Peter Wehrwein

1 week ago | managedhealthcareexecutive.com | Peter Wehrwein |Logan Lutton

In this interview with Managed Healthcare Executive, Peter Ehrenkranz, M.D., M.P.H., deputy director, HIV, at the Gates Foundation, discusses twice-a-year lenacapavir for HIV preexposure prophylaxis (PrEP). The FDA approved the preventive medication on June 18. Gilead Sciences is marketing it under the brand name Yeztugo. Ehrenkranz described Yeztugo as "really well tolerated, incredibly efficacious," and not requiring refrigeration.

2 weeks ago | managedhealthcareexecutive.com | Peter Wehrwein |Logan Lutton

In this fourth segment of an interview with Managed Healthcare Executive, Lyric CEO Rajeev Ronanki, M.S., discusses the use of artificial intelligence (AI) in finding errors in medical claims. "What we're doing is finding the billions of things that could go wrong in terms of human error or system error or a combination of the two," he said.

2 weeks ago | managedhealthcareexecutive.com | Peter Wehrwein

The Inflation Reduction Act (IRA) exempts biologics from CMS price negotiation for 13 years and small molecules for nine. The pharmaceutical industry has been pushing for a change that would give small molecules and biologics the same 13-year exemption. A bill to end the “pill penalty,” as it has been dubbed, has been introduced in Congress, and the healthcare executive order signed by President Donald Trump on April 15 seemed to endorse the change.

2 weeks ago | managedhealthcareexecutive.com | Peter Wehrwein

In the third segment from an interview with Managed Healthcare Executive, Lyric CEO Rajeev Ronanki, M.S., discusses revenue cycle management (RCM) and "disarming both sides to where RCM goes back to its roots of making sure that the billing for whatever services are rendered is accurate." Ronanki said that provider RCM started out with the intent of making sure billing was accurate but "all kinds of enhancements have crept in." Health plans responded with efforts to detect and weed out claims...

2 weeks ago | managedhealthcareexecutive.com | Peter Wehrwein |Logan Lutton

In this second segment of an interview with Managed Healthcare Executive, Rajeev Ronanki, M.S., CEO of Lyric, a payment integrity company, discusses the drawbacks of such companies being paid on a contingency basis in contrast to Lyric's subscription model. "There are hundreds of vendors that say, 'Hey, we'll do something and find some obscure thing in your claims data that you can recover,' which sounds attractive and no effort on the customer's part.