WellPoint and Cigna are turning heads in the financial world. Cigna's second-quarter earnings rose 73 percent from the same period last year to $720 million as its earnings kept well ahead of medical costs thanks to higher premiums and lower operating costs, reports the Wall Street Journal. Meanwhile, the newspaper says that WellPoint's earnings are expected to rise 15 percent a year for the next five years.... California health insurers have marked Jan. 1, 2007 on their calendars. That's when the state is expected to move more than a half-million recipients of Medicaid (known as Medi-Cal in that state) into managed care. Gov. Arnold Schwarzenegger sees the move as an important part of curbing soaring costs. Critics counter that only mass confusion will ensue, and the sought-after savings will not appear.... Transparency is key, according to a plan by a coalition of 52 employers that outlines how they want PBMs to conduct business. PBMs would have to give to their clients the drug company rebates that now often go to the PBMs, according to the Wall Street Journal. In addition, PBMs would have to disclose the acquisition costs for retail and mail-order drugs. So far, only three PBMs have agreed to the terms outlined by the employer coalition, HR Policy Association. Those PBMs: Aetna Pharmacy Management, MedImpact Healthcare Systems, and Walgreens Health Initiatives.... "Preventive care services" means different things to different health insurers, says a recent report in the Wall Street Journal. The article quotes Andrew Baskin, Aetna's senior medical director, as blaming the problem on a lack of a universally accepted standards. "There is no industrywide definition here," says Baskin, "so each insurer has the ability to define preventive services for [itself]." Patients can have a tough time trying to figure out, for instance, just what drugs are covered by an insurer as a preventive treatment.
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.