Optum Rx Invokes Open Meetings Law To Fight Kentucky Counties on Opioid Suits

UnitedHealth Group’s multibillion-dollar pharmacy benefit manager, Optum Rx, is suing five Kentucky counties in an attempt to force them out of national opioid litigation against the company. Pharmacy benefit managers, often called PBMs, act as middlemen that negotiate prescription drug prices between drug companies, insurance plans, and pharmacies. Some lawyers and advocates say PBMs helped…

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Most Insurance Covers IUDs. Hers Cost More Than $14,000.

During her annual OB-GYN visit, Callie Anderson asked about getting off the birth control pill. “We decided the best option for me was an IUD,” she said, referring to an intrauterine device, a long-acting, reversible type of birth control. Anderson, 25, of Scranton, Pennsylvania, asked her doctor how much it might cost. At the time,…

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Do orphan drugs deliver more survival gains per patient than non-orphan drugs?

Conventional wisdom holds that orphan drugs treat rare (by definition) and more severe diseases. Because they treat diseases with significant unmet needs, their health benefits per person are large. But are they really? Does conventional wisdom align with the evidence? To answer the question myself and colleagues at FTI Consulting, including co-author Marie Steele-Adjognon, conducted…

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Oshi Health Secures $60M To Scale Virtual Digestive Care

Oshi Health’s $60 million Series C funding round was led by Oak HC/FT and included participation from existing investors Bessemer Venture Partners, Flare Capital Partners, Frist Cressey Ventures, CVS Health Ventures and Takeda Digital Ventures. The post Oshi Health Secures $60M To Scale Virtual Digestive Care appeared first on MedCity News.

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5 Key Facts About Nursing Facilities and Medicaid

The substantial Medicaid savings in the reconciliation bill that has been passed by the House could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them. Nursing facilities provide medical and personal care services for older adults and people with disabilities, and Medicaid covered 44% of long-term institutional…

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Would delinking PBM reimbursement from rebates save money?

According to a Health Affairs Scholar paper by Geoffrey Joyce out this month, the answer is ‘yes’. He writes: Most PBM contracts tie their compensation to a percentage of a drug’s list price, creating a financial incentive to favor high-cost, high-rebate drugs on plan formularies at the expense of lower-cost generics and biosimilars. Furthermore, the…

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Imaging Utilization and Treatment Patterns of Brain Metastases in Patients with Non-Small Cell Lung Cancer

That is the title of my most recent paper published in Clinical Lung Cancer with co-authors Mark Danese, Melissa Laurie, Beata Korytowsky, Shane Jordan, Debbie Ryan and Sukhmani K. Padda. The study abstract is below. ObjectiveThis study examined brain metastases among patients with metastatic non-small cell lung cancer (mNSCLC), characterizing prevalence, use of brain imaging,…

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