State budgets got an unexpected gift last year. Medicaid spending declined in 2006, the first time that has ever happened. Medicaid spending fell 1.4 percent in the first nine months of 2006, USA Today reports. After adjusting for the rate of health care inflation, the decline was 5.4 percent.... Regence BlueShield has decided not to launch its Select Network plan for 45,000 Boeing workers in Washington state. The health plan pulled back as a result of a lawsuit filed by a physician and some patients that claims that the tiered network rates physicians with unproven measures of efficiency. The lawsuit is the first inspired by an effort by the American Medical Association to challenge insurers that the AMA says use unproven measures of efficiency to profile docs. The AMA says that Aetna's Aexcel, Cigna's Care Network, and UnitedHealthcare's Premium Physicians may also be challenged.... Mortality rates for hospitals ranked high on a government Web site were not that much better than those for hospitals ranked low. Researchers at the University of Pennsylvania reviewed 2004 data on the Hospital Compare Web site, which is run by the Centers for Medicare & Medicaid Services. The study was published in the Journal of the American Medical Association and a JAMA editorial says that the results "raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals." More discussion about this issue is sure to come.... It looks likely that Massachusetts Gov. Mitt Romney will run for president. That means that the state's universal health care plan might become the focus of debate, and even perhaps the model for a federal overhaul of the health care system. Massachusetts officials say that they've been overwhelmed by requests from officials from other states to discuss the plan. Stay tuned.... Probably nobody ever moved to California because the HMOs there offered the lowest premium rates in the country. Good thing, because that is not the case anymore, according to a survey by the California HealthCare Foundation, a charity organization funded by money the state garnered when Blue Cross of California converted from a not-for-profit to a for-profit organization. HMO enrollees there paid premiums that were in line with what enrollees everywhere paid last year.
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.