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style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/addressing-health-disparities-by-zip-code-key-factors-explored"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:56.25%"></span><img alt="Brita Roy, MD, MPH, MHS" title="Brita Roy, MD, MPH, MHS" 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2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">There are significant financial and psychological burdens of abortion care in the US, especially for those traveling out of state due to local restrictions in the increasingly restrictive post-Dobbs landscape.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/financial-psychological-burden-of-abortion-care-in-us-raises-calls-for-expanded-insurance"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/health-care-leaders-highlight-collaborative-patient-focused-strategies-for-advancing-value-based-care"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.73079565755118%"></span><img alt="Clinicians working as a team | Image Credit: Chanelle Malambo/peopleimages.com - stock.adobe.com" title="Clinicians working as a team | Image Credit: Chanelle Malambo/peopleimages.com - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Clinicians working as a team | Image Credit: Chanelle Malambo/peopleimages.com - stock.adobe.com" title="Clinicians working as a team | Image Credit: Chanelle Malambo/peopleimages.com - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F9cf11a77e8b5256174ffbac0ecf33d6329785f27-7277x4856.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/health-care-leaders-highlight-collaborative-patient-focused-strategies-for-advancing-value-based-care"> Health Care Leaders Highlight Collaborative, Patient-Focused Strategies for Advancing Value-Based Care</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/brooke-mccormick">Brooke McCormick</a></div><a href="/view/health-care-leaders-highlight-collaborative-patient-focused-strategies-for-advancing-value-based-care"><span class="text-sm text-gray-500 pl-4">November 12th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">At CAQH Connect 2024, health care leaders discussed advancing value-based care through collaboration, data standardization, patient-centered approaches, and adaptable partnerships. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/health-care-leaders-highlight-collaborative-patient-focused-strategies-for-advancing-value-based-care"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/the-trump-sequel-what-to-expect-on-pbms-340b-drug-pricing-and-rfk-jr"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:100%"></span><img alt="Lindsay Bealor Greenleaf, JD, MBA | Image credit: ADVI Health" title="Lindsay Bealor Greenleaf, JD, MBA | Image credit: ADVI Health" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Lindsay Bealor Greenleaf, JD, MBA | Image credit: ADVI Health" title="Lindsay Bealor Greenleaf, JD, MBA | Image credit: ADVI Health" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1be9d7bfde5437785227357702e5483d2d8a80ad-560x560.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1be9d7bfde5437785227357702e5483d2d8a80ad-560x560.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1be9d7bfde5437785227357702e5483d2d8a80ad-560x560.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1be9d7bfde5437785227357702e5483d2d8a80ad-560x560.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1be9d7bfde5437785227357702e5483d2d8a80ad-560x560.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/the-trump-sequel-what-to-expect-on-pbms-340b-drug-pricing-and-rfk-jr">The Trump Sequel: What to Expect on PBMs, 340B, Drug Pricing, and RFK Jr</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/interview-by-mary-caffrey">Interview by Mary Caffrey</a></div><a href="/view/the-trump-sequel-what-to-expect-on-pbms-340b-drug-pricing-and-rfk-jr"><span class="text-sm text-gray-500 pl-4">November 12th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Lindsay Bealor Greenleaf, JD, MBA, of ADVI Health, weighs in on what to expect in key health care policy areas in the wake of the election.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/the-trump-sequel-what-to-expect-on-pbms-340b-drug-pricing-and-rfk-jr"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/veterans-medicare-advantage-enrollments-drive-cost-duplication"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:61.5%"></span><img alt="Veteran spending | Image Credit: © mehaniq41-stock.adboe.com" title="Veteran spending | Image Credit: © mehaniq41-stock.adboe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Veteran spending | Image Credit: © mehaniq41-stock.adboe.com" title="Veteran spending | Image Credit: © mehaniq41-stock.adboe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387bccfa91b92d4a0329f03b74b80aaba0a3a3dd-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387bccfa91b92d4a0329f03b74b80aaba0a3a3dd-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387bccfa91b92d4a0329f03b74b80aaba0a3a3dd-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387bccfa91b92d4a0329f03b74b80aaba0a3a3dd-1200x738.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/veterans-medicare-advantage-enrollments-drive-cost-duplication">Veterans’ Medicare Advantage Enrollments Drive Cost Duplication</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><a href="/view/veterans-medicare-advantage-enrollments-drive-cost-duplication"><span class="text-sm text-gray-500 pl-4">November 11th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">This research is not the first to uncover duplicative and wasteful spending on health care for veterans who receive care primarily through the Veterans Health Administration as they are also enrolled in Medicare Advantage plans. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/veterans-medicare-advantage-enrollments-drive-cost-duplication"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/health-equity-access-weekly-roundup-november-9-2024"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:52.8052805280528%"></span><img alt="Center on Health Equity and Access" title="Center on Health Equity and Access" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Center on Health Equity and Access" title="Center on Health Equity and Access" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/health-equity-access-weekly-roundup-november-9-2024">Health Equity & Access Weekly Roundup: November 9, 2024</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/health-equity-access-weekly-roundup-november-9-2024"><span class="text-sm text-gray-500 pl-4">November 9th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The health policy implications and ballot measures in the wake of the presidential election, new trends in physician compensation, lessons from the Medicaid unwinding, disparities in cancer mortality, and privately negotiated hospital fees. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/health-equity-access-weekly-roundup-november-9-2024"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.66666666666666%"></span><img alt="Medicaid Budget| Image Credit: zimmytws - stock.adobe.com" title="Medicaid Budget| Image Credit: zimmytws - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Medicaid Budget| Image Credit: zimmytws - stock.adobe.com" title="Medicaid Budget| Image Credit: zimmytws - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks">Lessons Learned From Medicaid Unwinding as States Tackle Eligibility Checks</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks"><span class="text-sm text-gray-500 pl-4">November 7th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.” </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Physicians | Image credit: Iryna - stock.adobe.com" title="Physicians | Image credit: Iryna - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387daa801d9b788641f0f7e56d273a800da3008c-4968x2230.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387daa801d9b788641f0f7e56d273a800da3008c-4968x2230.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387daa801d9b788641f0f7e56d273a800da3008c-4968x2230.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F387daa801d9b788641f0f7e56d273a800da3008c-4968x2230.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/physician-compensation-changing-in-new-medical-landscape">Physician Compensation Changing in New Medical Landscape</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><a href="/view/physician-compensation-changing-in-new-medical-landscape"><span class="text-sm text-gray-500 pl-4">November 7th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Physician reimbursement stands to be affected by the consolidation of medical systems and changes in Medicare enrollment affecting their pay, which may lead to shifts in medical training and hiring.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/physician-compensation-changing-in-new-medical-landscape"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/persistence-of-provider-directory-inaccuracies-after-the-no-surprises-act"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:49.10025706940874%"></span><img alt="AJMC" title="AJMC" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" 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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/persistence-of-provider-directory-inaccuracies-after-the-no-surprises-act">Persistence of Provider Directory Inaccuracies After the No Surprises Act</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/simon-f-haeder-phd-mpa">Simon F. Haeder, PhD, MPA</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/jane-m-zhu-md-mpp-mshp">Jane M. Zhu, MD, MPP, MSHP</a></div><a href="/view/persistence-of-provider-directory-inaccuracies-after-the-no-surprises-act"><span class="text-sm text-gray-500 pl-4">November 7th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Relying on a 2-stage secret shopper survey, the authors found that inaccuracies in provider directories often persisted for well over 1 year.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/persistence-of-provider-directory-inaccuracies-after-the-no-surprises-act"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/trump-recaptures-white-house-spelling-uncertainty-for-federal-health-policy"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:57.99999999999999%"></span><img alt="USA American flag health stethoscope - 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Trump’s return to the White House portends a significant shakeup of health policy. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/trump-recaptures-white-house-spelling-uncertainty-for-federal-health-policy"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none 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href="/view/cigna-humana-resume-megamerger-talks-impact-on-stakeholders-health-outcomes-and-cost">Cigna-Humana Resume Megamerger Talks: Impact on Stakeholders, Health Outcomes, and Cost</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><a href="/view/cigna-humana-resume-megamerger-talks-impact-on-stakeholders-health-outcomes-and-cost"><span class="text-sm text-gray-500 pl-4">November 6th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">As Cigna and Humana pick back up on the potential for a megamerger, executives will be keeping a close eye on the outcomes of the presidential election. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/cigna-humana-resume-megamerger-talks-impact-on-stakeholders-health-outcomes-and-cost"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/goodrx-pbms-hit-by-price-fixing-lawsuits"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/goodrx-pbms-hit-by-price-fixing-lawsuits">GoodRx, PBMs Hit by Price Fixing Lawsuits</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><a href="/view/goodrx-pbms-hit-by-price-fixing-lawsuits"><span class="text-sm text-gray-500 pl-4">November 5th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/goodrx-pbms-hit-by-price-fixing-lawsuits"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/mapping-health-care-s-hidden-financial-burdens"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="The Center Logo | Image Credit: © Center for Innovation & Value Research" title="The Center Logo | Image Credit: © Center for Innovation & Value Research" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="The Center Logo | Image Credit: © Center for Innovation & Value Research" title="The Center Logo | Image Credit: © Center for Innovation & Value Research" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2Ffde80a9ad0b637290a3393628845033f6c6f5c63-318x159.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/mapping-health-care-s-hidden-financial-burdens">Mapping Health Care's Hidden Financial Burdens</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><a href="/view/mapping-health-care-s-hidden-financial-burdens"><span class="text-sm text-gray-500 pl-4">November 4th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Financial toxicity is a burden many patients and their families unfortunately are forced to shoulder, leading some to delay or skip care and incur bills related to their care that they lack the financial capacity to pay off.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/mapping-health-care-s-hidden-financial-burdens"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/how-the-2024-election-will-determine-the-future-of-america-s-health-crises"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:66.86399514268366%"></span><img alt="Studio Romantic - stock.adobe.com.jpeg" title="Studio Romantic - stock.adobe.com.jpeg" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Studio Romantic - stock.adobe.com.jpeg" title="Studio Romantic - stock.adobe.com.jpeg" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F862f6207128671c25eff54a7c5aaac8de6cc37db-6588x4405.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F862f6207128671c25eff54a7c5aaac8de6cc37db-6588x4405.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F862f6207128671c25eff54a7c5aaac8de6cc37db-6588x4405.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F862f6207128671c25eff54a7c5aaac8de6cc37db-6588x4405.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/how-the-2024-election-will-determine-the-future-of-america-s-health-crises">How the 2024 Election Will Determine the Future of America's Health Crises</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/how-the-2024-election-will-determine-the-future-of-america-s-health-crises"><span class="text-sm text-gray-500 pl-4">November 4th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">As presidential candidates Kamala Harris and Donald Trump diverge on health care reform paths, contrasting futures hinge on the outcome of the presidential election.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/how-the-2024-election-will-determine-the-future-of-america-s-health-crises"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/health-equity-access-weekly-roundup-november-2-2024"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:52.8052805280528%"></span><img alt="Center on Health Equity and Access" title="Center on Health Equity and Access" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Center on Health Equity and Access" title="Center on Health Equity and Access" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1fb0458d4007f177c86e1a37a8c9d4ba60b1f084-303x160.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/health-equity-access-weekly-roundup-november-2-2024">Health Equity & Access Weekly Roundup: November 2, 2024</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><a href="/view/health-equity-access-weekly-roundup-november-2-2024"><span class="text-sm text-gray-500 pl-4">November 2nd 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">This week’s Center on Health Equity & Access highlights emphasize the role of social determinants of health in policy-making and underscore the importance of addressing rising costs and challenges employers face. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/health-equity-access-weekly-roundup-november-2-2024"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Medicare | Image Credit: © zimmytws - stock.adobe.com" title="Medicare | Image Credit: © zimmytws - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F3a34c18fb30e230ed3e5665d823c6b2bda7cb8b7-1200x798.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage">Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage </a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/andrey-ostrovsky-md">Andrey Ostrovsky, MD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/anna-de-paula-hanika">Anna de Paula Hanika</a></div><a href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage"><span class="text-sm text-gray-500 pl-4">October 31st 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/aca-enrollees-share-mixed-opinions-ahead-of-open-enrollment-upcoming-election"><div class=""><span 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Care Act | Image credit: Vitalii Vodolazskyi - stock.adobe.com" title="Affordable Care Act | Image credit: Vitalii Vodolazskyi - stock.adobe.com" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0d6af7e5d45014ceb3f0bfb55fa7b8e384b6e35c-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0d6af7e5d45014ceb3f0bfb55fa7b8e384b6e35c-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0d6af7e5d45014ceb3f0bfb55fa7b8e384b6e35c-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0d6af7e5d45014ceb3f0bfb55fa7b8e384b6e35c-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/aca-enrollees-share-mixed-opinions-ahead-of-open-enrollment-upcoming-election">ACA Enrollees Share Mixed Opinions Ahead of Open Enrollment, Upcoming Election</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/pearl-steinzor">Pearl Steinzor</a></div><a href="/view/aca-enrollees-share-mixed-opinions-ahead-of-open-enrollment-upcoming-election"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Report reveals growing divide between subsidized and unsubsidized enrollees. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/aca-enrollees-share-mixed-opinions-ahead-of-open-enrollment-upcoming-election"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " 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mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/harnessing-ai-for-population-health-a-call-to-action-for-policy-makers-and-health-care-leaders"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span 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style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/harnessing-ai-for-population-health-a-call-to-action-for-policy-makers-and-health-care-leaders">Harnessing AI for Population Health: A Call to Action for Policy Makers and Health Care Leaders</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/clipper-f-young-pharmd-mph">Clipper F. Young, PharmD, MPH</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/diana-isaacs-pharmd">Diana Isaacs, PharmD</a></div><a href="/view/harnessing-ai-for-population-health-a-call-to-action-for-policy-makers-and-health-care-leaders"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The authors detail how artificial intelligence could be used in primary, secondary, and tertiary prevention to improve health outcomes and provide better value-based care.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/harnessing-ai-for-population-health-a-call-to-action-for-policy-makers-and-health-care-leaders"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/overhauling-quality-measurement-in-the-us-measure-what-matters"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="Overhauling 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Bright, MPA</a></div><a href="/view/overhauling-quality-measurement-in-the-us-measure-what-matters"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">As the US charts its course through the next political era, it is crucial that we boldly allocate resources and prioritize what truly impacts patients. When faced with complexity, feasibility concerns, or entrenched norms, we must proclaim: “It’s the outcomes, stupid.”