Good news for government workers enrolled in the Federal Employees Health Benefits Program. Premiums are expected to increase 7.9 percent next year. This after five consecutive years of double-digit hikes.... PPO demonstration projects for Medicare in 2001 and 2002 may have benefited by CMS officials exceeding their legislative authority, according to a General Accounting Office report. Apparently, former CMS Administrator Thomas Scully stepped over the line in having Medicare take most of the risk if costs for Medicare beneficiaries were higher than PPOs anticipated.... A class-action lawsuit filed by 900,000 physicians could mean financial disaster for the managed care industry, according to lawyers representing insurers who are alleged to have systematically underpaid the doctors. The 11th Circuit Court of Appeals says the doctors may sue as a group, rather than have to sue the insurers individually. Health plans involved are: Health Net, Humana, PacifiCare, Prudential, UnitedHealthcare, and Wellpoint.... Seventy-eight percent of the country wants universal health care similar to what exists in Canada and Great Britain, according to a survey by the Civil Society Institute. Further, about one-third of the 1,020 people surveyed say that they were already or would consider buying medication from Canada or other countries.
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.