Initial bids are in and it appears that premium growth will be slowing even more in 2007, according to a report by Hewitt Associates. On average, HMOs are proposing to raise premiums 11.7 percent next year. The companies last year initially asked for 12.4 percent increases. Some experts think that the rate increases might wind up in the 7 percent to 8 percent range, which will make 2007 the fourth consecutive year premiums rose more slowly than the year before.... Certification guidelines for health care information technology are in the works. The guidelines are expected to be developed by a coalition of companies called the Continua Health Alliance, which includes IBM, Cisco Systems, Kaiser Permanente, and Phillips Electronics. Two goals will be that the technology meet interoperability standards and that it become easier for consumers to get reimbursed by insurers for using monitoring technology in the home, according to the Wall Street Journal.... New technology doesn't come cheap. Spending on specialty drugs rose 17.5 percent last year, according to a study by Express Scripts. The PBM says that spending on specialty drugs will reach $90 billion by 2009.... Some interesting legislation is under consideration that would increase the ability of health insurers to obtain a share of money awarded to employees in personal injury lawsuits. Under the plan, insurers would be awarded a portion of settlement to recover money lost in providing medical care. Currently, state and federal law limit insurers' ability to do so. Patient advocates worry that there won't be much of the settlement left for the consumer after an insurer gets what it considers its share. The proposal is in a House-Senate conference committee.
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.