainable and cost-effective treatment for multiple sclerosis (MS). This study evaluated the potential financial impact of implementing a formulary change from reference to biosimilar natalizumab (NTZ) from the US commercial payer perspective. ⋯ Adoption of biosimilar NTZ can yield considerable cost savings to US health plans that could result in increased treatment access for patients with RRMS.
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In 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.
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Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not. ⋯ MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.
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In 2019 and 2020, Medicare Advantage (MA) plans received historic flexibility to begin to address members' nonmedical and social needs through a set of primarily health-related benefits (PHRBs) and Special Supplemental Benefits for the Chronically Ill (SSBCIs). We aimed to evaluate the impact of adoption on the number and composition of new MA plan enrollees. ⋯ We determined that supplemental benefit adoption was not associated with demographic shifts in MA plan enrollment.
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The authors advocate for a strategy that reallocates the substantial workforce effort and financial resources currently devoted to low-value care to enhance access and affordability of high-value services.