CER Daily Newsfeed

A New PCORnet® Population Insights Report Highlights Potential for Impactful Research on Sensory Health Conditions

(5/7, PCORnet Blog) comments “...The report offers a comprehensive overview of the demographics and geographic characteristics of over 9 million adults and children who received healthcare services at 75 sites participating in PCORnet between January 1 – December 31, 2024, and had a sensory health condition reflected in their electronic health record in the past five years, from January 1, 2020 – December 24, 2024. The report includes patients with sensory health conditions, such as vision disorders, hearing disorders, disorders that cause dizziness, smell and taste disorders, multiple sclerosis, spinal cord injuries, and autoimmune disorders.” Full

Understanding CMS’s Proposed Rule Regarding Prior Authorization For Drugs

(5/8, Michael Anne Kyle, Rachel Sachs, Health Affairs Forefront) comments “...In this article, we begin with a brief summary of CMS’s 2024 final rule on prior authorization. We then describe the ways in which the recent proposed rule extends the 2024 final rule’s requirements to the prescription drug context within medical benefits but also adopts new requirements specific to pharmacy benefits. We consider four broader implications of the proposed rule, situating it within ongoing policy discussions regarding health care costs, quality, and access.” Full

Turning a Challenge Into an Opportunity: How Better Health Outcomes Can Strengthen Payer-Provider Relationships

(5/7, Blue Shield of California) comments “...Today’s ‘pay-for-performance’ models are a step up from ‘fee-for-service’ systems, but have mostly been adopted by primary care and still leave more to be desired. This has Dr. Vojta and Dr. Kavasery calling for ‘pay-for-outcomes’...Dr. Vojta and Dr. Kavasery outline several priorities: Measure what matters. Focus on outcomes that reflect real improvements in patients’ health, not just activity. Align incentives. Give providers the flexibility to invest in care that drives better results.” Full

Patient Pathway Activation and Industry’s Role in Enabling Access to Innovation in the NHS

(5/7, Arlene Neville, Stephen Jowett, Jim McArdle, PharmaPhorum) comments “For many organisations endeavouring to launch a treatment in the UK, regulatory approval still carries an implicit assumption that once a treatment is proven clinically effective and deemed cost-effective, the NHS will absorb it. The logic is understandable. Years of evidence generation, regulatory scrutiny and health technology assessment culminate in a decision that confirms value for patients and the system. In theory, the pathway already exists. Clinicians are in place, referral routes are established, and patients will naturally flow toward a better option. But the reality is more complicated, and the gap between approval and adoption is where many promising treatments quietly stall.” Full

Good Communication From Companies Means Smoother EU-Level Joint Clinical Assessments

(5/8, Francesca Bruce, Pink Sheet) reports “...EU member state bodies working on new joint clinical assessments shared insights with the Pink Sheet on their preparations for using the JCA reports in their national pricing and reimbursement procedures, and how the assessments are impacting resources.” Subscription Required