The Year 2000 bug is quite the menace. HCFA doesn't really have a handle on the problem, according to Illinois Republican Rep. John Porter, chairman of the House panel that oversees the agency's operations. Porter said HCFA is in deep trouble because only 40 percent of its almost 500 "mission-critical" computer systems currently are compliant with Year 2000 requirements.... It's called Smart Choices — and it's expected to receive hundreds of thousands of hits in the near future. This new section of HHS's Web site www.healthfinder.gov helps consumers locate doctors and hospitals, report fraud and complaints in the health industry and obtain information on chronic diseases and preventive health care.... Managed care enrollees — for the first time — were included in the Medicare Payment Advisory Commission's annual survey of 16,500 Medicare beneficiaries. And guess what? The MedPAC survey found that a higher number of managed care beneficiaries were satisfied with the availability of health care than were fee-for-service beneficiaries.... New long-term, acute-care hospitals will receive a 15-percent reimbursement hike. The agency increased their reimbursement limit under Medicare to $21,494 per discharge. The change is expected to take effect this month.
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.
The results can be tragic. Patients with addictions are unlikely to wait the hours or days it takes health insurers to approve the medications they need. Insurers are changing their practices, but not without some outside pressure.