The American journal of managed care
-
To examine the use of step therapy, prior authorization, and Part D formulary exclusion by 4 large Medicare Advantage (MA) insurers to manage 20 physician-administered drugs with the highest total Medicare expenditures (top 20 drugs). ⋯ Four large MA insurers managed access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design. When a low-cost alternative exists, these tools can help reduce wasteful spending, but the administrative barriers may also reduce access.
-
Covishield and Covaxin vaccines have been introduced after rapid approval in India, the nation that has the second most COVID-19 cases globally. These vaccines have been administered in a 2-dose schedule since January 16, 2021. This study deals with the clinical profile of individuals who developed COVID-19 infection post COVID-19 vaccination. This is the first study of its kind in India. ⋯ The findings of this study should boost the ongoing initiative of maximizing the vaccinated population countrywide and emphasize the need for 2 doses of vaccination.
-
To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation. ⋯ Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed.
-
To evaluate the cost-benefit of sacubitril/valsartan in adults with heart failure (HF) enrolled in a state Medicaid plan to prevent HF-related hospitalizations and emergency department (ED) visits. ⋯ The benefit as demonstrated by the cost avoidance of HF-related hospitalizations and ED visits did not outweigh the additional costs of sacubitril/valsartan, but cost-benefit was observed in members who were adherent to sacubitril/valsartan.
-
The use of biosimilars in oncology and as supportive agents for patients with cancer has introduced an important opportunity to expand access to cost-effective care, but their utilization remains inconsistent and is influenced by a variety of factors. Promoting the uptake of biosimilars across healthcare systems relies on improving perception and education about biosimilars, which involves multiple stakeholders, including pharmacists, providers, and patients. ⋯ Real-world switch studies in oncology biosimilars that have demonstrated bioequivalence provide basis to support efficacy and safety to transition to a biosimilar product. Incorporating oncology biosimilars into treatment pathways will be an important next step in providing value-based care to patients with cancer.