The Department of Health and Human Services has published regulations describing how health plans can become part of the Medicare+Choice program, giving managed care organizations the go-ahead to apply for Medicare+Choice certification. The regulations provide for an annual open enrollment period (see a related story on page 42), much like managed care plans provide to employers. The regulations extend President Clinton's Patient Bill of Rights to all Medicare enrollees and shorten the time frame for initial decisions on patient appeals from 60 to 14 days.... Managed Medicare enrollment is growing dramatically, says a Lewin Group study. Lewin's head count shows Medicare managed care enrollment more than doubled between December 1995 and December 1997.... More than 40 percent of physicians are either very or somewhat dissatisfied with Medicare HMOs they contract with, according to a new HHS report. Some physicians complained that Medicare HMOs restrict access to care, but overall, physicians felt that Medicare HMO enrollees receive good care.... Medical privacy legislation may be enacted after all. Legislators don't want to cede authority to HHS to promulgate regulations next August, the deadline for Congress to act. And the buzz is that health insurance associations wouldn't mind uniform national standards governing patient medical records.
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.