</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/overhauling-quality-measurement-in-the-us-measure-what-matters"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="flex md:hidden justify-center items-center"></div><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/ten-ways-to-improve-health-care-right-now"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="Ten Ways to Improve Health Care, Right Now" title="Ten Ways to Improve Health Care, Right Now" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Ten Ways to Improve Health Care, Right Now" title="Ten Ways to Improve Health Care, Right Now" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F65da55f755d2bf6ea9d0c021b273cbaaf7a60ec9-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/ten-ways-to-improve-health-care-right-now">Ten Ways to Improve Health Care, Right Now</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/sachin-h-jain-md-mba">Sachin H. 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US Health Care System From a Complete Collapse</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/rajesh-balkrishnan-phd">Rajesh Balkrishnan, PhD</a></div><a href="/view/how-to-save-the-us-health-care-system-from-a-complete-collapse"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">There are 3 ways to make the US health care system more efficient and sustainable: address its burdensome complexity, emphasize primary care reimbursement, and regulate drug pricing.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/how-to-save-the-us-health-care-system-from-a-complete-collapse"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/no-free-lunch-the-misaligned-incentives-of-the-american-health-care-system"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="No Free Lunch: The Misaligned Incentives of the American Health Care System" title="No Free Lunch: The Misaligned Incentives of the American Health Care System" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="No Free Lunch: The Misaligned Incentives of the American Health Care System" title="No Free Lunch: The Misaligned Incentives of the American Health Care System" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F5acc8bd52f5c43909e191be7c5a098e2057eb97a-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/no-free-lunch-the-misaligned-incentives-of-the-american-health-care-system">No Free Lunch: The Misaligned Incentives of the American Health Care System</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/joel-e-segel-phd">Joel E. Segel, PhD</a></div><a href="/view/no-free-lunch-the-misaligned-incentives-of-the-american-health-care-system"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The author highlights reasons why we have not seen substantial cost savings in the health care industry and why future efforts are likely to continue to see forceful pushback, as well as offers potential solutions.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/no-free-lunch-the-misaligned-incentives-of-the-american-health-care-system"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="Improve American Health Care by Moving Away From Employer-Sponsored Insurance" title="Improve American Health Care by Moving Away From Employer-Sponsored Insurance" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Improve American Health Care by Moving Away From Employer-Sponsored Insurance" title="Improve American Health Care by Moving Away From Employer-Sponsored Insurance" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1c0eb1f984aab54d0efd346b175a65f2724a38f3-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance">Improve American Health Care by Moving Away From Employer-Sponsored Insurance</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/david-b-muhlestein-phd-jd">David B. Muhlestein, PhD, JD</a></div><a href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The US should consider reducing or eliminating employer-sponsored insurance. Here are some ways to do it efficiently.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/improve-american-health-care-by-moving-away-from-employer-sponsored-insurance"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/understanding-the-financial-return-to-investments-in-the-social-determinants-of-health"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="Understanding the Financial Return to Investments in the Social Determinants of Health" title="Understanding the Financial Return to Investments in the Social Determinants of Health" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Understanding the Financial Return to Investments in the Social Determinants of Health" title="Understanding the Financial Return to Investments in the Social Determinants of Health" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=1080&q=75 1080w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1200w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1920w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F392163653f09e104957696639c04e97b952d9fed-824x412.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/understanding-the-financial-return-to-investments-in-the-social-determinants-of-health">Understanding the Financial Return to Investments in the Social Determinants of Health</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/dennis-p-scanlon-phd">Dennis P. Scanlon, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/mark-sciegaj-phd">Mark Sciegaj, PhD</a></div><a href="/view/understanding-the-financial-return-to-investments-in-the-social-determinants-of-health"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">The policy community should consider these concrete suggestions to address the challenges presented by social determinants of health.</p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/understanding-the-financial-return-to-investments-in-the-social-determinants-of-health"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/the-need-for-regulation-to-positively-impact-drug-formulary-decisions-to-ensure-appropriate-patient-access-a-little-discussed-topic-in-pharmaceutical-policy-and-pricing-debate"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:50%"></span><img alt="The Need for Regulation to Positively Impact Drug Formulary Decisions to Ensure Appropriate Patient Access: A Little-Discussed Topic in Pharmaceutical Policy and Pricing Debate" title="The Need for Regulation to Positively Impact Drug Formulary Decisions to Ensure Appropriate Patient Access: A Little-Discussed Topic in Pharmaceutical Policy and Pricing Debate" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="The Need for Regulation to Positively Impact Drug Formulary Decisions to Ensure Appropriate Patient Access: A Little-Discussed Topic in Pharmaceutical Policy and Pricing Debate" title="The Need for Regulation to Positively Impact Drug Formulary Decisions to Ensure Appropriate Patient Access: A Little-Discussed Topic in Pharmaceutical Policy and Pricing Debate" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F641b2771ce59f37bd4a4476a7da80e71eab8eadd-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F641b2771ce59f37bd4a4476a7da80e71eab8eadd-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=2048&q=75 2048w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F641b2771ce59f37bd4a4476a7da80e71eab8eadd-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F641b2771ce59f37bd4a4476a7da80e71eab8eadd-830x415.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/the-need-for-regulation-to-positively-impact-drug-formulary-decisions-to-ensure-appropriate-patient-access-a-little-discussed-topic-in-pharmaceutical-policy-and-pricing-debate">The Need for Regulation to Positively Impact Drug Formulary Decisions to Ensure Appropriate Patient Access: A Little-Discussed Topic in Pharmaceutical Policy and Pricing Debate</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/jan-e-berger-md-mj">Jan E. Berger, MD, MJ</a></div><a href="/view/the-need-for-regulation-to-positively-impact-drug-formulary-decisions-to-ensure-appropriate-patient-access-a-little-discussed-topic-in-pharmaceutical-policy-and-pricing-debate"><span class="text-sm text-gray-500 pl-4">October 30th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">As health care moves toward a value-based payment model, the pharmacy benefit is going in the opposite direction, one that places unit cost over clinical appropriateness. </p><div class="pl-4"></div></a><a class="flex items-center justify-center w-24 h-8 mt-4 ml-4 bg-primary border border-primary text-white hover:text-primary hover:bg-white hover:border-primary" href="/view/the-need-for-regulation-to-positively-impact-drug-formulary-decisions-to-ensure-appropriate-patient-access-a-little-discussed-topic-in-pharmaceutical-policy-and-pricing-debate"><p class="font-bold text-[.75rem]">Read More</p></a><div class="flex flex-col sm:flex-row pl-2 mt-4"></div></div></div></div></div></div></div><div class="w-full text-center flex justify-center pb-24"><a class="px-4 py-2 border-y border-r bg-primary text-white" href="/topic/policy?page=1">1</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=2">2</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=3">3</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=4">4</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=5">5</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=6">6</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=7">7</a><a class="px-4 py-2 border-y border-r " href="/topic/policy?page=8">8</a><div class="px-4 py-2 border-y border-r">...</div><a class="px-4 py-2 border-y border-r" href="/topic/policy?page=76">76</a><a class="px-4 py-2 border-y border-r" href="/topic/policy?page=2">></a></div></div></div><div class="flex-none w-[300px] 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","url":"health-equity-access-weekly-roundup-november-9-2024"},{"_id":"4613cf76-fbcc-41b0-82e0-6207d0b0c9f9","title":"Lessons Learned From Medicaid Unwinding as States Tackle Eligibility Checks","url":"lessons-learned-from-medicaid-unwinding-as-states-tackle-eligibility-checks","contentCategory":{"_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z"},"factCheckAuthors":null,"thumbnail":{"_type":"mainImage","alt":"Medicaid Budget| Image Credit: zimmytws - stock.adobe.com","asset":{"_ref":"image-0efe5b83ba53d971045cea9267a0ae1e48f61311-5472x3648-jpg","_type":"reference"}},"summary":"Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.” ","published":"2024-11-07T18:48:50.218Z","updatedOn":null,"authors":[{"displayName":"Giuliana Grossi","url":"giuliana-grossi"}]},{"_id":"b05504ae-96e0-43f9-b359-6e90333f6d89","published":"2024-11-07T15:45:00.000Z","authors":[{"displayName":"Julia Bonavitacola","url":"julia-bonavitacola"}],"contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"},"factCheckAuthors":null,"title":"Physician Compensation Changing in New Medical Landscape","url":"physician-compensation-changing-in-new-medical-landscape","thumbnail":{"asset":{"_type":"reference","_ref":"image-387daa801d9b788641f0f7e56d273a800da3008c-4968x2230-jpg"},"_type":"mainImage","alt":"Physicians | Image credit: Iryna - stock.adobe.com","caption":"Physicians | Image credit: Iryna - stock.adobe.com"},"summary":"Physician reimbursement stands to be affected by the consolidation of medical systems and changes in Medicare enrollment affecting their pay, which may lead to shifts in medical training and hiring.","updatedOn":null},{"thumbnail":{"_type":"mainImage","alt":"AJMC","asset":{"_ref":"image-5421358c8f117ee86126333e135f08cf1e61ded6-778x382-png","_type":"reference"}},"authors":[{"displayName":"Simon F. 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","published":"2024-11-06T13:00:00.000Z","updatedOn":null,"contentCategory":{"name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory"},"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"_id":"1649444c-9d37-47bb-81e2-88598fffb96c","title":"Cigna-Humana Resume Megamerger Talks: Impact on Stakeholders, Health Outcomes, and Cost","thumbnail":{"_type":"mainImage","alt":"Business deal | Image credit: sebra - stock.adobe.com","asset":{"_ref":"image-9fdaabe729269f7e033d2d76014c5903b1541576-6000x3376-jpg","_type":"reference"}}},{"title":"GoodRx, PBMs Hit by Price Fixing Lawsuits","summary":"Independent pharmacies have filed 3 class action lawsuits against GoodRx Holdings and major pharmacy benefit managers (PBMs).","published":"2024-11-05T18:41:05.805Z","updatedOn":null,"contentCategory":{"_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh"},"factCheckAuthors":null,"_id":"7f084d67-0f4f-470e-95e8-46399f70c363","thumbnail":{"_type":"mainImage","alt":"Class action book and gavel | Image credit: Zerbor – stock.adobe.com","asset":{"_ref":"image-e44a4d4b672ee04afb2d72bd7d6d14b6e00ad2bf-4928x3262-jpg","_type":"reference"}},"authors":[{"displayName":"Hayden E. 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","updatedOn":null,"contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"},"factCheckAuthors":null,"title":"Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage ","url":"contributor-vulnerable-seniors-are-at-risk-with-looming-medicare-advantage-cuts-income-based-programs-can-minimize-the-damage","published":"2024-10-31T13:00:00.000Z"},{"_id":"724c0602-0ad3-414f-bc1d-277e29eb4c80","title":"ACA Enrollees Share Mixed Opinions Ahead of Open Enrollment, Upcoming Election","updatedOn":null,"url":"aca-enrollees-share-mixed-opinions-ahead-of-open-enrollment-upcoming-election","thumbnail":{"asset":{"_ref":"image-0d6af7e5d45014ceb3f0bfb55fa7b8e384b6e35c-5500x3667-jpg","_type":"reference"},"_type":"mainImage","alt":"Affordable Care Act | Image credit: Vitalii Vodolazskyi - stock.adobe.com"},"summary":"Report reveals growing divide between subsidized and unsubsidized enrollees.\n\n","published":"2024-10-30T20:53:33.631Z","contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"},"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"factCheckAuthors":null},{"thumbnail":{"default":false,"_type":"mainImage","alt":"The homepage of CMS.gov is seen on a smartphone | Tada Images - stock.adobe.com","asset":{"_ref":"image-e06646ca3ca64862748b1a07985b752837b45189-6000x4000-jpg","_type":"reference"}},"summary":"Program yields largest savings in its history of more than $2.1 billion in 2023.\n\n","published":"2024-10-30T14:08:55.219Z","updatedOn":null,"url":"medicare-shared-savings-program-continues-to-deliver-savings-quality-care","title":"Medicare Shared Savings Program Continues to Deliver Savings, Quality Care","contentCategory":{"_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles"},"authors":[{"displayName":"Pearl Steinzor","url":"pearl-steinzor"}],"factCheckAuthors":null,"_id":"fc7799b1-763f-4b37-9ecb-19e2c6dd2cef"},{"_id":"29af4d95-3fda-467f-b157-d02560db51e2","title":"Harnessing AI for Population Health: A Call to Action for Policy Makers and Health Care Leaders","updatedOn":null,"authors":[{"displayName":"Clipper F. 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When faced with complexity, feasibility concerns, or entrenched norms, we must proclaim: “It’s the outcomes, stupid.”","published":"2024-10-30T13:00:00.000Z","updatedOn":null,"contentCategory":{"name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory"},"url":"overhauling-quality-measurement-in-the-us-measure-what-matters","thumbnail":{"_type":"mainImage","asset":{"_ref":"image-2c33d067784076a97355f07de7a58793fa329fea-830x415-png","_type":"reference"}},"authors":[{"displayName":"Jennifer L. 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Kolodziej, MD:","_key":"0L6ww55e"},{"_type":"span","text":" So the biggest challenges I think that we will continue to face are that we have to make decisions based on incomplete data. As I said earlier, it is certainly true that our options are better than they used to be, but we still don’t know what the best option is. And we need to be sensitive to that when we’re counseling a patient about treatment options. I think we’re going to continue to be challenged by the cost. The cost is a huge issue: the cost to society, as well as the cost to the individual patient. And we have to come to grips with how we’re going to deal with that. And I’m not going to take a political stance on whether I like anything that the administration proposed or not, that doesn’t really make any difference. 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Kolodziej, MD:","_key":"fJ8tQwlT","_type":"span","marks":["strong"]},{"_key":"tLsnbD1m","_type":"span","text":" The payers initially will manage these like they manage all other drugs, which is that they’ll pay for them grudgingly. They’ll manage them in any way that they have at their access. It’s funny, I just recently completed a project where I spoke to a number of payers about step therapy in Medicare Advantage plans. As you know, Medicare Advantage plans were empowered to exercise step therapy even across benefits and they included medical injectables. They’re hesitant to do that, they are. People laugh at me when I say this, but it’s true. Payers hate disruption. They don’t want to make their beneficiaries angry, they don’t want to make doctors angry. That makes more work for them. And they don’t want to get it wrong. They don’t want to hurt people and that’s good. So we haven’t seen much of that, but the more drugs you have in a class, the more the drugs look the same, the more tempting it is to go after that."}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"QuIHFv2R"},{"markDefs":[],"children":[{"text":"We’re seeing that now, of course, in biosimilars. In biosimilars, I think payers have largely come to the conclusion that the regulatory universe, the regulatory pathways for biosimilar approvals are good, and they can trust the Food and Drug Administration [FDA] in this. They also have the advantage that this has been going on in Europe for a decade and there have been no ill effects, so they’ve got a little bit of a track record to go on. But they haven’t done it in other either supportive or more importantly, therapeutic, classes.","_key":"3x9XjkcU","_type":"span"}],"_type":"block","style":"normal","_key":"GNFRhdVp"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"Vb5btWZO"},{"_type":"block","style":"normal","_key":"WBr7nyr2","markDefs":[],"children":[{"_type":"span","text":"So we’ll see how that plays out. I expect that to happen. I can’t imagine, and I know it drives some people crazy when I say this, that they won’t do that, for example, in the PD-L1 space, PD-1 space. In the PD-1 space there are a lot of drugs. The FDA labeled indications overlap a great deal, not uniformly. And so it’s tempting to think about how payers might manage I/O [immune-oncology] therapy, which is quite expensive, very effective but quite expensive. So we’ll see what happens. I don’t think we’re going to have to wait very long. 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This is going to wind up being combinations inhibiting multiple pathways. So we will continue to be challenged by this. I think actually technology may be the key to solving this."}],"_type":"block","style":"normal","_key":"g6GlkbyZ"},{"_key":"shOw5kda","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"3AvI3hYz","markDefs":[],"children":[{"_type":"span","text":"As you may know, I worked at Flatiron Health for a while and we had these sessions where we just ideate. And I told one of my friends there that my vision of how an oncologist is going to manage their patient is not exactly like Watson on ","_key":"tzVvjMGS"},{"_type":"span","marks":["em"],"text":"Jeopardy","_key":"qouW5ZbO"},{"_type":"span","text":", but it’s not terribly different. So what we’d like to do is provide the physician at point of care with the “appropriate treatment options” in a probabilistic format because that’s how people make decisions, right? It’s very rarely binary, black and white, this is going to work, not going to work. More likely it is, well, we think there’s about a 35% chance this is going to work.","_key":"ppAzKeVA"}],"_type":"block"},{"style":"normal","_key":"Bh9GLfkO","markDefs":[],"children":[],"_type":"block"},{"children":[{"text":"And we want to somehow pull in what my friend, Amy Abernethy, MD, PhD, was always interested in, which is a rapid learning system. Every patient that we treat, we learn from. It feeds back into the system and that real-world evidence continues. So, when you’re seeing that patient and you have that critical clinical information, critical genotypic information, it all goes in the machine and it spits out information for you. And your job as a physician is to interpret that in the context of the patient’s needs and desires because the machine can never capture that, but true shared decision making will. 