Death rates after heart bypass surgery dropped 43 percent between 2000 and 2006, according to a recent Agency for Healthcare Research and Quality “News and Numbers” report. The proportion of patients who died in the hospital after undergoing the procedure fell from 42 per 1,000 admissions to 24 per 1,000. Rural hospitals reported the greatest improvement (92 percent), although their death rate of 38 deaths per 1,000 admissions was still higher than for other hospitals.... California regulators approved WellPoint’s plan to raise rates for individual health insurance policies by an average of 14 percent. WellPoint’s initial bid to increase the rate to 25 percent for 600,000 members drew heavy criticism earlier this year. The company, which is the largest U.S. health insurer by membership, says it intends to put the new rates into effect on Oct. 1.... The National Association of Insurance Commissioners voted to approve a guideline that would require large-group insurance plans to spend at least 85 percent of premiums collected on medical expenses, as opposed to administrative expenses. Small-group plans must spend 80 percent on medical expenses. The industry criticized the NAIC for adopting “a narrow category for what health plans count as medical care and quality improvements when calculating medical loss ratios.”
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.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.