Inhaling steroid medications might not be necessary, according to a study that finds no difference in outcomes for people with asthma who took the drugs each day or only when symptoms occurred. “The discovery that these two courses of treatment do not differ significantly could eventually change the way doctors and patients manage asthma, providing an option that is easier to follow and possibly less expensive,” says William Calhoun, MD, of the University of Texas Medical Branch at Galveston, and lead author of the study that appears in the September 12 issue of the Journal of the American Medical Association.... The 16 million new beneficiaries expected to flood Medicaid rolls in 2014 as a result of the Affordable Care Act might have a tough time finding doctors, according to a study in Health Affairs. Physicians in many parts of the country are wary of accepting new Medicaid patients because of what they perceive as unfair pay — Medicare pays much better. Another development: State participation in the expansion of Medicaid is optional under the Supreme Court’s ruling on the ACA, and some governors are leaning against it.... Physicians are in such high demand that they should be wary of just shooting their resume and C.V. out willy-nilly, because they could be inundated with responses, says physician recruiter Jim Stone of the Medicus Firm. Stone tells amednews.com that “Just shotgunning their C.V. out can result in a lot of extra work on their part.” A doctor posting on the job board of the National Association of Physician Recruiters (Stone is president-elect) might receive 200 to 500 responses within 48 hours. Nice to be wanted.... Insurers and employers cannot deny coverage or benefits to transgender people, according to a ruling by the Department of Health and Human Services. Citing Section 1557 of the ACA, the ruling says that the “sex discrimination prohibition extends to claims of discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity....” However, in further clarification, the HHS says that this does not mean that insurers have to cover gender transformation surgery.
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.