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to cost of novel therapeutic strategies, an expert shares insight on how these agents could be integrated into treatment pathways."}],"_type":"block","style":"normal","_key":"zGbJr9IN"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"7Xy1LSa4"},{"markDefs":[],"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"QMBYFjrB"}],"_type":"block","style":"normal","_key":"COw3rvbH"},{"children":[{"_type":"span","marks":["strong"],"text":"Michael A. Kolodziej, MD:","_key":"C2ZJ9bui"},{"_type":"span","text":" One of the presentations at the American Society of Hematology [ASH] meeting that got a lot of interest was the combination of venetoclax and ibrutinib. Now, this idea of putting together drugs is older than I am. It’s been around forever in oncology. Choose 2 pathways that are different, nonoverlapping toxicity, put them together. And the preliminary report on that combination is promising. Here’s the problem. You take one drug that’s $12,000 and another drug that’s $14,000, and now we’re looking at $26,000 a month. For how long, we don’t know. And how much better is worth it better?","_key":"IzgiRmql"}],"_type":"block","style":"normal","_key":"pgveIf3N","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"R4PYosuu"},{"_key":"2zRxVpnP","markDefs":[],"children":[{"_type":"span","text":"So the challenge I think as we move forward is, and this is actually well exemplified in the chronic myelogenous leukemia [CML] space, there’s little doubt that the second and third-generation tyrosine kinase inhibitors [TKIs] in CML are a little bit better than Gleevec, than imatinib. It’s imatinib now. It’s generic imatinib and in fact, although it took a little while, the price of generic imatinib has dropped a lot. It took actually several years, and people were freaking out but it’s resolved.","_key":"VDv33U4D"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"TGw1Q3Mj","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","text":"So, if you come to me as a payer, I know that through access, I’m going to give you access to those later-generation drugs but imatinib is so good. So what we’re going to see I think is this replay in combinations. We have a wealth or riches right now in these diseases. We’re going to figure it out from a clinical standpoint and then we’ll start thinking about the money. It’s so interesting. In multiple myeloma, which we started with at the very, very beginning, there has been so much new stuff, it’s almost unfathomable. I stopped seeing cancer patients about five years ago. As I’m frequently reminded by my wife and friends, I wouldn’t even know how to treat a patient with myeloma anymore. There’s a lot of truth in that.","_key":"ztjz6V2F"}],"_type":"block","style":"normal","_key":"azrYnr9D"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"1ihWUEB0"},{"_type":"block","style":"normal","_key":"XRjJhg95","markDefs":[],"children":[{"_type":"span","text":"I hate to say it’s not possible to get it wrong, that’s a little bit of exaggeration, but there are a ton of very effective therapies out there. We have a million effective therapies, they all cost a lot of money, and we haven’t the foggiest idea how to sequence them or which biological markers predict response to one versus the other. And now we’re going to have 2 or 3 chimeric antigen receptors [CAR] T-cell therapies by the end of the year and that’s going to change everything. So to me, I guess it’s a little bit challenging trying to balance the desire to get access for patients to these tremendously effective drugs yet recognizing that we’re making it up as we go along. I hate to say it. But it may be that it doesn’t matter. It may be that it does.","_key":"FmnjyK41"}]},{"_key":"vNTtjF9n","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"A8vAfjdv","markDefs":[],"children":[{"_type":"span","text":"Regarding the issue of how the National Comprehensive Cancer Network [NCCN] is going to tackle this, how pathways companies are going to tackle this stuff, I think they’re struggling like the rest of us. NCCN has always had the perspective that they want to make sure that they acknowledge all effective therapies. They’ve never really been in the pathways business, that’s not their thing. Now, they recently have become more interested in the value proposition. Initially it was evidence blocks, there were categories of preference. So they’re interested in it, but especially the categories of preference are really focused on efficacy, overwhelmingly.","_key":"e9t3v42G"}]},{"_type":"block","style":"normal","_key":"bDiCj7I8","markDefs":[],"children":[]},{"_key":"BSGqacdF","markDefs":[],"children":[{"text":"I don’t know about pathways companies. I think we’re going to have a period now, a transition period, where evidence is immature, incomplete. We’ll know enough such that we’re giving good therapy to the patients. We won’t know for a while what the best therapy for our patients is. It’s different. It’s so funny, it’s completely the opposite of the way it used to be when I was a young oncologist and we had nothing that worked. We’d try to find treatments based on our best available evidence and best available reasoning to treat our patients. Now we’ve got a lot of therapies that work. We just don’t know how to line them up. I’m actually hopeful that our understanding of the biology will improve our decision making. So we’ve already talking about deletion 17p in CLL. There’s some preliminary evidence that there may be similar genotypic mechanisms for determining optimal therapy in myeloma, if we could possibly get our hands around what molecular markers predict who should get what.","_key":"gO23n0SJ","_type":"span"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"FoFFPVQN","markDefs":[]},{"style":"normal","_key":"IurEutQv","markDefs":[],"children":[{"text":"The other thing is that I think we may see some changes in considering paying for patients in a more global way. So we pay for drugs now one at a time or in combination sequentially, right? So you could imagine me saying, “Dr Kolodziej, you’re going to get this much money to take care of your patient with CLL, choose wisely.” And we may see that evolve. Of course, the fear is that if the number is set too low, patients will be harmed. We want to avoid that at all costs. But, on the other hand, we do want to promote and encourage value-based clinical decision making. So, if you don’t need to give a super-expensive combination of specialty drugs, you shouldn’t do it.","_key":"Dv6obDQg","_type":"span"}],"_type":"block"},{"_key":"MEmhlH0q","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"X7EgtiU8","markDefs":[],"children":[{"_type":"span","text":"And I think that’s going to evolve. That’s going to take a little while to evolve. But I think there’s some evidence that we are headed in that direction, and so that will impact us. And then of course there’s the patient. How would we forget the patient? Financial toxicity is a huge issue right now. We need to deal with how much patients have to pay for these drugs. So, if you have commercial health insurance right now, you’re out of pocket is capped. That doesn’t mean it’s trivial, it just means it’s capped at $6000 $7000, $8000. That’s a lot of money. If you’re a Medicare patient, as of today, it’s not capped. If you’re a Medicare patient who has Part D coverage, you have to pay the catastrophic portion of your specialty drug, which is 5% and there is no cap. So just think about that for a second. You’re a retiree Medicare beneficiary, Part D, and you have to go through the initial phase and the donut hole and all that and then you’ve got 5%. So 5% of $150,000 a year is $7500. Of course, it’s more than that because they have to pay their initial phase of therapy.","_key":"WgOyfhwp"}]},{"children":[],"_type":"block","style":"normal","_key":"cNeLbWmZ","markDefs":[]},{"_type":"block","style":"normal","_key":"X48OBiDB","markDefs":[],"children":[{"_key":"3koU3eVp","_type":"span","text":"There are, of course, bills in front of Congress to try to fix that. I would say that even in today’s political environment, it is likely that that will get fixed. There will be a cap in Medicare Part D, but I think the impact of these novel therapies on patients’ finances hasn’t gotten as much notice or attention as perhaps it ought to. 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Kolodziej, MD:","_key":"N9kSbum4"},{"_type":"span","text":" Ibrutinib has been around for several years now. There’s a lot of clinical experience with it. Acalabrutinib has been around a year and change. Zanubrutinib just got approved for mantle cell lymphoma. I think we’ll see Waldenström macroglobulinemia soon to follow, we’ll see chronic lymphocytic leukemia [CLL] to follow after that, probably within the next year or year-and-a-half. So we will see some uniformity in terms of the Bruton tyrosine kinase [BTK] inhibitor label indications. There will be subtle differences. The preclinical information on zanubrutinib is very interesting because it really does have a longer plasma half-life and block the enzyme more effectively. Again, we’ll have to wait and see. It does appear to have less toxicity in the limited data that are out. I would say that’s attractive in general.","_key":"nTBIw8AM"}],"_type":"block","style":"normal","_key":"aCe6GjVD","markDefs":[]},{"style":"normal","_key":"n5FrRS6M","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"text":"But the challenge that we have as clinicians and the challenge that we have as payers is that things are happening so fast. We probably won’t have a real good handle on the benefits of the second-generation BTK inhibitors. And keep in mind there’s a third generation that’s about to hit. There are at least 2 drugs that are close to making it to meaningful clinical trials. And those drugs may actually work even when patients are ibrutinib-resistant, so again, very interesting.","_key":"NpITKS5i","_type":"span"}],"_type":"block","style":"normal","_key":"DmLyD7Ou"},{"style":"normal","_key":"g3UaGe5K","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"LRcgwQso","markDefs":[],"children":[{"_type":"span","text":"I would be remiss not to talk a little bit about cost. Ibrutinib and zanubrutinib are pretty much the same. Acalabrutinib is a little bit more expensive, 8% or 10% more expensive, something like that. We shall see what happens with the cost over time. As we discussed earlier, if you’re in a payer’s seat and you’ve got these three drugs and they all work pretty much the same and they cost, give or take, $150,000 a year—because that’s what they cost, give or take $150,000 a year\u0026mdash;there’s a temptation to start thinking about, let’s make a deal. Because if you can show comparable efficacy and comparable toxicity profiles, then because they’re oral drugs the ability to manage access through innovative contracting is really an attractive thought.","_key":"NADOFrxy"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"8Xda1q36"},{"_key":"4EAAyoCQ","markDefs":[],"children":[{"_type":"span","text":"I mention oral agents because, of course, intravenous drugs are much more complicated because of ASPs and all that other stuff. Oral drugs are the area where we will most likely see—at least initially, in my opinion\u0026mdash;more innovative contracting models because you don’t have to worry about ASPs. If, over time, however, the second-generation drugs wind up having a more favorable toxicity profile, it makes it a little bit harder to be innovative in the contracting universe. We’ll have to wait and see.","_key":"gFxObGoB"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"fzHawnUo","markDefs":[],"children":[]},{"children":[{"_key":"TwJNwhix","_type":"span","text":"So the issue with dosing, we’ll see whether it matters. It either matters or it doesn’t matter. What do I mean by that? So, when you think about dosing, there’s a couple of things. Number 1 is adherence. So you want to make sure that you optimize adherence, and this is not unique to this class of drugs. This is true across the spectrum of oral cancer drugs, and oral cancer drugs are a third of cancer drugs so it’s a big deal."}],"_type":"block","style":"normal","_key":"o1NUlw9R","markDefs":[]},{"_key":"D7rAiKgO","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","text":"You want to make it convenient for the patient. And second of all, you want to make it easy to modify the dose in the event of toxicity. And that’s really important because of waste. So, if you’ve got a limited number of dosing opportunities—pill size, or capsule size\u0026mdash;and you have to modify the dose, if you have to throw away that prescription, that’s like throwing away $10,000. That’s not so grand. So the advantage of being flexible in dosing from a payer and a physician and a patient perspective are No. 1. Does it make it easier for me to be compliant? And No. 2 Do the dosing formulas make it easy for me to modify the regimen and maintain efficacy, while being able to adapt to toxicity and avoid waste? Because boy, the payers hate waste with these specialty drugs. They hate it so much.","_key":"BSwi9gps"}],"_type":"block","style":"normal","_key":"BRybUhbE"},{"_type":"block","style":"normal","_key":"I5RxRxyR","markDefs":[],"children":[]},{"markDefs":[],"children":[{"text":"It’s early days, and we’ve got a lot to learn about the differences between these drugs. There are a couple of theoretical differences that may be important. We talked briefly about ibrutinib and bleeding risk, and that’s a big deal because these people are old and they’re on anticoagulants, and you don’t want to give ibrutinib to somebody on anticoagulants. On the other hand, these novel agents, both acalabrutinib and zanubrutinib, don’t have the bleeding risk. It’s a fraction. And so they may be better choices.","_key":"OPXOlyDn","_type":"span"}],"_type":"block","style":"normal","_key":"ZLv1kbng"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"lSlUsVQf"},{"style":"normal","_key":"0KI0nBJR","markDefs":[],"children":[{"_type":"span","text":"The other thing that seems to be true, especially for zanubrutinib, there’s less drug interactions. All these patients are immunosuppressed, 100% of them. If you need to give somebody fluconazole, that’s a big deal. But with zanubrutinib, it doesn’t appear to be a big deal. 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B-cell malignancies.","_key":"xtaacDXy"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"g9OdW7Hi"},{"_key":"0OxzwRef","markDefs":[],"children":[{"marks":["underline"],"text":"Transcript","_key":"jD34PvEE","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"61OGc6yo","markDefs":[],"children":[{"_key":"BNvAd8AJ","_type":"span","marks":["strong"],"text":"Michael A. Kolodziej, MD:"},{"_type":"span","text":" The mechanism of Bruton tyrosine kinase [BTK] inhibitors is that they inhibit signaling downstream from antigen binding on B cells. That pathway has been known to be important since I was in medical school because there is a hereditary immunodeficiency disorder where children born with that defect can’t make antibodies and they lack the enzyme, the tyrosine kinase. So that enzymatic pathway is specifically targeted. Of course, inhibitors of tyrosine kinases are all over the place in oncology. When we think about, for example, probably the single most revolutionary therapy of our lifetimes, which is the treatment of chronic myelocytic leukemia [CML] with Gleevec [imatinib], Gleevec inhibits the tyrosine kinase. We see it in solid tumors now as well.","_key":"SO6xyTno"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"dxNHKtTy"},{"_type":"block","style":"normal","_key":"HfgRE3jM","markDefs":[],"children":[{"_type":"span","text":"And so tyrosine kinases are very important. And it turns out that for a number of B-cell malignancies, inhibiting that enzyme is an excellent way to control the disease. I didn’t say cure the disease, I said control the disease. We don’t know, for example, whether you can stop the therapy after achieving a really good remission. We know, for example, in CML you can in some patients stop the Gleevec at one point or another. But in these diseases, we actually don’t know that, and historically they have been considered “incurable.” We will see I think some expansion of the BTK drugs into roles in other cancers, diffuse large B-cell lymphoma, for example. There’s a lot more that we don’t know about these drugs. We largely have not studied combinations of these drugs, all to be forthcoming.","_key":"r4zHlqET"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"0FnpeEsp"},{"style":"normal","_key":"JZ1Jdzc0","markDefs":[],"children":[{"_type":"span","text":"At this point, BTK inhibitors have become the standard first-line therapy in chronic lymphocytic leukemia [CLL]. And again, that’s based on excellent phase 3 randomized clinical trials. They’re not for everybody. They’re absolutely the right thing for some patients. For example, we know that 17p deletions in chronic lymphocytic leukemia are really a bad thing, with terrible prognosis. We also know it’s an indicator that standard chemotherapy options do not work well. And so it’s very clear that those patients should be treated with the BTK inhibitors.","_key":"QsU5SvH4"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"774TRA60"},{"markDefs":[],"children":[{"_type":"span","text":"Regarding the role of BTK inhibitors in let’s call it standard-risk CLL, again, I think the evidence supports a first-line approach. What has happened though—and recently I was at a meeting where this was discussed in detail\u0026mdash;is that there’s a little bit of hesitation in some patients because when you start ibrutinib, for example, it’s an open-ended proposition. You’re on it until you fail clinically, relapse or progress. It actually didn’t happen very often. More patients stop therapy because of toxicity than actually progress on therapy. And so the idea that you give chemotherapy for a short duration, with a defined start, defined stop, and defined cost, is attractive in some circumstances without a doubt. Even though there are randomized phase 3 data that show ibrutinib gives you a superior clinical outcome.","_key":"FbdC0sig"}],"_type":"block","style":"normal","_key":"fyEDZHcz"},{"children":[],"_type":"block","style":"normal","_key":"ui9clcCC","markDefs":[]},{"_type":"block","style":"normal","_key":"4H2hFPi3","markDefs":[],"children":[{"_type":"span","text":"How the new BTK drugs are going to fit into this is really not completely clear because what we know is this for both acalabrutinib and zanubrutinib: Number 1) They are better at blocking that enzyme. They’re better than ibrutinib. Whether that will translate into clinical benefit, we don’t know. The second thing is, they’re more specific. A lot of the problem that we experience with ibrutinib is off-target problem. And let’s be clear, in addition to fatigue, which is by far the most common problem that people on ibrutinib experience, there are a couple of serious problems with ibrutinib. There’s bleeding and there are what’s broadly classified as cardiovascular toxicities. And that includes atrial arrhythmias and hypertension. Those are fairly common adverse effects, especially as time goes on.","_key":"W5SJhZSe"}]},{"_key":"YPMJcTg0","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","text":"The preliminary evidence is that acalabrutinib and perhaps even more so, zanubrutinib, have fewer of those toxicities. Again, probably because they’re more specific for inhibiting the BTK as opposed to ibrutinib. Whether those differences are going to wind up being clinically borne out, we will