Pay for performance so far has been only a stopgap measure to fix the fundamentally broken payment system, according to a report issued by PricewaterhouseCoopers' Health Research Institute. The organization found that there is little quantifiable effect on health care quality, outcomes, and efficiency and there are insufficient financial incentives to change physician behavior. Findings were based on in-depth interviews with top executives of 10 of the nation's largest commercial payers.... The underinsured account for 24 percent of the United States population, according to a survey in Consumer Reports. This population lives with health coverage that barely covers medical needs, and leaves them unprepared to pay for medical expenses. Forty-nine percent of people overall, and 43 percent of people with insurance, said they were "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year.... Communicating with employees is the greatest challenge employers face when introducing a consumer-directed health plan, according to the consulting firm Watson Wyatt. The sparse information about provider cost and quality is another obstacle that hampers consumer-directed health care acceptance. A study jointly conducted with Rand showed that specific resources needed to help workers evaluate the cost and quality of care are often lacking. Just 2 percent rated cost information about providers as "excellent" and only 5 percent rated it as "good."
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.