Speaking of Medicare+ Choice, HCFA issued an operational policy letter explaining how some reimbursement models will adapt to the new structure. The Balanced Budget Act eliminated prepayment plans, which provide only Part B benefits, and medicare risk contracts after this year, and cost contracts by 2002. Current cost contractors that also have a prepayment agreement may move members into cost contracts with HCFA approval.... President Clinton's proposed 1999 Veterans Affairs budget includes a $17 billion cut in health care spending. In past years, the VA health care budget has increased $1 billion annually. The Clinton administration does not want to spend money on vets who claim their illnesses resulted from smoking.... Even with Medicare, senior citizens spend almost one-fifth of their incomes on health care. According to a report by the American Association of Retired Persons, Medicare recipients shelled out an average of 19 percent of their incomes, or $2,149, for health care in 1997.... The Department of Health and Human Services has kicked 1,400 health care professionals out of Medicare and Medicaid for defaulting on federal health education loans. A list of those disqualified is posted on the Internet at http:// www.defaulteddocs.dhhs.gov and is updated regularly.
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.