see.","_key":"zjAk1L01"}],"_type":"block","style":"normal","_key":"0ZIb6iu6"},{"_type":"hrtag","_key":"k_DurXGBrR"}]},{"_id":"episode_f8f91ff777f175e0412991b76f4cb29f","seoTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"],"documentGroup":{"_ref":"media_series_article_post-conference-perspectives_ash-2019-leukemia-lymphoma","_type":"reference"},"factCheckAuthorMapping":null,"_createdAt":"2021-05-14T18:39:40Z","thumbnail":{"asset":{"extension":"jpg","uploadId":"qfGZ3RsKMvorSQKIYt7lOGen2WvSGGu4","_createdAt":"2021-05-14T18:39:33Z","_updatedAt":"2021-05-19T23:19:03Z","_rev":"bafW25ONKtGvbhpujwzYm9","_type":"sanity.imageAsset","sha1hash":"a4f80d4a7af691ac97e046cac5c799c7bee5ed1f","url":"https://cdn.sanity.io/images/0vv8moc6/ajmc/a4f80d4a7af691ac97e046cac5c799c7bee5ed1f-480x360.jpg","assetId":"a4f80d4a7af691ac97e046cac5c799c7bee5ed1f","metadata":{"_type":"sanity.imageMetadata","palette":{"_type":"sanity.imagePalette","darkMuted":{"background":"#365771","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":2.72},"muted":{"population":1.4,"background":"#668aa1","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"lightVibrant":{"background":"#75b0cf","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.17},"darkVibrant":{"background":"#054d72","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":22.31},"lightMuted":{"foreground":"#000","title":"#fff","population":7.18,"background":"#b1a5a4","_type":"sanity.imagePaletteSwatch"},"vibrant":{"background":"#065c94","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":0.4},"dominant":{"population":22.31,"background":"#054d72","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"}},"hasAlpha":false,"lqip":"data:image/jpeg;base64,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","dimensions":{"aspectRatio":1.3333333333333333,"height":360,"_type":"sanity.imageDimensions","width":480},"isOpaque":true},"size":34075,"_id":"image-a4f80d4a7af691ac97e046cac5c799c7bee5ed1f-480x360-jpg","originalFilename":"sanity_hqdefault.jpg","mimeType":"image/jpeg","path":"images/0vv8moc6/ajmc/a4f80d4a7af691ac97e046cac5c799c7bee5ed1f-480x360.jpg"}},"_type":"article","contentCategory":{"_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z"},"documentGroupMapping":[{"_ref":"media_series_article_post-conference-perspectives_ash-2019-leukemia-lymphoma","_type":"reference","_key":"ORzk7ue7w"}],"title":"B-Cell Malignancies: Coverage, Access, and Cost","link":"/view/b-cell-malignancies-coverage-access-and-cost","authorMapping":null,"is_visible":true,"internalTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"],"published":"2020-01-21T19:00:03Z","body":[{"url":"https://www.youtube.com/embed/aOxwJgzgKAw?rel=0\u0026fs=0","_type":"youtube","_key":"gurJLeM7b"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"n1M0fH6R"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"jiNspyL6"},{"style":"normal","_key":"EPZzgqe5","markDefs":[],"children":[{"text":"In-depth considerations for the coverage, access, and cost of novel therapeutic agents used to treat B-cell malignancies.","_key":"pYoZ3Zdr","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"weTBB1fD"},{"_type":"block","style":"normal","_key":"K9U3cjFC","markDefs":[],"children":[{"text":"Transcript","_key":"kzMXaqrf","_type":"span","marks":["underline"]}]},{"markDefs":[],"children":[{"text":"Michael A. Kolodziej, MD:","_key":"1QBhZvNd","_type":"span","marks":["strong"]},{"_type":"span","text":" Payers historically have defaulted coverage policy to FDA label and compendia listing. Now, over the years, there have been a number of CMS recognized compendia. The reason that’s important is because CMS coverage policy is actually dictated by law. Commercial payers technically are not bound by that same law. However, the majority of states have passed rules from the insurance commission, if you will, that require the same coverage policy for commercial payers. The way it stands now is that commercial payers would pay for FDA labeled indications and they’ll pay for compendia listing. And, as it turns out, these days National Comprehensive Cancer Network [NCCN] compendia are the most commonly referred to, and it’s been that way for years. Yes, they clearly pay close attention to what it says. They pay close attention to what it says in the guideline. They pay close attention to what it says in the footnotes. They pay close attention to what it says in the text. And of course, they pay close attention to the compendia, which are a derivative of the guidelines.","_key":"REYHrid4"}],"_type":"block","style":"normal","_key":"wXN9VFID"},{"style":"normal","_key":"BrCPpqVk","markDefs":[],"children":[],"_type":"block"},{"children":[{"_type":"span","text":"Now, we should be very clear that coverage is different than access. Let me explain what I mean by that. Coverage means the insurance company says, “We cover it,” but there’s been a lot of discussion about having preferred agents. It doesn’t mean the non-preferred agent is not covered. It might be covered, but access is dictated by let’s say formulary placement or placement on the pathway or something like that. We have not seen a ton of that yet, but as we’ll discuss, in patients who are being treated for chronic lymphocytic leukemia, there are actually a lot of treatment choices now. And there are multiple drugs in a class. And that opens the opportunity for payers to consider access and specifically favoring 1 agent within a class over another if they’re otherwise pretty much interchangeable.","_key":"LVY3M8Jj"}],"_type":"block","style":"normal","_key":"A98q6slY","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"XW84v2ol"},{"markDefs":[],"children":[{"_key":"WcfpTK5h","_type":"span","text":"There were some interesting presentations at the American Society of Hematology [ASH] meeting regarding durability of response, regarding management of toxicity, and regarding combinations that heretofore have not really been in the mainstream. Some of those presentations are very interesting. For example, we had a presentation on the durability of ibrutinib in mantle cell lymphoma. It’s pretty durable, which is good. I don’t have a dog in this fight, so I look at this and I think, well, that’s probably class effect, right? It’s probably going to be true of acalabrutinib and zanubrutinib. Whether 1 is going to wind up being superior to another will remain to be seen."}],"_type":"block","style":"normal","_key":"vAaeSuYg"},{"_type":"block","style":"normal","_key":"NpiGwLGi","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_key":"Hgcb8RN4","_type":"span","text":"I think the other thing that’s interesting about that class, for example, is whether there are going to be toxicity differences because they really are different agents. The toxicity profile may ultimately impact the drug of choice. And then of course, we haven’t even started talking about cost. These drugs are very expensive. On the one hand, durable is good. On the other hand, durable means cumulative cost is high. We have this tension right now in hematological malignancies between a concept that we have fallen in love with the last few years, which is turning cancer into a chronic disease, and we’ve flipped that on its ear and are thinking about, can we actually cure some of these cancers? That’s the chimeric antigen receptor T-cell therapy [CAR T] approach. So we’re going to continue to experience this tension."}],"_type":"block","style":"normal","_key":"i5LGIN09"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"4ftLKVI0"},{"children":[{"_type":"span","text":"It’s so interesting to me because as you may know, Institute for Clinical and Economic Review [ICER] looked at a cost effectiveness profile for the CAR T therapies. And they looked at milestones and projected durability and whether CAR T would be cost-effective at different time points. And there’s clearly a point at which it becomes cost-effective if it’s that durable. The problem is we don’t know right now if it’s that durable. It costs a lot of money up front. That’s a whole different issue regarding healthcare financing. But if you could offer a therapy and cure the patient, is that theoretically a better approach than taking a pill every day forever? And I think a lot of people would say, yes, that’s better. 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Kolodziej, MD:","_key":"u9UdQSwH","_type":"span"},{"_type":"span","text":" The National Comprehensive Cancer Network [NCCN], of course, has panels that are considering the best available evidence. For the purposes of today’s discussion, let’s focus on mantle cell lymphoma and chronic lymphocytic leukemia [CLL]/small lymphocytic lymphoma [SLL]. Mantle cell lymphoma has been a really tough disease to treat for a very long time. If you look back on the history of mantle cell lymphoma, it was thought to be just another subtype of chronic lymphocytic leukemia, except those patients did much poorer than patients with CLL. They relapsed, they died of their lymphoma fairly quickly. And then we started to understand a little bit about the molecular biology of it and a little bit about what makes mantle cell lymphoma different. And so mantle cell lymphoma was distinct in treatment recommendations.","_key":"WVbxy5Dh"}],"_type":"block","style":"normal","_key":"xltzS0LO"},{"style":"normal","_key":"r5BmeyBW","markDefs":[],"children":[],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","text":"Even within mantle cell lymphoma, there are a couple of subtypes, but when people think about mantle cell lymphoma, they usually think about the aggressive subtype. And the aggressive subtype of mantle cell lymphoma is treated much like, interestingly, aggressive lymphomas like diffuse large B-cell lymphoma. There are conventional aggressive regimens like rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP] that are frequently used, especially in the community, to treat these patients. And then there are other regimens like hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone [hyper-CVAD], which was from, I believe, MD Anderson Cancer Center a million years ago. The idea being to get patients into a good remission and then consider them for transplant, transplant at first remission or at first relapse.","_key":"qsA56tTt"}],"_type":"block","style":"normal","_key":"tPEV9QmV"},{"_type":"block","style":"normal","_key":"4q1CjB13","markDefs":[],"children":[]},{"_key":"fzQjnYss","markDefs":[],"children":[{"_key":"FhLGYzkS","_type":"span","text":"Now, given the age at onset of mantle cell lymphoma, that’s not such a wonderful option for most patients. And interestingly, it’s a heterogeneous disease, and there are some patients who actually seem to do pretty well. Until recently, treatment of relapsed and refractory mantle cell lymphoma was really not particularly good. But that changed really, I think, when it became clear that this new class of drugs, the Bruton tyrosine kinase [BTK] inhibitors, were active in this disease. So ibrutinib was the first one on the scene. Acalabrutinib and zanubrutinib came later. These drugs are highly effective in treating relapsed and refractory mantle cell lymphoma, often for a very durable period, often with quite acceptable toxicity."}],"_type":"block","style":"normal"},{"_key":"vbJlKTHV","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"jCV944ao","markDefs":[],"children":[{"_type":"span","text":"The NCCN guidelines recommend the efficacy of these agents and offers them as a treatment of choice, if you will. Chemotherapy can be repeated in these patients, particularly those who have a very good first remission duration. But in patients who have the truly aggressive type, we’re seeing the BTK inhibitors becoming the predominant therapy. Interestingly, we’re going to see chimeric antigen receptor T-cell therapy [CAR T] make its way into this space. There’s no reason why CAR T shouldn’t work in these patients, and so we will undoubtedly see that emerge over the next period of time. This is not a particularly common subtype of non-Hodgkin lymphoma. It’s only about 4% or so of all non-Hodgkin lymphoma. So getting big studies done in this patient population is tough.","_key":"VGO20tf9"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"CycQMNHR"},{"children":[{"_type":"span","text":"CLL and small lymphocytic lymphoma are a little bit further along than mantle cell lymphoma. For one thing, it’s a lot more common. Secondly, it’s another disease where we really were stuck in a rut for a very long time. Conventional chemotherapy was used for a very long time. Mind you that not all patients with CLL or SLL actually need treatment. Many of them can be observed for a long period of time. They have a very indolent disease, but in patients who need to be treated, particularly those who are symptomatic, standard chemotherapy was the treatment of choice: bendamustine, rituximab or fludarabine, cyclophosphamide, and rituximab [FCR] were chemotherapy regimens.","_key":"QwIuOmmp"}],"_type":"block","style":"normal","_key":"oX2NLXRO","markDefs":[]},{"style":"normal","_key":"cj9obqaJ","markDefs":[],"children":[],"_type":"block"},{"style":"normal","_key":"squMxuHJ","markDefs":[],"children":[{"text":"The problem is, particularly with fludarabine, cyclophosphamide, and rituximab, it’s tough therapy. Old people do not do well with fludarabine, cyclophosphamide, and rituximab. Now several years ago the BTK inhibitors came out. Ibrutinib has been around for several years now. It is recommended as the treatment of first choice based on very good phase 3 randomized clinical trial data. Again, acalabrutinib and zanubrutinib came out more recently. Again, we’re starting to see data with those agents in CLL and SLL initially now in the relapsed and refractory setting, but they’ll make their way up the chain. That’s just what’s going to happen. We have other classes of drugs interestingly. We’ve got the phosphatidylinositol-3 [PI3] kinase drugs, idelalisib and duvelisib, totally different mechanism of action, very effective therapies. The drug that may wind up doing the best of all of them is venetoclax, which is a BCL2 inhibiting agent. All of those got a lot of press at the recent American Society of Hematology [ASH] meeting.","_key":"MOjiW3ZY","_type":"span"}],"_type":"block"},{"_type":"hrtag","_key":"0Pqa13H39W"}],"is_visible":true,"_rev":"aPp0Na72MVbP19l859yC1y","title":"MCL and CLL: NCCN Guidelines and Treatment Options","contentCategory":{"_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z"},"internalTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"],"seoTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"]},{"seoTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"],"taxonomyMapping":[{"name":"Policy","_id":"topic_policy","_updatedAt":"2020-07-30T14:47:46Z","identifier":"policy","parent":{"_ref":"15012229-f713-4f0a-8f82-7667530bb382","_type":"reference"},"_createdAt":"2020-05-04T23:46:13Z","_rev":"GQ2iWOdzjKwgYpKUFVt5oL","_type":"taxonomy"}],"published":"2020-01-21T19:00:01Z","title":"An Overview of B-Cell Malignancies","is_visible":true,"internalTag":["Post Conference Perspectives","lymphoma","leukemia","bcell","cancer","nccn","cost","b cell","mcl","cll","payer"],"_id":"episode_a80d9c82b211ce233ae55c20181222a9","_createdAt":"2021-05-14T18:39:34Z","body":[{"_type":"youtube","_key":"pa7P4g2xB","url":"https://www.youtube.com/embed/n843Hg_if58?rel=0\u0026fs=0"},{"_key":"DE9UoZAN","markDefs":[],"children":[],"_type":"block","style":"normal"},{"style":"normal","_key":"eP9JRF7X","markDefs":[],"children":[],"_type":"block"},{"children":[{"_type":"span","text":"A comprehensive review of the individual diseases that constitute B-cell malignancies.","_key":"JQvebod1"}],"_type":"block","style":"normal","_key":"FPh2E4vz","markDefs":[]},{"_type":"block","style":"normal","_key":"ap5qf2dY","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_type":"span","marks":["underline"],"text":"Transcript","_key":"Sh6EiBYL"}],"_type":"block","style":"normal","_key":"CnRi27ZE"},{"_key":"eo4oLDZv","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Michael A. Kolodziej, MD:","_key":"Y2XXiVRM"},{"_type":"span","text":" The American Society of Hematology [ASH] meeting every year often has a wide variety of presentations on malignant hematology. There’s all this information about sickle cell disease and thrombosis. That’s not what we’re going to talk about. What we are talking about is malignant hematology and more specifically within malignant hematology, lymphoma, for all intents and purposes.","_key":"xtm1RyEb"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"MeeH5zFk","markDefs":[],"children":[]},{"markDefs":[],"children":[{"_key":"vYYQfi1J","_type":"span","text":"Now, when you talk to hematologists about lymphoma, the first thing that they think about is diffuse large B-cell non-Hodgkin lymphoma. That’s the most common subtype of non-Hodgkin lymphoma, and there were some presentations at the meeting about that. And then there’s a large group of lymphomas, very heterogeneous, called follicular lymphomas. We’re not going to really spend much time on those."}],"_type":"block","style":"normal","_key":"ArGdTrFO"},{"_key":"h4FIDEfL","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"LNfgiHLi","markDefs":[],"children":[{"_type":"span","text":"And then there are these other hematological malignancies, B-cell neoplasms, that have in general a more indolent course. There’s a ton going on in those diseases right now, both presented at the ASH meeting and then in and around the ASH meeting. We’d be remiss not to mention plasma cell neoplasms, multiple myeloma, which has been a particularly active area the last couple of years and was highlighted at the ASH meeting.","_key":"cczaSVQ7"}]},{"_key":"qy5az6HF","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"c5Dqq7pA","markDefs":[],"children":[{"_type":"span","text":"So, if we talk briefly about diffuse large B-cell lymphoma first, I was talking to somebody the other day and we haven’t really done anything interesting in diffuse large B-cell lymphoma since we got Rituxan in 1997—that’s a long time ago\u0026mdash;until chimeric antigen receptor T-cell therapy [CAR T], and CAR T changed everything. We are still figuring out CAR T, and there were a lot of presentations at the meeting about CAR T and diffuse large B-cell non-Hodgkin lymphoma, most specifically about the durability of response. We have not yet realized the full potential of those malignancies. I think there’s a couple of reasons for that. One is that CAR T remains largely locked within the inpatient setting. That makes access somewhat of a challenge. The second thing is that we frankly don’t know how to pay for it. Diffuse large B-cell lymphoma is a disease of older patients, and Medicare reimbursement for CAR T is frankly inadequate, and that has really hindered the ability to treat patients with CAR T. But hopefully we’ll figure that out.","_key":"z1UMY3rT"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"4gLMQ8Py"},{"style":"normal","_key":"4J0QVhqT","markDefs":[],"children":[{"text":"Interestingly, there was a presentation looking at a bifunctional antibody. CAR T is complicated because making CAR T is complicated, and it’s expensive to make it. So people have been interested in these “off-the-shelf” solutions. One of them is a bifunctional antibody that was reported in patients with relapsed/refractory non-Hodgkin lymphoma, including patients who had failed CAR T, and the results were very remarkable. I don’t know if they’re going to prove to be durable. That’s going to be a recurring theme in our talk today, I think. But that’s tremendously exciting. That’s what’s largely happening in diffuse large B-cell lymphoma.","_key":"I9XTSqHz","_type":"span"}],"_type":"block"},{"children":[],"_type":"block","style":"normal","_key":"hLuJK8Gg","markDefs":[]},{"_type":"block","style":"normal","_key":"iREu7m9c","markDefs":[],"children":[{"_type":"span","text":"There wasn’t that much about follicular lymphoma, but then we’ve got this other group of disorders. We’ve got chronic lymphocytic leukemia/small lymphocytic lymphoma. We’ve got Waldenstrom macroglobulinemia. We’ve got mantle cell lymphoma. I talk as if they’re all lumped together. 