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Emerging trends in managed care pharmacy: A mixed-method study.
J Manag Care Spec Pharm
January 2025
Academy of Managed Care Pharmacy Foundation, Alexandria, VA.
Background: Over the past 5 years, managed care pharmacy has been shaped by a global pandemic, advancements in generative artificial intelligence (AI), Medicare drug price negotiation policies, and significant therapeutic developments. Collective intelligence methods can be used to anticipate future developments in practice to help organizations plan and develop new strategies around those changes.
Objective: To identify emerging trends in managed care pharmacy.
Economic impact associated with dronedarone use in patients with atrial fibrillation.
J Med Econ
January 2025
Sanofi, Bridgewater, NJ.
Objective/AimIn 2009, dronedarone was approved by the United States Food and Drug Administration based on results from the ATHENA trial (NCT00174785), which showed significant reduction of cardiovascular (CV) hospitalization and death in patients with atrial fibrillation (AF) randomized to dronedarone versus placebo. In 2020, a retrospective study by Goehring et al. showed CV hospitalizations and deaths were lower in clinical practice following initiation of dronedarone compared to other antiarrhythmic drugs (AADs) in patients with AF and atrial flutter.
View Article and Find Full Text PDFThe Comparison of Cost-Effectiveness Between Magnetic Resonance Spectroscopy and Provocative Discography in the Identification of Chronic Low Back Pain Surgery Candidates.
Clinicoecon Outcomes Res
January 2025
Department of Orthopaedic Surgery, UC San Francisco, San Francisco, CA, 94143-0728, USA.
Background/context: Chronic low back pain (CLBP) is a significant US healthcare burden with millions of lumbar spine procedures annually. Diagnostic tests are essential to guide treatment but provocative discography (PD), the most common diagnostic procedure, is without robust evidence of its value. A non-invasive alternative using Magnetic Resonance Spectroscopy (MRS) offers a potential solution.
View Article and Find Full Text PDFBackground: The Centers for Medicare and Medicaid Services (CMS) New Technology Add-on Payment (NTAP) program supports adoption of new, costly medical technologies demonstrating substantial clinical improvement. In 2021, CMS waived the "substantial clinical improvement" criterion for devices designated under the FDA Breakthrough Devices Program (BDP). This study characterized risk-standardized payments associated with hospitalizations in which Medicare beneficiaries received calcium modification during PCI for acute myocardial infarction (AMI) following the adoption of the Shockwave C Coronary Intravascular Lithotripsy (IVL) Catheter (Shockwave Medical) with BDP designation.
View Article and Find Full Text PDFFinancial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures in 2023.
Otolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
The Centers for Medicare & Medicaid Services (CMS) recently increased payment for evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits.
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