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From the Editor

Alternate Funding Programs claim to offer self-insured employers solutions to save money on specialty drugs, but at what cost? Read More ›

Beware of a new model that at least one, if not more, of the BlueCross BlueShield plans are offering to their self-insured employer customers as a way to compete with the alternate funding programs that have been pushed heavily onto those same employers in recent years. Neither model is conducive to good patient care, and both place private profits ahead of the needs of patients and their health. Read More ›

Every day, providers and patients struggle with health plan, pharmacy benefit manager, specialty pharmacy, and other intermediary coverage and reimbursement policies that adversely affect individuals with cancer. These challenges may include coverage delays, step edits, prior authorizations, nonmedical switching, high out-of-pocket costs, and/or the intrusion of intermediaries into care or the drug chain, leaving patients confused, frustrated, and reeling from financial, physical, and emotional distress. Read More ›

Where do we really stand when it comes to artificial intelligence (AI)? What is the value? Who is using it? What are the risks and drawbacks? This technology has been discussed as a solution to complicated medical management as long ago as the 1970s, in the early days of developing clinical decision support systems. Read More ›

In the December 2022 and February 2023 issues of Oncology Practice Management, I identified external vendors (called specialty drug carve-out or alternate funding programs [AFPs]) that are charging self-insured employers a fee to find “specialty funding” or other resources so that employers and employees can pay sharply reduced prices, or nothing at all, for expensive drugs. However, these specialty carve-out vendors do not disclose the sources for this alternative funding or the drugs themselves, hiding the true impact of this practice on patient care and charity. Read More ›

Big business has been investing billions of dollars per year into healthcare, and, if successful, it may make private practices and community hospitals anachronistic. Read More ›

Practices and patients are now coming forward to explain how these programs have put individuals, patient assistance programs (PAPs), foundations, and other patient support systems at risk. Read More ›

Self-insured employers, perhaps even yours, are being presented with programs called “specialty carve-outs” as an opportunity for saving significant money on the drug portion of their employee benefits. Read More ›

Decades ago, I remember when biosimilars were a light on the horizon. Visions of sharply discounted alternatives to reference brands that could swoop in and help patients receive the care they needed at prices that were at least 50% below current market rates. Read More ›

We now know what will follow the Oncology Care Model (OCM). On June 27, 2022, the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center announced the voluntary Enhancing Oncology Model (EOM). Read More ›

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