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Salgo, MD:","_key":"fv0sJcjg"},{"_type":"span","text":" Let’s examine the way the newer agents are authorized. We’re doing a little economics lesson here. Are the payers requiring step therapy? And in this disease, what is step therapy?","_key":"rnivxhFl"}],"_type":"block","style":"normal","_key":"uVE71thD"},{"_type":"block","style":"normal","_key":"JbgBqNRe","markDefs":[],"children":[]},{"_key":"Ua1gdbTy","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Andrea J. Singer, MD, FACP, CCD:","_key":"B4weO417"},{"_key":"MMgij4Qk","_type":"span","text":" So the simple answer is, it depends. The reason I say that is because there is a lot of variation, both geographically, even within the same payer, and then by payers in terms of what they require. And there’s a difference between Medicare and commercial insurance, and obviously we’re talking largely about a Medicare-based population because we’re talking about an older population. But we see lots of fractures in people between the ages of 50 and 64, so commercial insurance comes into it as well. Sometimes step therapy is required, or they will at least inquire about whether the patient been tried on a bisphosphonate, an oral bisphosphonate. Have they tried or been intolerant to or failed a couple? Have they tried other agents before you sort of move on? That’s not across the board. And again, as a provider, I think if you can make a good argument that clinically this is why I feel we need to start here, sometimes that works [and] other times it does not."}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"2vaNJhob","markDefs":[]},{"_key":"xQ8qSerl","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"cY8j4iNF","_type":"span","marks":["strong"]},{"_type":"span","text":"Do they need prior authorization?","_key":"IPHkeE4w"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"sTm7gIPB"},{"_type":"block","style":"normal","_key":"8g0cg9PC","markDefs":[],"children":[{"text":"Andrea J. Singer, MD, FACP, CCD: ","_key":"7TwPajFc","_type":"span","marks":["strong"]},{"_type":"span","text":"Some of them. Again, with Medicare and those drugs that fall under Part B—and denosumab and romosozumab fall under Part B, as opposed to Part D\u0026mdash;then you’re talking about medical benefits versus pharmacy benefits. Their prior authorization tends to be less of an issue in the nonmanaged Medicare group, as compared with drugs, or some of the other anabolics, and all that, which fall under Part D.","_key":"yAMIOor3"}]},{"_key":"V4lCu04H","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_key":"j1B8GEjy","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"AN6f3SXd","_type":"span"},{"_type":"span","text":"I’ll tell you what this sounds like to me. Back when we first introduced the statins, there were no generics. They were very expensive. And I heard from third-party payers, “It’s too much money. We’re not going to leave it on the formulary.” And I asked, “Well, what about all these folks who have myocardial infarctions a year from now, who might not have if their serum lipids had been controlled?” And they said, “Not my problem. I’ve got to make my quarter.” Does this sound to you like the same argument?","_key":"Krkykbmy"}],"_type":"block","style":"normal"},{"children":[],"_type":"block","style":"normal","_key":"KriMJ7ZG","markDefs":[]},{"style":"normal","_key":"gAlofde7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Thomas P. Olenginski, MD, FACP, CCD:","_key":"pC3YFCTg"},{"_type":"span","text":" I mean, in a way. I think there’s another segment of the high-risk population for whom the attractiveness of how these drugs work is going to be a harder sell. And that’s going to be someone, let’s say younger but at higher risk because of really bad scores, for whom we really want to prevent the event. That’s going to be a different challenge and hurdle. I proactively try to communicate to a medical director this goal-directed, individualized, treat-to-target therapy that I hope continues, at least to make it understandable.","_key":"4ariJsoH"}],"_type":"block"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"DZSzYlkc"},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"WGRW9B9D"},{"_type":"span","text":"Going forward into the future, do you see a complete shift toward these—I’ll call them ","_key":"IPVDy4D5"},{"_type":"span","marks":["em"],"text":"biologicals","_key":"BmpvA8Yo"},{"text":" for lack of a better phrase—away from the bisphosphonates, away from the standard therapies? Is this where we’re all going, given time, given price decreases over time?","_key":"3AK5oycJ","_type":"span"}],"_type":"block","style":"normal","_key":"FHpNxYpv","markDefs":[]},{"_key":"lK5zrMOF","markDefs":[],"children":[],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Thomas P. Olenginski, MD, FACP, CCD: ","_key":"nQQIahtk"},{"_type":"span","text":"I don’t think the bisphosphonates. I think the bisphosphonates are here to stay. The 1 advantage that Dr. Singer pointed out is that once you get to a place that you like, there’s persistence of effect. So 1 of the patients I’m talking about, younger but higher risk, if you use something and get them somewhere, then maybe you can give them a bisphosphonate and watch them.","_key":"w9XPfWiR"}],"_type":"block","style":"normal","_key":"QkitpaEJ","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"lZQEQOlx"},{"children":[{"_key":"7Mvv5gjl","_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: "},{"_type":"span","text":"Again, what I hear is that it depends. It depends. A lot of drugs, some drugs are good, some of these new drugs are really good.","_key":"a1nvFvf0"}],"_type":"block","style":"normal","_key":"wcTEUmsP","markDefs":[]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"CZ6Qfs7X"},{"markDefs":[],"children":[{"_key":"14AnVonY","_type":"span","marks":["strong"],"text":"Claire Gill:"},{"_type":"span","text":" They are. And I think, again from a patient-efficacy perspective, part of what we spend a lot of time advocating for is that, again, given the unique circumstances of osteoporosis patients and the chronicity of the disease—and as you’ve heard the doctors explain how it can vary so differently from patient to patient\u0026mdash;having access to all the treatments available for osteoporosis is essential.","_key":"h4YNjtbX"}],"_type":"block","style":"normal","_key":"K6Xh60Sy"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"ZmTMmYsl"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"kUDLeLtH","_type":"span"},{"_type":"span","text":"This has been great, but now it’s time to wrap things up. Why don’t we go around and ask each of you for 30 seconds or your final crystalline thought. Is there something you’d like to share with your viewers? Why don’t we start here?","_key":"meV1MnkQ"}],"_type":"block","style":"normal","_key":"BwLn5kkk"},{"children":[],"_type":"block","style":"normal","_key":"KMxoCYqx","markDefs":[]},{"_type":"block","style":"normal","_key":"euCHPLEB","markDefs":[],"children":[{"marks":["strong"],"text":"Claire Gill: ","_key":"4G61REFE","_type":"span"},{"_type":"span","text":"I think from our perspective, again, it’s appreciating what the doctors are doing every day for their patients and just, again, looking at those at highest risk for fracture, those who have had a hip fracture, those who have had any type of fracture, to consider getting them a DEXA [dual-energy x-ray absorptiometry] scan.","_key":"F0e68TLj"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"s0EjQc1P"},{"_key":"KxVD4Kuu","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"KnaFPQ31"},{"_type":"span","text":"Tom?","_key":"NtaiW07V"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"7CBJsr8N"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Thomas P. Olenginski, MD, FACP, CCD: ","_key":"RlXU0uwm"},{"_type":"span","text":"Well, first of all, thank you for inviting me. I would say for anyone who’s concerned about their bone health, ask your doctor what you should do. For patients who sustain a fracture, my hope over the next decade is that the standard of care will always be a risk-assessment evaluation and treatment if appropriate.","_key":"hQnQnNOg"}],"_type":"block","style":"normal","_key":"C0Tpd3V9"},{"_type":"block","style":"normal","_key":"yMVr67Ms","markDefs":[],"children":[]},{"_type":"block","style":"normal","_key":"PsdS95VT","markDefs":[],"children":[{"text":"Peter L. 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This has been kind of an eye-opening discussion for me, in terms of risk and some new drugs that are out there. I know new drugs are coming because there [are] new drugs everywhere. But thank you all. It’s been just terrific. I want to thank you, too, for watching. It’s nice of you to be with us. I hope you found this ","_key":"pbejt26r"},{"_type":"span","marks":["em"],"text":"Peer Exchange","_key":"h19Kp9zp"},{"_type":"span","text":" discussion to be useful and informative. 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Salgo, MD:","_key":"f86cIQOj","_type":"span","marks":["strong"]},{"_type":"span","text":" What is the cost, if you know, of 1 fracture to an individual and to the system? How much does it cost?","_key":"aQtgqhP7"}],"_type":"block","style":"normal","_key":"miNb3WZO"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"0Zs77c2z"},{"_type":"block","style":"normal","_key":"sjNWV7x4","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Andrea J. Singer, MD, FACP, CCD:","_key":"tRcjCP0U"},{"_type":"span","text":" Depends on what type of fracture we’re talking about.","_key":"irU0laij"}]},{"_key":"F8hHPFmq","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"AYdpYYGO","_type":"span","marks":["strong"],"text":"Peter L. 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Is it 50%?","_key":"J8xmohZ4"}],"_type":"block","style":"normal","_key":"eNfpKAhS"},{"_key":"aKhQR3KJ","markDefs":[],"children":[],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"PeKneTDL","_type":"span","marks":["strong"],"text":"Thomas P. Olenginski, MD, FACP, CCD:"},{"text":" Thirty-eight percent.","_key":"mtVHPfvg","_type":"span"}],"_type":"block","style":"normal","_key":"2EaFrjkb"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"OPE7NkBX"},{"style":"normal","_key":"dJhManmE","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"UUX71j6J"},{"_type":"span","text":"Thirty-eight percent. 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It’s balancing long-term cost. It’s balancing being stewardly. Clearly, we do not want every patient with osteoporosis on these drugs. I think it gives us strategies for the more severe, more risky patient that, over time, we will modify and be better with.","_key":"BrJBQb0I"}],"_type":"block","style":"normal","_key":"IyM06osM"},{"_type":"block","style":"normal","_key":"UnDMLGJ3","markDefs":[],"children":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"COzdy3Nj"},{"_type":"span","text":"Wait. I want you to run that back for me. Those are numbers. I’ve heard a lot of numbers. I haven’t heard the death numbers. What were those percentages again?","_key":"DtUeHH6h"}],"_type":"block","style":"normal","_key":"UG1ll1x4","markDefs":[]},{"children":[],"_type":"block","style":"normal","_key":"jI0bO3Vj","markDefs":[]},{"markDefs":[],"children":[{"text":"Thomas P. 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You told me that a fair number of these people, in the 20% range, are simply dead 6 months later.","_key":"FYWG5qpV"}],"_type":"block","style":"normal","_key":"GKoAWbD0"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"BtJW7Sa4"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Thomas P. Olenginski, MD, FACP, CCD: ","_key":"GH6JZHM6"},{"_type":"span","text":"Six months to a year, yeah.","_key":"nn0FdfPH"}],"_type":"block","style":"normal","_key":"i776BFXE"},{"_key":"A10GUQev","markDefs":[],"children":[],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"dvDKo2D7","markDefs":[],"children":[{"marks":["strong"],"text":"Peter L. Salgo, MD: ","_key":"m7jLbA1h","_type":"span"},{"text":"That is a number that nobody has heard. I haven’t heard it. It’s huge. And if we’re talking $20,000 for a drug that will have a significant impact on death, now you’re up there—heart disease, breast cancer, other lethal diseases.","_key":"I6tRjaM0","_type":"span"}]},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"J8ssNH5k"},{"markDefs":[],"children":[{"text":"Claire Gill: ","_key":"yLOQyKU5","_type":"span","marks":["strong"]},{"_type":"span","text":"Well, we actually beat those numbers. Nationwide, it’s about 25%. We see 25% of people die within the first year after hip fracture, so that’s 75,000. There are 300,000 hip fractures. That’s 75,000 people a year. That is more than women who die from breast cancer, yet we as a society spend so much time and concern on breast cancer. We have to, but this is also happening every day in osteoporosis and people do not know.","_key":"HLUfMKE1"}],"_type":"block","style":"normal","_key":"4vKe4Rvp"},{"markDefs":[],"children":[],"_type":"block","style":"normal","_key":"qu9Opxpg"},{"style":"normal","_key":"kP9laPFH","markDefs":[],"children":[{"text":"Peter L. Salgo, MD: ","_key":"MMXumhsD","_type":"span","marks":["strong"]},{"_key":"O3WlOwzn","_type":"span","text":"That’s called burying the lede in the news business. “Oh, it’s bad. You’re going to have to use a walker. You’re going to have height loss. You’re going to have pain. You’re going to be dead!” Why am I shocked by this? Did I miss this?"}],"_type":"block"},{"_type":"block","style":"normal","_key":"JSnjD1wS","markDefs":[],"children":[]},{"_key":"JSVdlNmn","markDefs":[],"children":[{"_key":"rDbhRPMc","_type":"span","marks":["strong"],"text":"Thomas P. 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How can legislation change that and provide patients with better access to these treatments?","_key":"8768e106630e0","_type":"span"}]},{"style":"normal","_key":"5fafa562323e","markDefs":[{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/view/loss-of-agencies-power-could-slow-everything-down-in-health-care-chernew-explains","_key":"b25ff44dd98b"},{"_key":"58e8f609c7bb","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/view/how-chevron-s-overturn-could-complicate-the-health-policy-environment"}],"children":[{"_type":"span","marks":[],"text":"Legislation I think is really important here, especially in a ","_key":"2ddddbbade200"},{"text":"post-","_key":"22b8e66ca79b","_type":"span","marks":["b25ff44dd98b"]},{"_type":"span","marks":["b25ff44dd98b","em"],"text":"Chevron","_key":"7e9ad042f8d7"},{"_type":"span","marks":[],"text":" ","_key":"c66afed5e9f7"},{"_type":"span","marks":["58e8f609c7bb"],"text":"world","_key":"f37dd8ec4e03"},{"_key":"e7bb72c47977","_type":"span","marks":[],"text":". We've seen CMS take a couple of actions that haven't gone quite as far as we need to create the infrastructure necessary for commercial payers to feel confident in coverage, as well. A big part of that is the coding. There's a legislation that AMCP supports, which is the Access to Prescription Digital Therapeutics Act, that is bicameral, bipartisan legislation that would create a Medicare Part B benefit category for prescription digital therapeutics—it's those PDTs that have gone through the FDA review for safety and efficacy and they've been authorized for market access."}],"_type":"block"},{"_type":"block","style":"normal","_key":"27bf580e4896","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"51ce5095f7190"}]},{"children":[{"_type":"span","marks":[],"text":"Part of that bill would also direct CMS to develop product-specific HCPCS [Healthcare Common Procedure Coding System] codes. That is, in our view, one of the most important components of the legislation. Right now, there's only a couple of codes that are being used for PDTs. Many of them are on a shared A-code, and so that's an issue in terms of incomplete information on a claim. You have to go back to the provider, it takes time from them, it takes time from the payer. That's not good for anyone. It's not good for the patient. Their prescription is being delayed in that case.","_key":"1f4346bf80450"}],"_type":"block","style":"normal","_key":"dffd59f0b179","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"64ad765ca1bd0"}],"_type":"block","style":"normal","_key":"af314377607d"},{"_type":"block","style":"normal","_key":"ce6e6d2b5ce5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We really want CMS to help clear up some of those issues through the coding piece and then sort of lay out their vision for how coverage looks. With a new modality like PDTs, this is different than traditional small molecule drugs or biologics, where we've known what those are for a very long time. This is new. I think this requires us to think a little bit differently about how we design coverage, but some of those missing puzzle pieces really need to be in place first before we can do that. And so that's what the Access to PDTs Act would do.","_key":"175cfc4c6c3f0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c9256342189d0"}],"_type":"block","style":"normal","_key":"8db4e228d082"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"As I mentioned earlier, CMS, in a post-","_key":"18b9a66ad4680"},{"_type":"span","marks":["em"],"text":"Chevron","_key":"93915d5e9705"},{"_key":"f0464d6e70b9","_type":"span","marks":[],"text":" world, needs the clarity of statutory law. They were one of the agencies that relied very heavily on "},{"_type":"span","marks":["em"],"text":"Chevron","_key":"6942291e6478"},{"_type":"span","marks":[],"text":" deference for carrying out their responsibilities. Without that in place, I think there is a question of what they can do with PDTs without statutory authorization. Although we have seen they proposed to cover about 5 products in the Physician Fee Schedule for 2025. We're waiting to see what the final fee schedule looks like. But if that's where we end up, I think we can feel pretty safe that is the extent of their authority without additional authorizing statutory language.","_key":"8d5459f8ea7b"}],"_type":"block","style":"normal","_key":"589cc407e03e"}],"_updatedAt":"2024-11-04T17:21:11Z","title":"Legislation Can Help Increase Uptake of PDTs, Improve Reimbursement","summary":"CMS is creating infrastructure to improve coverage of prescription digital therapeutics (PDTs), and new legislation would also drive uptake of 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She served as Oregon State Representative from 2020 until her recent resignation in August 2024. She resigned because she is on track to ","_key":"1888c3aa508f"},{"text":"take a seat in Congress","_key":"3c6064dfe6e6","_type":"span","marks":["383545962b9b"]},{"_type":"span","marks":[],"text":", replacing a retiring congressman. During her office, Dexter leveraged her medical expertise to champion legislative efforts grounded in science and public health, addressing pressing issues like the opioid crisis and air pollution. ","_key":"1a3e5212cd31"}],"_type":"block","style":"normal","_key":"2c74df8a29e7"},{"_type":"block","style":"normal","_key":"6eb193de8394","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e2a4266f1dca"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Notably, her work on a 2023 harm reduction omnibus package and air quality initiatives highlighted the intersection of health, politics, and environmental impacts. As a former Northwest Permanente board chair of a 1600-physician group, Dexter's experience in a multispecialty, capitated care system further shaped her policy perspectives, merging clinical insight with a vision for healthier communities through proactive legislation.","_key":"8360ce285590"}],"_type":"block","style":"normal","_key":"8bee80c664f0"},{"children":[{"_type":"span","marks":[],"text":"","_key":"404b79c0a751"}],"_type":"block","style":"normal","_key":"9587fb9fca66","markDefs":[]},{"style":"normal","_key":"6ab625167310","markDefs":[],"children":[{"marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"6b2a02c115a6","_type":"span"}],"_type":"block"},{"_key":"7739ffc57f67","markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"a3350f2cb3a2"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"5a611262d881","markDefs":[],"children":[{"_key":"d4c85c36065e","_type":"span","marks":["strong"],"text":"Can you describe the topic of your session \"Prescribing Change: Redefining the Physician Role in Public Health Advocacy\"?"