Oregon's governor signed a bill creating a reference formulary for Medicaid. The new law bases reimbursement for all medications in a class on the cost of a chosen "reference" drug in that class.... Pharmaceutical Research and Manufacturers of America is suing the Centers for Medicare and Medicaid Services (formerly HCFA) for approving Maine's new drug-discount program. PhRMA claims Healthy Maine violates Medicaid laws because manufacturers must shoulder the cost of rebates.... Weiss Ratings reports that fewer than three dozen large plans are driving HMO-industry profits, which totaled $908 million in 2000, through September.... Aetna will shed much of its small-employer (50 or fewer employees) business, as part of its financial strategy, the Hartford Courant reports.... On a per-capita basis, inpatient admissions have not changed in 40 years, according to an Agency for Healthcare Research and Quality study.... The same can not be said for ER visits; federal statistics indicate a 14-percent increase in annual ER visits from 1992 to 1999. Considering that the number of hospitals remained static during the '90s but Census figures show an 11-percent U.S. population growth from 1990 to 2000, ERs are maxed out.
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.