From the Editor

Patient care is very personal. The physicians and care teams of cancer practices constantly assess what they see and hear relating to the patients when they are in the office. Unfortunately, patients are outside the office more than they are in front of the care team. Read More ›

As patients search for financial options, medical practices, health systems, and patient advocacy organizations may want to increase diligence on options and referral opportunities that come to them offering to “help” patients.  Read More ›

Medical practices that prescribe drugs for their patients have an ethical and legal liability to obtain drugs that meet safety, efficacy, and quality standards. Employers have a fiduciary responsibility to their employees to provide health benefit plans that follow important US drug safety measures and help to ensure that counterfeit and/or unsafe drugs are not provided to unsuspecting employees. Yet, some specialty pharmacies and vendors are offering international drugs to employee health benefit plans. Read More ›

State legislators have been focusing on reducing drug costs deemed “unaffordable” for patients via prescription drug affordability boards (PDABs). However, PDABs allow government-appointed board members to make critical medical decisions on pricing and access to prescription drugs for a state’s patients—without consulting medical providers or individual patient information. It is critical that we advocate for our patients to ensure that they receive medically necessary medications. Read More ›

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 ›