}]},{"style":"normal","_key":"6cd8cdd5a7e1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It's born of an acknowledgment that physicians have a powerful role to play in public policy making, and that we actually should see ourselves more in that role. So, talking about why I ran for office and how I've been able to take my practice as a physician to the state legislature where I've served from 2020 to 2024—I just resigned at the end of August, and I talked about a couple case studies, including the opioid crisis and a harm reduction omnibus package that I passed in 2023.","_key":"c4b66d27913d0"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"b66090c5ba0e"}],"_type":"block","style":"normal","_key":"81b937bca6e9","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"We also talked about air pollution and climate impacts on health, and the different bills that we've been passing really focused on the health impacts. It takes a controversial, sometimes politicized issue and really just bases it on the science. And we know the impacts of air pollution. We don't know all of them, but we know the significant impacts of air pollution on health, and we should be mitigating those for not just the wellness of people but the economic and downstream impacts of prevention.","_key":"9154b2c7aa1f"}],"_type":"block","style":"normal","_key":"cabdb4650144","markDefs":[]},{"style":"normal","_key":"ba773d569b41","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"183d1a424409"}],"_type":"block"},{"_type":"block","style":"normal","_key":"e7249140eeea","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Would you shed light on how public health and policy intersects with the state of health care?","_key":"36a0067a5933"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I didn't talk about the whole spectrum of that. The focus of my talk was on how I'll be the first pulmonary and critical care physician to serve in Congress. So, I think that, at a pulmonary and critical care conference, was what a lot of folks were interested in, and why I wanted to go into office, and how I see my role as a physician impacting that—which I think is really important. ","_key":"058b7916bb8d0"}],"_type":"block","style":"normal","_key":"cb5450d4d421"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cb7e4d61305b"}],"_type":"block","style":"normal","_key":"0911abfbc706"},{"_key":"508808917099","markDefs":[],"children":[{"text":"And I'll just go down that road really quickly because physicians see patients of every economic level, of every cultural background, language background. We take social histories; we need to understand whether people have housing, whether they have children, whether they smoke or use drugs. We take a very comprehensive history when we're talking to people. So, not only do we see people from every walk of life, but we understand their social issues. 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As a scientist, that's challenging, but we need to continue to try to use data-driven principles to pass public policy that really thinks about public health.","_key":"afbc5375a029"}],"_type":"block","style":"normal","_key":"dfab5f118ab9","markDefs":[]},{"style":"normal","_key":"417e62a09b7e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6434e552fbfa"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Back to the question about public health, the most impact that we can make on the health of our communities is public health interventions, whether it's, decreasing smoking or making sure that people have clean air and clean water. You know, it used to be sewage systems and garbage collection. There are things that we have done as a nation that protects the public's health, and now we're backing away from things like vaccination, and you know, it's really a challenge for me. 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disease","IRA","CMS","Medicare"],"_rev":"YWcaOEnoBlIIUJkIBnYD1E","articleType":"Commentary","link":"/view/comprehensive-care-the-key-to-managing-diabetes-and-its-complexities","is_visible":true,"url":{"current":"comprehensive-care-the-key-to-managing-diabetes-and-its-complexities","_type":"slug"},"ExcludeFromPubMedXML":false,"_createdAt":"2024-09-03T15:04:26Z","summary":"Ian Neeland, MD, of University Hospitals and Case Western Reserve University, recommended a team-based, comprehensive approach to managing diabetes and its related complications.","_updatedAt":"2024-09-04T00:36:22Z","body":[{"videoObject":{"videoDuration":"PT3M01S","videoDescription":"dr ian neeland, diabetes, cardivascular disease, CMS, IRA","_type":"videoDetails","videoTitle":"Comprehensive Care: The Key to Managing Diabetes and Its Complexities","thumbnail":{"_type":"image","asset":{"_ref":"image-263b531d9534ac200208a55fddaddab42d9b1abf-2880x1617-png","_type":"reference"}}},"_type":"video","videoID":"6361448904112","disableAutoPlayVideo":false,"source":"brightcove","_key":"640ec920956f"},{"children":[{"_type":"span","marks":[],"text":"Ian Neeland, MD, director of cardiovascular prevention and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart \u0026 Vascular Institute, sees the CMS-negotiated drug prices under the Inflation Reduction Act (IRA) as a positive step to improve access to essential therapies for patients with Medicare. ","_key":"ea88d93336300"}],"_type":"block","style":"normal","_key":"eeb13766173b","markDefs":[]},{"style":"normal","_key":"0ef01a9ba6dc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4ab2477e30c1"}],"_type":"block"},{"style":"normal","_key":"bf235eaf630a","markDefs":[{"_key":"14f1c8385db3","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/diabetes"},{"href":"https://www.ajmc.com/compendium/cardiovascular","_key":"e181fbdaa281","nofollow":false,"blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"He also recommended a team-based, comprehensive approach to managing ","_key":"38acfc6c60c8"},{"_type":"span","marks":["14f1c8385db3"],"text":"diabetes","_key":"4dcb82a33ee4"},{"_type":"span","marks":[],"text":" and its related complications. Although Neeland eagerly anticipates new developments in glucagon-like peptide-1 (GLP-1) medications and other cardio-renal-metabolic therapies, he noted that medication adherence concerns in patients with ","_key":"cc9ef034e434"},{"marks":["e181fbdaa281"],"text":"cardiovascular disease","_key":"75ebce2bb3a6","_type":"span"},{"_type":"span","marks":[],"text":" highlight the risks of access barriers.","_key":"6c7872192b43"}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"2ebb6bc744d6","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"701741c8d82b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Neeland is also an associate professor of medicine at the Case Western Reserve University School of Medicine.","_key":"708afc5be26a"}],"_type":"block","style":"normal","_key":"8ba6fb8671fb"},{"style":"normal","_key":"9fa7b4ee4063","markDefs":[],"children":[{"_type":"span","marks":[],"text":"\n","_key":"4821ff4884ab0"},{"text":"This transcript has been lightly edited for clarity.","_key":"4821ff4884ab1","_type":"span","marks":["em"]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"43eb77b31f3c"}],"_type":"block","style":"normal","_key":"fd3c12279fb2"},{"style":"normal","_key":"00b39d6b02b7","markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"564edefefe7f"}],"_type":"block"},{"children":[{"_key":"8e3d632ff0fc","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"9dd2649101fa","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?","_key":"02c5eda4543b0"}],"_type":"block","style":"normal","_key":"64c57a3fec0e","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"efe94791944a"}],"_type":"block","style":"normal","_key":"80f1c80517ad","markDefs":[]},{"style":"normal","_key":"d022031bd37d","markDefs":[],"children":[{"marks":[],"text":"I think it's a very positive move. I think that access to evidence-based therapies has been hindered by cost, especially for folks with Medicare who can't afford the donut hole and those issues that go along with it, so I think this is a great step forward. As many people who can access appropriate care as possible is always a positive thing.","_key":"d85efb9e67e10","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"7cb78c4b0fd1","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"811cb63be63a"},{"style":"normal","_key":"6483f9bfe32e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What does a team approach look like when treating a patient with diabetes to prevent or address other health issues they have?","_key":"2409f3a2f6470"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f98531665d9f"}],"_type":"block","style":"normal","_key":"20fff7f46474"},{"markDefs":[],"children":[{"text":"Because diabetes is a complex disease with issues related to not just blood sugar control but cardiovascular, kidney, other metabolic [diseases], and obesity, you need a comprehensive team and a management plan that can address all of those different issues together in a way that can attack the central problem and, therefore, resolve many of the issues together. ","_key":"cbe7c013bf310","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2018527ee962"},{"_type":"block","style":"normal","_key":"0e4c1ad616d5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a10f88061ef5"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"So, a team-based approach that's patient centered and comprehensive is, in my opinion, the best way forward in treating diabetes and its complications.","_key":"52032fa033aa"}],"_type":"block","style":"normal","_key":"81c3cb5dd199"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0dfe6ae5be6c"}],"_type":"block","style":"normal","_key":"f110c516d2a9"},{"style":"normal","_key":"6e0157609bf2","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Are there patients who we know are likely to benefit the most from the use of GLP-1s?","_key":"9dff51b7458a0"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"47493160d15e","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"dff298146356"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Patients who have multiple comorbidities, for example, diabetes, obesity, and cardiovascular disease, those patients would most likely benefit from GLP-1–related therapies, because they address many of those different comorbidities together in a comprehensive fashion.","_key":"273ca05712160"}],"_type":"block","style":"normal","_key":"26de2105f966"},{"_key":"048ca0dd5491","markDefs":[],"children":[{"_key":"bd6d912da881","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"What is the prevalence of adherence to medication among patients with cardiovascular disease and how does that impact the risk of developing something else down the line?","_key":"b70c151d27070"}],"_type":"block","style":"normal","_key":"c52d2d0b2495","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"2eab64d9f85e"}],"_type":"block","style":"normal","_key":"d338ba827dc9","markDefs":[]},{"_key":"0f0515bfd679","markDefs":[],"children":[{"text":"It depends on the type of medication in terms of how adherent one may be. In general, it's about 80% adherence to therapies, with about 20% of individuals who can't tolerate certain therapies and are unable to take them. ","_key":"fa5014b1b9e00","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6fffa4ba5842"}],"_type":"block","style":"normal","_key":"3af5a91c1852"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There's also an issue of access. Even if patients want to take the therapies, they may not be able to get the therapy paid for, so that can have deleterious consequences down the line. If patients are not on appropriate therapies, they're at high risk for recurrent cardiovascular events and even death.","_key":"78cc5d3c2b61"}],"_type":"block","style":"normal","_key":"a904d22cbfc6"},{"_key":"0bbff46cfb6d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bc1592a2ae85"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?","_key":"6fceed0931380"}],"_type":"block","style":"normal","_key":"cbcd8bc71236","markDefs":[]},{"_type":"block","style":"normal","_key":"53101f790405","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7977c42d8dcd"}]},{"markDefs":[],"children":[{"text":"I think new compounds and new advances in therapies are very exciting. There [are] GLP-1–related therapies, and there [are] more coming down the market in terms of different agonists, dual- [and] triple-agonists, and even antagonists, that are now out there. ","_key":"b69b62dc4c120","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"df4b0aa13657"},{"_key":"6923276eef4b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"73d026a73495"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think those are very exciting, because the more we learn about those therapies, the more we see benefits across different cardiovascular-kidney-metabolic areas. 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Denlinger, MD, FACP, CEO of the National Comprehensive Cancer Network. ","_key":"bdb0936ff1400"}],"_type":"block","style":"normal","_key":"203c285be6a4"},{"_type":"block","style":"normal","_key":"5fe40c419e1e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3bf67197029a"}]},{"markDefs":[{"_key":"991ed612001f","nofollow":true,"blank":true,"_type":"link","href":"https://www.nccn.org/business-policy/policy-and-advocacy-program/nccn-findings-on-cancer-drug-shortages"}],"children":[{"_type":"span","marks":[],"text":"In June, the NCCN released ","_key":"3f2e87fe5077"},{"_type":"span","marks":["991ed612001f"],"text":"its latest survey","_key":"cd4ec153f9e7"},{"_type":"span","marks":[],"text":" on the ongoing cancer drug shortage among its member institutions.","_key":"531db9fe218c"}],"_type":"block","style":"normal","_key":"2be4075a16f7"},{"_key":"0e0981fa0ff5","markDefs":[],"children":[{"text":"","_key":"29fc1bf6cd9d","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/cancer-drug-shortage-causes-trends-and-implications-for-clinical-trials","_key":"137099bc02df","nofollow":false}],"children":[{"marks":["137099bc02df"],"text":"Click here for part 1","_key":"5ac5f8182c9e","_type":"span"},{"_type":"span","marks":[],"text":" of our interview with Dr Denlinger.","_key":"c2aa1f4a91f7"}],"_type":"block","style":"normal","_key":"30c533282fd0"},{"style":"normal","_key":"5c2d806e34e1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0ab9cfdbda30"}],"_type":"block"},{"_type":"block","style":"normal","_key":"21dc4759d5ba","markDefs":[],"children":[{"marks":["em"],"text":"This transcript has been lightly edited. ","_key":"fd25a451060f","_type":"span"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4fe3b0908997"}],"_type":"block","style":"normal","_key":"ca15b3a733bb"},{"_key":"1e4b3a2e2f8e","markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"411b6bc454f2"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":["strong"],"text":"How effective have waste reduction and adjusted dosing strategies been in managing shortages, and what challenges remain in their implementation?","_key":"b55eaae099680","_type":"span"}],"_type":"block","style":"normal","_key":"55e47cb93a5c"},{"style":"normal","_key":"6312a7e81c44","markDefs":[{"_type":"link","href":"https://www.ajmc.com/view/nccn-survey-reveals-best-practices-for-cancer-drug-shortage-management","_key":"40ced9b425fa","nofollow":false,"blank":true}],"children":[{"_type":"span","marks":[],"text":"We don't have any data on long-term effectiveness of these strategies, but what we do know from our studies and this ","_key":"0bd51a518c010"},{"_type":"span","marks":["40ced9b425fa"],"text":"most recent survey","_key":"7c6728d206ae"},{"_type":"span","marks":[],"text":" is that all of the responding centers have been able to treat all of the patients that were receiving regimens that included drugs that were in short supply. Although, slightly over half of those centers required some mitigation strategy. What that means is they're essentially doing more with less in order to ensure that every person with cancer is still able to achieve the best possible outcome.","_key":"c4dc91817135"}],"_type":"block"},{"_key":"ccb15685b813","markDefs":[],"children":[{"text":"","_key":"1227efceee81","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"style":"normal","_key":"3916b2bbd40f","markDefs":[],"children":[{"_key":"86c5ebb256a6","_type":"span","marks":[],"text":"The centers that responded and that are participating in our survey are doing a tremendous job of mitigating the impact of drug shortages through careful waste management procedures, but also working to adjust timing and dosing of the regimens within evidence-based recommendations. So, they are not stretching the regimens too long or lowering doses too much, but most chemotherapy regimens have a little bit of a window that we know is within the therapeutic window, and there are ways in which you can modify doses and time for that."}],"_type":"block"},{"_type":"block","style":"normal","_key":"6a90beb9a262","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fc7117438fed0"}]},{"style":"normal","_key":"50b260b16850","markDefs":[],"children":[{"text":"We've seen centers that are also potentially limiting the ability to order multiple cycles of therapy at a time. So instead of being able to order maybe 4 cycles, you only order 2 cycles, so that there is more thought about whether that drug needs to be allocated to that patient. We may also see physicians that are switching to an alternative regimen that doesn't include the drug on shortage, or a regimen that has similar effectiveness and efficacy, again, according to evidence-based guidelines and evidence-based practice. But all these processes are very time consuming, both for the physician at the decision-making process, as well as the downstream burden of making these switches. The additional administrative components of this care delivery can be challenging as well.","_key":"4f565a72e30a0","_type":"span","marks":[]}],"_type":"block"},{"_key":"b9de1c470d8d","markDefs":[],"children":[{"marks":[],"text":"","_key":"cf9ff7e68d660","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"584394741eb5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We've unfortunately found that although all the patients were able to receive the therapy that they were intended to receive, 27% of our centers reported that the current shortages were causing treatment delays due to additional prior authorization needed for a modified treatment plan, when that treatment plan was due to a drug shortage concern. And so, while these mitigation strategies are put into place to protect the patients, it does mean that there is some potential for challenges in receiving therapy in a timely fashion.","_key":"5b023974c01a0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"c3568cd9ea6d","markDefs":[],"children":[{"text":"","_key":"6a8a7414a2ee0","_type":"span","marks":[]}]},{"_key":"ff3022183d55","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We also want to note that our member institutions are leading academic cancer centers across the country, which are particularly well equipped to deal with these types of disruptive shortages. So, the data that we're seeing in the survey, where additional mitigation strategies are necessary and authorization could result in treatment delays, could actually be part of a larger problem or just the tip of the iceberg when we look more broadly across the US hospital systems, and look at things like safety net hospitals and community practices that serve more vulnerable members of our community.","_key":"4e5f9f3b082b0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"","_key":"d5b9ee99cd81","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"6277e7f0dd64"},{"_key":"aacf47fc6642","markDefs":[],"children":[{"text":"The survey suggests economic incentives like tax breaks or manufacturing grants for generic drugmakers. How do you envision these incentives working in practice, and what policy changes are necessary to support their implementation?","_key":"4ac3c25d28e60","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"d9ddfa2e96420","_type":"span","marks":[],"text":"The good news about the current drug shortage, especially the drug shortage over the past year with the carboplatin and cisplatin—if there is a silver lining in all of this—is that people started talking about this challenge and this problem. I've been a GI [gastrointestinal] medical oncologist for my career and 5-fluorouracil leucovorin has intermittently been on shortage for a while now. In fact, that's one of the drugs that was consistent across all 3 surveys as being in shortage."