A study from the University of Michigan Institute for Social Research finds that 90 percent of Americans age 65 and older now have prescription drug coverage, compared to more than 75 percent who were covered in 2004. And the poor are as likely to have coverage as those who are rich.

The analysis compares drug coverage in a nationally representative sample of 10,175 Americans who were interviewed both in 2004 and in 2006, when Medicare Part D was launched.

David Weir, PhD, assistant director of the institute and co-investigator of the study, says that although Part D is complex and confusing, "older Americans have been able to make good choices."

The findings were similar to those reported by the U.S. Department of Health and Human Services, with roughly a quarter of Medicare beneficiaries enrolled in stand-alone Part D coverage in 2006, according to the study.

The interviews are part of an ongoing Health and Retirement Study sponsored by the institute and funded by the National Institute on Aging.

Weir and his colleague, Helen Levy, were able to show that rich and poor Americans were equally likely to sign up for Part D and for private coverage, and to lack coverage. Wealthy Americans were much more likely to have employer-provided drug coverage, but poor Americans were much more likely to have drug coverage through Medicaid.

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.