Twenty million young adults between ages 19 and 29 were uninsured at some time during the past year, according to a recent survey by the Commonwealth Fund. Eighty-eight percent of young adults think it is important that Congress and the president pass health reform legislation that would assure affordable insurance for all and improve health care.... Value-based benefit designs (VBBDs) are gaining more traction among health plans. A recent HealthLeaders-InterStudy report says that three major insurers — Blue Cross Blue Shield of Massachusetts, Health Alliance, and Blue Shield of California —are rolling out VBBD packages to the fully insured market. VBBD reduces cost barriers to medications deemed most effective in controlling chronic diseases to drive patient compliance with treatment.... The National Committee for Quality Assurance (NCQA) issued changes to its disease management accreditation and certification requirements, adding voluntary performance reporting for five chronic conditions. With the new changes, NCQA becomes the first DM accreditation organization to use performance measures to assess the effect of programs on care for people with asthma, diabetes, chronic obstructive pulmonary disease, heart failure, and ischemic vascular disease. Additional changes to the standards focus on care coordination, data integration, quality improvement, and transparency in reporting.
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.