}],"_type":"block","style":"normal","_key":"5cd4a4f73c97"},{"_key":"39be752edf1c","markDefs":[],"children":[{"marks":[],"text":"","_key":"6fccaeebfb980","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"The centers that were surveyed found that the most promise is really in the idea of tax breaks and manufacturing grants to incentivize the production of high-quality generic medications. And of course, that's important because these medications form the backbone of many of our multiagent regimens across both the curative and palliative intent setting. There's a recognition that one of the challenges is inadequate infrastructure around communication and information, as well as limited preparedness strategies. 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The policies around the incentives, like tax breaks and manufacturing grants, could serve to help correct this process in the current marketplace, because everyone in the marketplace operates on such a narrow margin and the current marketplace incentivizes business practices that may falter in the face of any sort of threat."}]},{"_key":"b870b8574377","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1ba526dfbc01"}],"_type":"block","style":"normal"},{"children":[{"_key":"68fa0726b45d","_type":"span","marks":[],"text":"There are a number of proposals that we've seen through legislation recently in Congress, which include limiting the application of generic drug inflation rebates under the Medicaid Drug Rebate Program, recognizing that these critical medications are already underpriced; exempting generic sterile injectable drugs with at least 1 indication for serious diseases or conditions that are made by more than 1 manufacturer from being required to provide 340B pricing and rebates; and then also developing tax incentives that encourage the manufacturing of generic medications in the United States. 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patients could benefit from payers learning more about a new drug by joining clinical trials earlier.","body":[{"disableAutoPlayVideo":false,"source":"brightcove","_key":"2a5538bf6c8c","videoObject":{"videoDescription":"Fulling and Cournoyer discuss payers in clinical trials","_type":"videoDetails","videoTitle":"Patients could benefit from payers being introduced into clinical trials earlier","thumbnail":{"_type":"image","asset":{"_ref":"image-f20bffe851b935217ac5bbc5365250a16eb5a664-1280x720-jpg","_type":"reference"}},"videoDuration":"2M38S"},"experienceID":"6358318831112","_type":"video","videoID":"6358318831112"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Doug Fulling, MA, president of Precision AQ, and Andrew Cournoyer, MBA, senior vice president and director of the access experience team, Precision AQ, spoke with ","_key":"6f4f811886e1"},{"_key":"3adbe61dac3e","_type":"span","marks":["em"],"text":"The American Journal of Managed 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clarity."}]},{"_type":"block","style":"normal","_key":"62b5dab87725","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3b5c80c6469f"}]},{"_key":"70fc9cab5531","markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"735f796f6ab60"}],"_type":"block","style":"normal"},{"_key":"822443e4c03e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How can patients benefit from payers being introduced into clinical trials earlier?","_key":"1c0a6684024a0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"7ac6cd29090d","markDefs":[],"children":[{"marks":["strong"],"text":"Doug Fulling:","_key":"75323952f2d40","_type":"span"},{"_type":"span","marks":[],"text":" One of the big focuses in clinical research is to diversify the patient populations that actually participate in clinical research. And if you think about payers, they have access and exposure to those diverse patient populations. So by working closely with them during the clinical trial, we have the ability to focus on making sure that there's a true representation of the US population, for those clinical trials through payers who can identify diverse patient populations. So that's number 1.","_key":"41cdf5bf049e"}]},{"_type":"block","style":"normal","_key":"d124c7665ad4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Number 2, is not everybody has access to a clinical trial. There are limitations on where research is done, and we believe that payers can be the missing link in connecting patients who might be eligible to facilities that are actually running these clinical trials. There's a big gap in how many people actually have the opportunity to participate.","_key":"2446d84aef88"}]},{"_key":"21395fd49e38","markDefs":[],"children":[{"text":"Those are where there's opportunities for patients. It's really in diversifying the clinical research and giving those populations that wouldn't necessarily have accessibility to those trials and then also just broadening the education and the awareness of clinical trials that are taking place in the market.","_key":"de30bfa8346e","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"2b6c83df11db","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"339a0a84abaf0"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Andrew Cournoyer:","_key":"b2a5aba15cff0"},{"_type":"span","marks":[],"text":" On that education front, there might be one other thing that payers have an opportunity to support, because they have a large team of case management or case managers, or they are individuals who are making direct patient contact or out in the field. When it comes to a clinical trial, there's a lot of stigma associated with them that's kind of a treatment of last resort. And that's not usually the case, actually. It's getting someone involved earlier, like we were saying earlier, may actually drive a better outcome quicker soonere and then ultimately a better quality of life for that patient.","_key":"68de9b3a37d8"}],"_type":"block","style":"normal","_key":"cd933de629ab"},{"_type":"block","style":"normal","_key":"29a9900af364","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think payers are in a unique position to help educate their members or patients, if you will, about the benefits of clinical trials to help remove some of the stigmas in the adoption. There are certainly a number of health disparities and social determinants of health that are negatively impacting the certain trust factors that go into patients entering into trials. 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There are 3 simple recommendations that I would make to ICER that could improve the accuracy of their reports.","_key":"d5ba4ed317710","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d18938a2034e0"}],"_type":"block","style":"normal","_key":"fa82cf70ffbc"},{"_type":"block","style":"normal","_key":"813dac6554a5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The first one is methods, and there's all sorts of things that ICER could do to change their methods, but [there are] 2 that I think are low-hanging fruit at this point. One is dynamic pricing, and dynamic pricing is looking at pricing over the life cycle of a drug. Drugs go generic, which is a benefit that drugs have that most other health care services and treatments don't. Dynamic pricing involves looking at the pricing over the life cycle of the drug, and factoring in that pricing when it goes generic, which is a significant drop in price. That other low-hanging fruit from a method standpoint is looking at the discount rate. ICER’s been using a 3% discount rate, which again, is looking out into the future and discounting future costs and benefits. There's a lot of evidence now that shows that maybe a 2% discount rate would be better, and that's going to dramatically change the results that you get from an ICER value assessment. So that's point number 1, some low-hanging fruit changes in the methods.","_key":"8f53f9d623ff0"}]},{"_type":"block","style":"normal","_key":"dbf100ae4a2a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b18a4b6d9cda0"}]},{"children":[{"_type":"span","marks":[],"text":"Point number 2 is eliminating what ICER is calling it’s shared savings model. This is something that ICER originally introduced for its short-term and transformative therapies. It's not evidence-based, and what it does is it artificially caps the price. So rather than looking at what ICER would recommend as its health benefit price benchmark that comes out of its cost effectiveness analysis model, it caps and comes in at a lower price. It positions this as sharing the savings with society, but what it's really doing is capping the price, and sharing the savings with the payers. That's of concern because it can affect the incentives for future innovation, and again, it can affect patient access. So that's point number 2, to eliminate the shared savings, which has also started to creep into ICER’s regular value assessments, not just the single and short-term transformative therapies, which is a big concern.","_key":"17cca5dd2b3d0"}],"_type":"block","style":"normal","_key":"ee21854f05ea","markDefs":[]},{"_key":"7b957ddaf669","markDefs":[],"children":[{"_key":"6412a90e34680","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"74bc967e4283","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/36316575/","_key":"3367220e4827"}],"children":[{"_type":"span","marks":[],"text":"The third area is patients themselves. ICER has a patient engagement program that has developed over the years. They went from having an informal program to a formal program, and they have made great strides in engaging with patients and talking with patients, which is fantastic. Where they haven't made great strides is for the feedback that's coming from patients to really be impacting the results of the assessments. We're at an inflection point where ICER could be thinking about, “How do we pull that information from patients into the assessments in a way that it actually has a meaningful impact on the results?” There's an interesting","_key":"9ba656aca13d0"},{"_type":"span","marks":["3367220e4827"],"text":" model","_key":"14675c7bca22"},{"_type":"span","marks":[],"text":" that's come out from Brett McQueen [Robert Brett McQueen, PhD, associate professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences] and others that looks at involving patient feedback as part of the deliberative process in a meaningful way. So those are my recommendations for ICER. Number 1: do some of the method changes that are low-hanging fruit. Number 2: eliminate the shared savings approach. And number 3: involve patient feedback and patient engagement in a way that it meaningfully impacts the results of the assessment.","_key":"ca7cbfa7689c"}],"_type":"block"},{"style":"normal","_key":"4bd108ccc11d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"380224d306cb"}],"_type":"block"}],"contentCategory":{"_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z"},"source":null,"authorMapping":[{"url":{"current":"pearl-steinzor","_type":"slug"},"displayName":"Pearl Steinzor","_createdAt":"2022-10-05T15:22:49Z","_type":"author","_id":"8f51e09f-2c76-4ef0-83e7-d577a5dfcdd1","profileImage":{"_type":"mainImage","alt":"Pearl Steinzor","asset":{"_ref":"image-aaad3972f041cf080c4994a923d62017c74f0ac3-512x512-jpg","_type":"reference"}},"firstName":"Pearl ","lastName":"Steinzor","_rev":"r4x1XD7WYsdf9YL1ZVgDGC","_updatedAt":"2024-10-25T15:48:33Z"}],"url":{"current":"kimberly-westrich-s-icer-recommendations-to-improve-drug-pricing-data-accuracy","_type":"slug"},"ExcludeFromPubMedXML":false,"articleType":"Commentary","thumbnail":{"asset":{"extension":"png","path":"images/0vv8moc6/ajmc/51a9b215e0f8ed1d7a4322c0bf5341c39425e2d5-2870x1558.png","size":2226412,"originalFilename":"Screen Shot 2024-05-06 at 8.14.52 PM.png","metadata":{"hasAlpha":true,"lqip":"data:image/png;base64,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","dimensions":{"_type":"sanity.imageDimensions","width":2870,"aspectRatio":1.8421052631578947,"height":1558},"isOpaque":true,"blurHash":"MjIZSYgOPqrWvz~padrWW=R%$%WBjEbco#","_type":"sanity.imageMetadata","palette":{"_type":"sanity.imagePalette","darkMuted":{"background":"#3f252b","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":0.24},"muted":{"title":"#fff","population":3.11,"background":"#9f4f6d","_type":"sanity.imagePaletteSwatch","foreground":"#fff"},"lightVibrant":{"_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.02,"background":"#69ccfc"},"darkVibrant":{"background":"#134b6f","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":0.3},"lightMuted":{"_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.03,"background":"#b5c4cd"},"vibrant":{"foreground":"#000","title":"#fff","population":0.01,"background":"#42b4e2","_type":"sanity.imagePaletteSwatch"},"dominant":{"title":"#fff","population":3.11,"background":"#9f4f6d","_type":"sanity.imagePaletteSwatch","foreground":"#fff"}}},"uploadId":"PPYzmHnnlCoYwX867MHRhlV3L5R1jUT6","mimeType":"image/png","url":"https://cdn.sanity.io/images/0vv8moc6/ajmc/51a9b215e0f8ed1d7a4322c0bf5341c39425e2d5-2870x1558.png","_rev":"R1ZyLttsGV4TgeIGV8JhkZ","_type":"sanity.imageAsset","_id":"image-51a9b215e0f8ed1d7a4322c0bf5341c39425e2d5-2870x1558-png","sha1hash":"51a9b215e0f8ed1d7a4322c0bf5341c39425e2d5","assetId":"51a9b215e0f8ed1d7a4322c0bf5341c39425e2d5","_createdAt":"2024-05-07T00:15:46Z","_updatedAt":"2024-05-07T00:15:46Z"}},"summary":"Kimberly Westrich, MA, chief strategy officer of the National Pharmaceutical Council, shares 3 key recommendations to improve the accuracy and quality of drug pricing data. 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","documentGroup":{"_ref":"conference_ispor","_type":"reference"},"authorMapping":[{"_id":"8f51e09f-2c76-4ef0-83e7-d577a5dfcdd1","profileImage":{"_type":"mainImage","alt":"Pearl Steinzor","asset":{"_ref":"image-aaad3972f041cf080c4994a923d62017c74f0ac3-512x512-jpg","_type":"reference"}},"url":{"current":"pearl-steinzor","_type":"slug"},"displayName":"Pearl Steinzor","_createdAt":"2022-10-05T15:22:49Z","_type":"author","_updatedAt":"2024-10-25T15:48:33Z","firstName":"Pearl ","lastName":"Steinzor","_rev":"r4x1XD7WYsdf9YL1ZVgDGC"}],"title":"Dr Phaedra Corso Discusses How to Incorporate Economic Research Into Health Policy","taxonomyMapping":[{"name":"Conference","_id":"1862ee25-8e65-4dbe-8fd3-d4c11642b211","_updatedAt":"2022-07-31T01:47:04Z","identifier":"conference","_createdAt":"2020-03-30T19:06:53Z","_rev":"Zzg2CQjl4x3UedGJkY3tyu","_type":"taxonomy"},{"_updatedAt":"2023-10-30T17:48:32Z","identifier":"interviews","_createdAt":"2020-03-30T19:16:54Z","sortOrder":3,"_rev":"xqhc4WIQcOa1P2rns6bqkh","_type":"taxonomy","name":"Interviews","_id":"2d909731-8acf-4e3d-8962-d59b0da85320"},{"parent":{"_ref":"15012229-f713-4f0a-8f82-7667530bb382","_type":"reference"},"_createdAt":"2020-05-04T23:46:13Z","_rev":"GQ2iWOdzjKwgYpKUFVt5oL","_type":"taxonomy","name":"Policy","_id":"topic_policy","_updatedAt":"2020-07-30T14:47:46Z","identifier":"policy"}],"_updatedAt":"2024-05-08T18:49:15Z","body":[{"_type":"video","videoID":"6352541325112","disableAutoPlayVideo":false,"source":"brightcove","_key":"d3985cfd975c","videoObject":{"thumbnail":{"_type":"image","asset":{"_ref":"image-311cfc16a4aeb44aeaf3ac9f240979cc7afbdd2c-2872x1549-png","_type":"reference"}},"videoDuration":"2 min 30 seconds","videoDescription":"Dr Phaedra Corso Discusses How to Incorporate Economic Research Into Health Policy","_type":"videoDetails","videoTitle":"Dr Phaedra Corso Discusses How to Incorporate Economic Research Into Health Policy"}},{"_type":"block","style":"normal","_key":"84eb8e7f1bb7","markDefs":[],"children":[{"_key":"169fbf93ad89","_type":"span","marks":[],"text":"It is important to consider the cost-effectiveness of interventions in order to prioritize resources and maximize impact, says Phaedra Corso, PhD, associate vice president for research at Indiana University. "}]},{"_key":"6d78ad3eeff5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8e58c01cd014"}],"_type":"block","style":"normal"},{"children":[{"_key":"bffd6b9edbb6","_type":"span","marks":["strong","underline"],"text":"Transcript"}],"_type":"block","style":"normal","_key":"3626989264f6","markDefs":[]},{"_key":"598377198aca","markDefs":[],"children":[{"marks":["strong"],"text":"How can economic research methods effectively inform public health policy decisions?","_key":"7adffe854c2c0","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"I think in the world of public health, we are doing a good job of looking at the evidence of our interventions in terms of the effectiveness of prevention interventions within a community, for example. The way that economic evidence plays a role there is, we don't just look at how effective our interventions are, but we look at how cost effective interventions are. More and more, as public health resources are becoming scarce, policy makers really do need to know about their returns on investment, and that's what economic evidence provides the answer to.","_key":"19117ecf04780"}],"_type":"block","style":"normal","_key":"2e6586503aeb","markDefs":[]},{"children":[{"text":"","_key":"575261bc2865","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9801e57f842f","markDefs":[]},{"_key":"c5981f1a3416","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What challenges do policy makers face when incorporating economic research findings into public health policy, and how can these challenges be addressed?","_key":"b18671d866920"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"I think one of the big challenges for policy makers who want to consider economic evidence in their decision-making is the lack of evidence, in particular. So just as an example, The Guide to Community Preventive Services, which looks at the effectiveness of public health interventions, also has a component that looks systematically at the evidence of economic evidence. And oftentimes, there's only 1 or 2 studies available. And so, they may have a lot of evidence on the effectiveness, but very little evidence on cost effectiveness. It's the lack of research in that area that causes, perhaps, the biggest problem.","_key":"ca5ac7ec47590"}],"_type":"block","style":"normal","_key":"5f581d5a9aca","markDefs":[]},{"style":"normal","_key":"f404ab9940c9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"60c31f7de783"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"I would say another challenge for policy makers who want to use economic evidence for public health interventions is the fact that a lot of times, the evidence we have an effectiveness is a preliminary outcome measure, like cases prevented, instead of looking at a more final outcome, like lives saved. And so, when you look at cases prevented, you have to look at economic evidence that is similar to that type of evidence. So, it has to be cases of hepatitis prevented, for example. In cases of hepatitis prevented, as opposed to cases of lives saved, or cost per lives saved, where you could look across public health interventions. 