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Single-tablet regimen (STR) coverage under qualified health plans (QHPs) varies widely across the US. Although bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) coverage has grown over time, many QHPs in priority jurisdictions for the Ending the HIV Epidemic (EHE) have coinsurance requirements. Delay in QHP coverage and benefit design may hinder access to new antiretroviral treatment (ART) regimens.

Orthopedic surgeon Dr. Ahmed Siddiqi wanted to find a better approach to postoperative monitoring – one that came closer to direct, continuous visibility of patient progress during recovery – while reducing the burden on patients and the management team. His new digital care solution enabled his team to provide long-term remote patient monitoring while directly communicating with all patients. The platform’s remote therapeutic monitoring (RTM) module helps the team meet the minimum engagement and data submission requirements to be eligible for RTM coverage.

The Food and Drug Administration has approved digital therapeutics, but insurance coverage has remained a problem. Some businesses have pushed for patient pharmacy benefits to pay for their software-based therapies, but AppliedVR is going in a different direction. A new HCPCS (Healthcare Common Procedure Coding System) code that describes the company’s treatment as a virtual reality cognitive behavioral therapy device with pre-programmed therapy software was granted by CMS to the company. The program complied with all five criteria set forth by CMS to qualify as durable medical equipment.

The merit-based incentive payment system (MIPS), which adjusts clinician Medicare Part B payments for performance on quality, cost, improvement activities, and use of certified EHR technology for interoperability, along with EOM quality measurement systems for Medicare, should ideally be meaningful to physicians and patients and coordinated to magnify the quality signal. How do these novel methods compare, then, in terms of genuinely comprehending the standard of cancer care provided to Medicare beneficiaries?

For some of the most often applied treatments for meibomian gland dysfunction (MGD), such as imaging, exfoliation therapy, heat therapy, strong pulsed light therapy, and meibomian probing, Myranda Partin, OD, offers advice, coding, and reimbursement information.

According to a survey conducted by the Association for Clinical Oncology, the majority of respondents (96%) said prior authorization has led to delays in cancer treatment, with 80% claiming prior authorization has enabled disease progression, and 36% of them saying prior authorization has led to patient deaths. 300 ASCO members who work in academic or university (29%) settings, private practice (34%), or community or hospital-based health network/systems (35%), completed the survey.