Extending coverage to more children and adults and directing Medicare to negotiate Part D prices with suppliers are the health care items that the public would most like the new Congress and individual states to address in 2007.

A new 50-state survey released by the Kaiser Commission on Medicaid and the Uninsured reports that many states have expressed interest in improving access to their Medicaid and State Children's Health Insurance Programs (SCHIP) to more needy children, and to some parents as well. With state treasuries in better financial shape than earlier in the decade, one third of states increased access to health coverage in 2006, and more may do so this year. In fact, for the first time in four years, no state reduced the income level that makes a person eligible for Medicaid or SCHIP.

In a poll, conducted by the Kaiser Family Foundation and Harvard School of Public Health, the majority said the federal government should negotiate drug prices under Medicare. Eight in 10 said this would make medications more affordable; 31 percent said it would result in less research and development by drug companies. There was also support for permitting purchase of prescription drugs from Canada.

Opinions on drug price negotiation

Do you agree or disagree with the following statements about allowing the federal government to use its buying power to negotiate with drug companies to get lower-priced prescriptions for people on Medicare?

On buying prescription drugs from Canada

Do you favor or oppose Congress changing the law to allow Americans to buy prescription drugs from Canada if they think they can get a lower price?

Source: KFF/HSPH. The public's health care agenda for the new Congress and Presidential campaign (conducted November 9–19, 2006)

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.