Sometimes even wonderful news comes with caveats. Deaths from cancer fell for the second straight year, the American Cancer Society reports. There was a drop of 3,014 cancer deaths from 2003 to 2004, the most recent year for which information is available. This was "no fluke," says John R. Seffrin, the society's chief executive officer. He mentions tobacco control policies and breathtaking clinical advances. Managed Care's cover story next month will focus on the effectiveness of these therapies and how health plans should handle them. "Health plans face a significant challenge in determining how much cancer treatment, especially experimental treatment, they will cover," says William A. Peck, director of the Center for Health Policy at the Washington University School of Medicine in St. Louis.... A simple patient education intervention encouraged patients undergoing treatment for depression to use antidepressant medications more consistently and continuously (i.e., with fewer gaps and shorter gaps), according to research by Francisca Azocar, PhD, that was published in the Journal of Behavioral Health Services and Research. The collaboration between a managed behavioral health organization, an HMO, and a state employer, had a moderate impact on consistency of antidepressant medication use and on use of psychotherapy in combination with antidepressant medications. However, the intervention did not have an effect on the length of time patients stayed on antidepressant medications.... Giving physicians free electronic prescribing software is the solution that the National ePrescribing Patient Safety Initiative (NEPSI) has identified to address preventable medication errors, which injure at least 1.5 million Americans and claim more than 7,000 lives each year, according to the Institute of Medicine. NEPSI, a coalition led by Allscripts, a clinical software manufacturer, will provide Web-based software to physicians in solo practice or in small groups. Other members of the coalition include the technology companies Dell Computers, Cisco Systems, Microsoft, and Sprint Nextel, and the health benefits companies Aetna and WellPoint. The software can generate secure electronic prescriptions that can be sent from computer to computer or via fax to 55,000 retail pharmacies. More information is at «www. nationalerx.com», the NEPSI Web site. Physicians may also sign up at that Web site.
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.