Category: reimbursement

  • Medicare limits Aduhelm coverage to clinical trial participants

    Biogen’s difficult launch of controversial Alzheimer’s therapy Aduhelm has been made even harder by a proposal by Medicare to cover the drug only for certain patients enrolled in clinical trials. Biogen and partner Eisai had been hoping for good news from the review of Aduhelm (aducanumab) by the Centre for Medicare and Medicaid Services (CMS), […]

  • Biogen’s Aduhelm rollout goes from bad to worse

    Analysts were predicting sales of Biogen’s recently approved Alzheimer’s therapy Aduhelm may start to gather a little momentum in the third quarter, but the drug seems to be going into reverse. As it turned out, Aduhelm (aducanumab) made just $300,000 in the three-month period from July to September, against analysts’ estimates of $12 million, suggesting […]

  • Remote patient monitoring use is on the rise, but reimbursement needs to catch up

    The reimbursement model for remote patient monitoring needs to evolve as it may be holding providers back from investing in these programs, according to panelists at the MedCity INVEST Digital Health conference. Key issues with the structure as it stands now include the fact that there are too many gray areas that result in claims […]

  • Sutter Health to pay $90M to resolve False Claims allegations

    The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.

  • Health insurer Excellus will not fund Alzheimer’s drug Aduhelm

    Health insurer Excellus BlueCross BlueShield has said it will not cover treatment with Biogen and Eisai’s new Alzheimer’s disease drug Aduhelm because it has not been shown to be medically effective. The company – said to be the largest health insurer in New York – said in a statement that Aduhelm (aducanumab) remains an investigational […]

  • Gene therapy specialist bluebird exits “untenable” European market

    Europe market has proved so hostile to gene therapies when it comes to pricing and reimbursement for gene therapies that bluebird bio has decided to quit the market altogether, according to Andrew Obenshain, president of its severe genetic diseases unit. On the firm’s second-quarter results call, Obenshain said the biotech will start “an orderly wind-down” […]

  • A roadmap for adopting New Science 

    The pandemic’s disruption galvanised the biopharma industry into unprecedented action, demonstrating what’s possible when the global scientific community collaborates in exceptional ways and public-private partnerships drive innovation to address a common need. Can the biopharma industry step up again to shatter industry orthodoxy and create new pathways for innovation, access, and affordability? The adoption of […]

  • Healthcare bills to pay? Let pick up the tab

    Just over a year ago, launched an app that takes the legwork out of submitting reimbursement claims to private health insurers. Now, the startup has taken another leap forward, settling users bills immediately.  Fredrik Debong The addition to the app acts as a digital health expense account, according to the company’s co-founder and […]

  • Stanford Health Care seeks up to $1.9M from Anthem in new suit

    The California-based provider has filed a lawsuit against the payer, claiming Anthem has yet to pay for the care it provided to patients covered by its affiliate. Stanford and Anthem had an implied contract, and if it is not upheld by the court, the provider is seeking $1.9 million in reimbursement.

  • Navigating the complexities of health coverage and reimbursement beyond the pandemic

    Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. […]

  • White paper reveals pathway for digital therapeutics use in Italy

    A white paper has outlined a pathway that could allow Italy to realise the potential of digital therapeutics (DTx). The official journal of the Smith Kline Foundation, Tendenze Nuove, has published the paper entitled “Digital Therapeutics, an Opportunity for Italy” earlier this month. The book features insights and recommendations from 40 leading experts in the […]

  • Assessing the impact of prevalence on pricing of rare disease drugs in Germany

    In this first article of a three-part series exploring pricing in Europe, CRA’s Life Sciences Practice team discuss the role that disease rarity plays in reimbursement decisions among payers in Germany. Historically, payers have accepted factors including small target patient populations and high clinical development costs as justifications for the high prices of rare disease […]

  • 2021 market access prospects for Italy

    Italy was working up big changes in market access throughout 2020 which will be implemented in 2021. In the latest of a suite of features looking at the biggest markets in Europe, Leela Barham takes stock of what 2021 could bring for market access in Italy. AIFA, the Italian Medicines Agency and the agency tasked […]

  • The US biosimilar market: Predictions for 2021

    It has been five years since the first biosimilar launched in United States market—marking the first steps in expanding access to innovative biologic-based treatments that help patients manage and treat difficult illnesses such as cancer, rheumatoid arthritis, and other life-altering diseases. As we’ve seen over those five years, biosimilars are critical in continuing to provide […]

  • 46 hospitals file suit to reverse HHS bad debt policy

    A group of hospitals have sued HHS Secretary Alex Azar, arguing he should reverse a policy that prevents hospitals from getting reimbursed for Medicare-related bad debts pending at outside collection agencies. The policy has raised hospital debt payments by about $1.35 million, the lawsuit claims.

  • Vertex Pharma’s vision for reimbursement innovation

    As regional vice president for Northern Europe & Australia, Simon Lem led the digital launch of Vertex Pharma’s novel cystic fibrosis drug Kaftrio. He tells pharmaphorum about embracing digital change and the need for innovative reimbursement solutions. For Vertex, COVID-19 accelerated a digital transformation much needed for the patients they serve. As the leading developer […]

  • Telehealth Benefits Expansion: Helping Providers Maximize Reimbursement

    Patients today expect digital capabilities from their provider and will increasingly choose those who offer digital capabilities. Knowing this, many providers have been working to shift more of the patient journey online, through telehealth and virtual care. Not all care needs to be delivered face to face, and technological advances allow patients to access more […]