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Survivor Views: Open Enrollment
... survey explores open enrollment, and the issues and priorities cancer patients and survivors consider as they make choices about purchasing health care coverage. The web-based survey was conducted among 1,279 patients and survivors nationwide who have been diagnosed with or treated for cancer in the last seven years. Of those, 57% have employer-provided health care coverage (722n), 28% are enrolled in Medicare (363n), 6% purchase their coverage privately such as through the marketplace (74n), and ...
The Medicare Appeals Process: Reforms Needed to Ensure Beneficiary Access
... for a needed service or treatment, cancer patients face having to pay the full cost out of pocket or making the difficult decision to forego care that could save their lives. To better understand how the Medicare program’s appeals process works for beneficiaries who have a history of ... or Part D plans) to override utilization management tools. Evidence suggests that plans’ initial denials are often overturned : In 2019, the Health and Human Services (HHS) Office of the Inspector General released a report on the Part D appeals process and found that enrollees and ... should be covered by Medicare or choose to forgo care altogether instead of appealing, which could have negative implications for their overall health and wellbeing. The Medicare Appeals Process: Reforms Needed to Ensure Beneficiary Access ...
Step Therapy in Medicare Part D Oncology Drugs
Executive Summary Escalating drug costs in the United States are placing pressure on both the federal government and health plans to implement strategies aimed at controlling drug expenditures and optimizing utilization. Utilization management (UM) tactics are ... SNPs provide the same Medicare Parts A and B coverage for beneficiaries as other MA plans but also offer tailored benefits and coordinated care for beneficiaries that have specific health conditions or meet other requirements. Step Therapy in Medicare Part D Oncology Drugs ...
Utilization Management in Breast Cancer and Hepatocellular Carcinoma
Executive Summary Utilization management (UM) refers to a variety of practices that health plans and pharmacy benefit managers employ to confirm the use of specific drugs or services aligns with the payer’s policy. Plans can use ... necessary, or to limit utilization of high-priced, specialty medications. UM use in oncology may have unintended consequences to patient care, such as delaying patient access to medication or increased administrative burden for the patient and provider. Prior to 2019, Medicare ...