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Reach out to Kaitlyn Musessen, Strategic Alliance Partnership Manager, to learn more about the complimentary strategic partnership program at 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the IRA May Shift Economic Incentives for Drug Manufacturers: Dr Julie Patterson","_createdAt":"2024-05-06T20:46:21Z","body":[{"_key":"55a18449524b","videoObject":{"thumbnail":{"_type":"image","asset":{"_ref":"image-a261315462c3f4c4c5f764bafbf545415d36d7dd-1032x580-png","_type":"reference"}},"videoDuration":"PT4M12S","videoDescription":"Dr Julie Patterson on How the IRA May Shift Economic Incentives for Drug Manufacturers","_type":"videoDetails","videoTitle":"Dr Julie Patterson on How the IRA May Shift Economic Incentives for Drug Manufacturers"},"_type":"video","videoID":"6352486652112","disableAutoPlayVideo":false,"source":"brightcove"},{"markDefs":[],"children":[{"text":"Aspects of the Inflation Reduction Act (IRA) have potential to shift incentives for drug manufacturers and impact the amount of long-term evidence generated for approved drugs, said Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council. ","_key":"7c4a36ac9ce8","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"b5c042230857"},{"style":"normal","_key":"91c3e774a9a3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"04abe9b9874f"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"In a study published in ","_key":"517c5ca2395e"},{"_type":"span","marks":["em"],"text":"The American Journal of Managed Care","_key":"9b1bebed06c9"},{"marks":["superscript"],"text":"® ","_key":"29de3c27ddd4","_type":"span"},{"text":"(","_key":"b7f8adf88e53","_type":"span","marks":[]},{"text":"AJMC","_key":"2d4737d7bfd0","_type":"span","marks":["em"]},{"_type":"span","marks":["superscript"],"text":"®","_key":"6028e33717bf"},{"_type":"span","marks":[],"text":"), Patterson and colleagues discussed potential unintentional effects of the IRA. The paper, \"","_key":"9ecc18a9ce3c"},{"_type":"span","marks":["046f40c22189"],"text":"Unintended Consequences of the Inflation Reduction Act: Clinical Development Toward Subsequent In","_key":"249a4f105585"},{"marks":["3281df1b9839"],"text":"dications","_key":"183a705431f8","_type":"span"},{"_type":"span","marks":[],"text":",\" highlights several areas of small molecule drug research and development that could be impacted as the IRA's Medicare Drug Price Negotiation Program is implemented.","_key":"4b266163f7fc"}],"_type":"block","style":"normal","_key":"2faef1d1c3b5","markDefs":[{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/view/unintended-consequences-of-the-inflation-reduction-act-clinical-development-toward-subsequent-indications","_key":"3281df1b9839"},{"href":"https://www.ajmc.com/view/unintended-consequences-of-the-inflation-reduction-act-clinical-development-toward-subsequent-indications","_key":"046f40c22189","nofollow":false,"blank":true,"_type":"link"}]},{"_type":"block","style":"normal","_key":"8295f49ebf72","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"19924317a826"}]},{"style":"normal","_key":"963de9140642","markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/how-potential-unintended-impacts-of-the-ira-may-affect-patients-dr-julie-patterson","_key":"52c79e426a9e","nofollow":false},{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/dr-julie-patterson-discusses-potential-unintended-effects-of-the-ira-on-drug-development","_key":"7ed711a09c54","nofollow":false}],"children":[{"_key":"f544ab1bffe8","_type":"span","marks":[],"text":"In previous video interviews with "},{"_type":"span","marks":["em"],"text":"AJMC","_key":"e596c9a7d68d"},{"marks":[],"text":", Patterson spoke about","_key":"d330ad18d22b","_type":"span"},{"marks":["7ed711a09c54"],"text":" the study's findings","_key":"f811f7680433","_type":"span"},{"_type":"span","marks":[],"text":" and what they could mean for pharmaceutical innovation, as well as ","_key":"270f8f6c937f"},{"_type":"span","marks":["52c79e426a9e"],"text":"how the unintended consequences may impact patients","_key":"d8a7c8092146"},{"text":". ","_key":"4959968e6b9b","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"aacc164753a4"}],"_type":"block","style":"normal","_key":"e8749fa5fc10"},{"_key":"6edfdab7e054","markDefs":[],"children":[{"_key":"5d30f1bc80ac","_type":"span","marks":["strong","underline"],"text":"Transcript"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How does the IRA shift economic incentives for manufacturers, and how could shifting incentives impact drug development?","_key":"76b4230f7ce7"}],"_type":"block","style":"normal","_key":"ce89c0585557"},{"children":[{"text":"We already ","_key":"e6a1cc520b12","_type":"span","marks":[]},{"_type":"span","marks":["10a2a117443f"],"text":"talked a bit about what the research showed","_key":"975840f7a986"},{"_type":"span","marks":[],"text":" and what the potential unintended consequences of the IRA might mean for clinical development. There's another area that will also be impacted by the IRA's clock for small molecule drugs that could reduce the amount of available information typically used by providers to inform patient-centered medicine and establish clinical guidelines. It takes a long time to generate evidence about the safety and effectiveness of new medicines. This is true for evidence required to gain FDA approval of a subsequent indication, which we've talked about already. It's also the case for long-term outcome studies that don't necessarily result in a subsequent indication, but do help to provide critical information that clinicians and providers rely on to inform best practices to treat patients and help establish guidelines. ","_key":"2c0b754b1e5d"}],"_type":"block","style":"normal","_key":"4b0cd08002cf","markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/dr-julie-patterson-discusses-potential-unintended-effects-of-the-ira-on-drug-development","_key":"10a2a117443f","nofollow":false}]},{"_type":"block","style":"normal","_key":"8e5ef46ffaaa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e583c2c09851"}]},{"markDefs":[{"_key":"58266ae7f62b","nofollow":true,"blank":true,"_type":"link","href":"https://www.healthaffairs.org/content/forefront/ira-could-delay-pharmaceutical-launches-reduce-indications-and-chill-evidence"}],"children":[{"_type":"span","marks":[],"text":"We ","_key":"07d528eda083"},{"_type":"span","marks":["58266ae7f62b"],"text":"published a case study late last year","_key":"9a34d6205aac"},{"text":" exploring how the IRA's short timeline to potential price setting reduces the incentives to generate this evidence. The concern is that providers and their patients may know less about the benefits of new medicines as a result.\n","_key":"81ddee69c88f","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"f6e186255ecd"},{"style":"normal","_key":"e564996e336b","markDefs":[],"children":[{"_key":"afbf80753668","_type":"span","marks":["strong"],"text":"What questions remain around implementation, and what are potential policy recommendations to address the issues you've identified in the paper?"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"f5d154f2768e0","_type":"span","marks":[],"text":"We'll be closely watching the implementation of the Drug Price Negotiation Program because there is still so much unknown about how the program will be implemented, and the choices that are made can exacerbate or perhaps help mitigate the potential unintended consequences that are being identified. "}],"_type":"block","style":"normal","_key":"9f2ad4beb697"},{"style":"normal","_key":"98185844f049","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"36466baa2f0a"}],"_type":"block"},{"_key":"9649982e1c37","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For example, what evidence is the government going to value in determining the set price? Is the government engaging solely in a cost-reduction exercise, or is it trying to pay based on the value of a medicine? And critically, how will the patient perspective be incorporated into the process, both for the first 10 drugs and going forward? People living with diseases, their families, their caregivers, ought to be critical voices in a process that is supposed to help patients. The final guidance from CMS about how their price determination process will be implemented was not clear about the patient experience, how that or the patient preferences and priorities will be incorporated into their decision. Failing to incorporate the patient voice in a systematic and transparent way threatens access and continued innovation. ","_key":"bfbc9e9931ee"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"","_key":"6dfbb4969b56","_type":"span"}],"_type":"block","style":"normal","_key":"3f96423af329","markDefs":[]},{"_key":"b59e175b18bf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our paper provides important data about the potential impact that the IRA's clock towards potential selection for price setting of small molecule drugs may have in delaying launches and reducing the number of diseases and patient populations that see newly approved therapies. It's important to note that the IRA's clock towards selection for the drug price negotiation program is shorter for small molecule drugs than biologics. So, many have called for extending the clock for small molecule medicines to at least be the same as biologics to prevent the so-called \"pill penalty.\" Others have noted the potential unintended consequence of the IRA on innovation and access to new treatments that treat orphan or rare diseases. There are proposals designed to help dampen the negative impacts of the IRA for patients living with rare conditions. 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Traditional observational research has always used existing data like health insurance claims and, more recently, electronic medical records. But [with] direct-to-patient approaches, you get to find out how the patient really feels; what their lived experience is, either with the disease or with a treatment; and often you get to find out things that even the clinician may not know, either because they don't have a strong relationship with the patient, or the short time of the encounter, or the limited time for notes. So, you get the real truth from patients.","_key":"d89054ef7a4e0","_type":"span"}],"_type":"block","style":"normal","_key":"55e0a27fe66a"},{"_key":"74ac8e446d72","markDefs":[],"children":[{"marks":[],"text":"","_key":"5a025bc74d3b","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"980eabdf9565","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you elaborate on some examples of how direct-to-patient approaches have been used to enhance the depth of real-world data collection in observational research?","_key":"4d151657b3050"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Some of the best ways that direct-to-patient research has been done are ways that help both the researcher and the patient. For example, take a consented patient: If you're able to enroll the patient directly and get them to consent to participate in a study, this allows you to do 2 things. First of all, it allows you to tokenize their data for data linkage with other data-like health insurance claims and pharmacy claims. It also allows you to act as their agent to assemble their medical records across the entire health system, even if they've seen clinicians outside of their own system. So, the that the patient is the only throughput throughout the whole clinical experience is really important. And it's also important for their nonclinical experiences. So, all the lived experiences, the quality of life, the ability to get out of bed and greet the day.","_key":"04b97df677bd0"}],"_type":"block","style":"normal","_key":"32499b992f1d"},{"_key":"c192764d6b29","markDefs":[],"children":[{"_key":"6279f1e92f7f","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"871c58edea0b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What tools or strategies have been employed to support greater patient retention in observational studies utilizing direct-to-patient approaches?","_key":"2365ffe932e70"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"One of the things I'm most excited about are the direct-to-patient tools that actually give the patients something they can use every day. For example, giving them back their data in an organized fashion that allows them to better manage their clinical care. That's a huge gift. We also shouldn't forget the value of just reimbursing patients for their contribution. I've been doing direct-to-patient research for about 15 years, and in focus groups, people always say the same thing. You value what the clinician tells you, [so] \"show me you value what I show you.\" And we also know that that has a strong improvement in retention. Not as strong as giving them a tool they can use, regardless of the research program, but it sure does help.","_key":"fac85f923c1c0"}],"_type":"block","style":"normal","_key":"d74362b7041b","markDefs":[]}],"summary":"Nancy Dreyer, PhD, MPH, FISE, chief scientific advisor to Picnic Health, shares some of the ways that direct-to-patient approaches have improved observational research. 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There is a need for a multidisciplinary approach that incorporates mixed methods and patient-reported outcomes to gain a more comprehensive understanding of health care delivery and financing, Seth Berkowitz, MD, MPH, associate professor of medicine, University of North Carolina at Chapel Hill, said. ","_key":"f0ca016df0b90","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"53c3cdf6c12c"}],"_type":"block","style":"normal","_key":"2df15361972c"},{"markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"78c1d6a7ab5c"}],"_type":"block","style":"normal","_key":"a8427bf2e423"},{"_type":"block","style":"normal","_key":"64159d609260","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you elaborate on the concept of a whole-person health index and how it could be developed and utilized to measure the effectiveness of interventions aimed at supporting whole health?","_key":"901d137d69640"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"This might be a bit of a nerdy answer. I think there's actually a sub question as to whether an index is possible, or whether you're talking about different components that can't really be combined. So, the idea of an index, to me at least, is that you've got various commensurate outcomes. You can put a couple of different ones together, maybe you weigh some more than others, but fundamentally, you can generate a single kind of score, number, or something to it. And then once you have that, you can either minimize it or maximize depending on whether you think it's a good thing or a bad thing. So, highest level of health or lowest level of disability, or something like that.","_key":"4b18bb0f10d60"}],"_type":"block","style":"normal","_key":"4dfc5ee176d0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3c0c6ae6d44f0"}],"_type":"block","style":"normal","_key":"dbd754e8aeec"},{"_type":"block","style":"normal","_key":"45217eda6675","markDefs":[],"children":[{"_type":"span","marks":[],"text":"If things aren't commensurate though, then you can't necessarily put them all into a single index. And so, you instead have a couple of different outcomes. And then instead of minimizing or maximizing, you actually have to optimize over those. So, a combination of things that can't necessarily be traded off with each other. And I think one of the challenges of whole health is that it might be more like this kind of optimization problem, where you have a couple of different things that aren't exactly equivalent to each other or can't be weighted to make them equivalent. And so, what you're trying to do is pick patterns of different aspects of health that are important to look at. That's a challenging thing. But I think in some ways, it might better capture just sort of the nuance and the distinctiveness of the different aspects of health that whole health is trying to get at.","_key":"8658f4a50ae60"}]},{"markDefs":[],"children":[{"text":"","_key":"c88a41da2f3b","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"3a951cad475e"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"In addressing the \"wrong pocket problem,\" what strategies do you recommend for effectively accounting for the value of interventions across different sectors?","_key":"ed3df8c90d970"}],"_type":"block","style":"normal","_key":"6de5b8ff70ac"},{"_key":"3a0f521925a1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"This might be a bit of an unpopular answer, but the “wrong pocket problem” to me really speaks to the need for state or government involvement in these issues. I think, classically, we think of different sectors as being able to operate effectively when things are kind of self-contained, right? The resources they need to put in to produce an outcome are the outcomes that those resources then produce, are sort of all within the same sector. And when that doesn't happen, then the ability to organize the production of whatever you're trying to do, health services or something like that, by sector, kind of breaks down. And this, I think, has become sort of a justification for having state involvement, because the state is sort of the actor that can take this broader perspective and say, “Alright, resources put in one domain produce an outcome that's in a different domain, but because we're responsible for people's lives as a whole, then we can do this.\"","_key":"15841dc964d20"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7719b11b3f270"}],"_type":"block","style":"normal","_key":"335ed32f908a"},{"markDefs":[],"children":[{"marks":[],"text":"I fundamentally think a lot of the issues that are brought up by the “wrong pocket problem” become an argument for having the state be involved. To sort of give that more concretely, I do a lot of research on food insecurity. And so, a way that a “wrong pocket problem” might develop in that space is if an organization that is providing food insecurity interventions improves health, but then the benefits of that health improvement accumulate to a health care system that didn't have to expend as much on health. And so that creates the problem.","_key":"3760c20ce0950","_type":"span"}],"_type":"block","style":"normal","_key":"2e42a030de8c"},{"style":"normal","_key":"8cd57a1e842d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"66288a4b3ddc0"}],"_type":"block"},{"markDefs":[],"children":[{"text":"The solution might be that instead of having a private human services organization or something like that, you instead, focus more on state or government programs to alleviate food insecurity or prevent food insecurity from occurring in the first place, which might even be better. And then the state or government organization can sort of see the benefits of that in terms of an improvement in population health.","_key":"7f29f3ff48c20","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"070ed78487b4"}],"seoTag":["Whole Person Health Index","Whole Health","Health Index"],"_rev":"W5TjuiMsKRC9lGbuBIaban","_createdAt":"2024-05-06T18:00:31Z","_id":"fa87eb5a-9002-4dbf-88c5-ecd18475b6d0","published":"2024-05-06T17:36:12.215Z","authorMapping":[{"displayName":"Pearl Steinzor","_createdAt":"2022-10-05T15:22:49Z","_type":"author","_id":"8f51e09f-2c76-4ef0-83e7-d577a5dfcdd1","profileImage":{"_type":"mainImage","alt":"Pearl Steinzor","asset":{"_ref":"image-aaad3972f041cf080c4994a923d62017c74f0ac3-512x512-jpg","_type":"reference"}},"url":{"current":"pearl-steinzor","_type":"slug"},"firstName":"Pearl ","lastName":"Steinzor","_rev":"r4x1XD7WYsdf9YL1ZVgDGC","_updatedAt":"2024-10-25T15:48:33Z"}],"_type":"article","taxonomyMapping":[{"identifier":"interviews","_createdAt":"2020-03-30T19:16:54Z","sortOrder":3,"_rev":"xqhc4WIQcOa1P2rns6bqkh","_type":"taxonomy","name":"Interviews","_id":"2d909731-8acf-4e3d-8962-d59b0da85320","_updatedAt":"2023-10-30T17:48:32Z"},{"identifier":"conference","_createdAt":"2020-03-30T19:06:53Z","_rev":"Zzg2CQjl4x3UedGJkY3tyu","_type":"taxonomy","name":"Conference","_id":"1862ee25-8e65-4dbe-8fd3-d4c11642b211","_updatedAt":"2022-07-31T01:47:04Z"},{"_createdAt":"2020-05-04T23:46:13Z","_rev":"GQ2iWOdzjKwgYpKUFVt5oL","_type":"taxonomy","name":"Policy","_id":"topic_policy","_updatedAt":"2020-07-30T14:47:46Z","identifier":"policy","parent":{"_ref":"15012229-f713-4f0a-8f82-7667530bb382","_type":"reference"}}]}],"topArticlesData":[{"factCheckAuthors":null,"title":"Questions Loom as HHS Appointment Approaches","url":"questions-loom-as-hhs-appointment-approaches","thumbnail":{"_type":"mainImage","alt":"Lindsay Bealor Greenleaf","caption":"Lindsay Bealor Greenleaf","asset":{"_ref":"image-25a7cc9c4b47924174990b8292c058c6e2063755-3750x2000-png","_type":"reference"}},"updatedOn":null,"source":null,"_id":"cd049f91-2ec9-486f-bc6e-32a1b8db5d3d","summary":"Lindsay Bealor Greenleaf, JD, MBA, discusses how the appointment of Robert F. 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