L.A. Care, a California Medicaid HMO, is rewarding physician groups that excel at preventive care. Those that exceed some HEDIS benchmarks, for instance, could receive performance bonuses.... Regence BlueShield will pay $30 million to settle suits over denial of claims for alternative therapies covered under Washington State law.... The Journal of the National Cancer Institute reports that access and outcomes for colorectal cancer patients in HMOs are comparable to those for fee-for-service enrollees.... Misuse of prescription drugs costs $177 billion a year, says a study published in the Journal of the American Pharmaceutical Association.... Forget about prescription drug reimportation. President Bush's budget guts 90 percent of funds allocated to the program Congress passed last year.... Jack Ebeler, of the Robert Wood Johnson Foundation, has succeeded the retiring Daniel Wolfson as CEO of the Alliance of Community Health Plans. ACHP is a 22-member consortium of not-for-profit health plans.... Partnerships for Quality Education is accepting grant proposals for chronic-illness management programs that encourage young physicians to learn to manage care. PQE is a collaboration between health plans and medical schools. For more information, see «http://www.pqe.org».... In Oregon, Providence Health Plan's announcement that it would remove the gatekeeper for its 300,000 enrollees brought to mind recent comments in the Los Angeles Times by George Lundberg, M.D., Medscape's editor in chief. "Managed care is basically over," he said. "Like an unembalmed corpse decomposing, dismantling managed care is going to be very messy and very smelly, and take a while."... Health information has surpassed porn as the most-searched-for subject on the Internet.
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.