Aetna is unveiling something it calls the Medicare Open Plan, targeted for employers who want to offer retirees age 65 or over a fee-for-service Medicare Advantage plan. If CMS approves, Aetna hopes to launch the plan in January 2007.... A consumer-directed effort by Tufts Health Plan hasn't planned out the way management had hoped. Tufts is canceling its three-year joint venture with Destiny Health, a CDHP provider, because of a failure to meet enrollment goals. The plan, called Liberty, gained about 10,000 members since its launch in September 2003.... Medicaid managed care is making "outroads" in Colorado. Citing low payment rates, Colorado Access, the only private Medicaid HMO left in the state, plans to end its contract with Colorado in August. It has been a bumpy road for the program all along. In 2004, four HMOs sued the state for alleging underpaying. Colorado paid millions to settle and those four HMOs left the program. Now Colorado Access is leaving. Its CEO, Don Hall, says there just isn't enough money to be made.... People with unhealthy lifestyles should pay more for insurance, according a poll taken by the Wall Street Journal and Harris Interactive. An online survey of 2,325 adults in the United States found that 53 percent of respondents are fine with the idea of charging smokers and overweight people more. In 2003, 37 percent liked the idea when asked the same question. Could be a societal switch, something to think about on your cigarette break — way, way off in the corner of the parking lot there.
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.