The American journal of managed care
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In this time of aging and increasingly multimorbid populations, effective and efficient case management approaches play a crucial role in supporting patients who are navigating complex health care systems. Until now, no rigorous systematic review has synthesized studies about the cost-effectiveness of case management. ⋯ Existing studies often have adequate quality and, in many cases, show cost-effective or even cost-saving results. Case management appears to be a promising method to support patients facing complex care situations. However, variation among case management approaches is very high, and the topic needs further study to determine the most cost-effective way of providing such care coordination.
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The annual special issue of Evidence-Based Oncology™, a publication of The American Journal of Managed Care® (AJMC), features coverage of the 2022 Annual Meeting of the American Society of Clinical Oncology, held June 3-7, 2022, in Chicago, Illinois. Clinical trials presented during the meeting and summarized in the issue include DESTINY-Breast04, DETERMINATION, SHINE, and ECHELON-1. ⋯ A final section features clinical findings presented by scientists affiliated with Strategic Alliance Partners of AJMC. Each issue section includes an interview with a key opinion leader participating in the meeting.
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To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning. ⋯ These results present a compelling rationale for developing a data-driven oncologist selection tool, optimizing patient and provider involvement in care, and expanding the portion of patients who have an advance directive at the start of their cancer care to optimize their cancer journey.
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Biologics account for an increasing share of US prescription drug spending. Biosimilars could lower biologic prices through competition, but barriers to increasing both supply and uptake remain. We projected US biosimilar savings from 2021 to 2025 under different scenarios. ⋯ Biosimilar savings from 2021 to 2025 were $38.4 billion under our main assumptions. Greater savings may be feasible if managed care and other settings increase biosimilar utilization and promote competition.
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To examine the use of step therapy, prior authorization, and Part D formulary exclusion by 4 large Medicare Advantage (MA) insurers to manage 20 physician-administered drugs with the highest total Medicare expenditures (top 20 drugs). ⋯ Four large MA insurers managed access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design. When a low-cost alternative exists, these tools can help reduce wasteful spending, but the administrative barriers may also reduce access.