Managed Care
Disease
Management
News & Commentary
The clinical use of opioids nearly doubled between 2000 and 2010, with simultaneous increases in the incidence of abuse, addiction, injury, and death. Some health insurers are creating tighter formularies that require some form of prior approval for certain medications.
Tomorrow’s Medicine
Thomas Morrow, MD

Thomas Morrow, MD

It involves two separate procedures with two sets of catheters, albeit during the same procedure episode. Invariably, this will cost more because of the cost of the second procedure, which involves extra time in the cath lab and additional materials.
ACO Update
Peter Wehrwein

Clif Gaus

The proposed regulations would open up a third track in the shared savings program that could mean a shared savings rate of up to 75% for some organizations, compared with a 50% maximum in track 1 and a 60% maximum in track 2.
Feature
Linda Cahn

Linda Cahn

Three conditions — hepatitis C, diabetes, and cancer — show how budgets can be busted (and patients harmed) if providers and payers don’t astutely manage the use of costly new drugs
Cover Story
Peter Wehrwein

Patrick Gleason

Moving medications to the pharmacy benefit won’t win prizes for innovation or box-departing thinking. The fact is that it has been talked about for years, but it’s not so easy to do. What’s changed? Insurers are more intent on finding a solution for something that can bust their budgets.
The Formulary Files
Krishna Rutvij Patel, PharmD

Krishna Rutvij Patel, PharmD

A clinical trial by the American Heart Association looked at the effects of ezetimibe over seven years. Researchers concluded that the drug lowers LDL while simultaneously lowering the risk of cardiovascular events, though minutely. The drug will probably have little effect on health care costs.
Legislation & Regulation
Richard Mark Kirkner

Nancy Hammer 

When the federal court in Minneapolis denied the Equal Employment Opportunity Commission’s request to block Honeywell’s employee wellness program for 2015, employer groups and their lawyers exhaled, then went right back to holding their breaths, wondering what the next move by the commission might be.
News & Commentary
Generics have traditionally put a brake on cost, but legislation allowing for generics “does not apply to biologics, which are the most costly subset of specialty pharmaceuticals,” says a Health Affairs study. Location matters. Drugs administered in a doctor’s office can cost 50% less than those given in a hospital.
News & Commentary
Medicare beneficiaries in two ACO projects feel that they have better access to care, according to a study in the New England Journal of Medicine. Researchers say that their “findings would indicate that ACOs may be able to achieve savings in ways that do not adversely affect patients’ experiences.”
The Formulary Files
Krishna Rutvij Patel, PharmD
The result is a chain of events in which beneficiaries blame payers for higher cost-sharing as payers in turn blame drug companies for hiking prices. Is there constructive action to be taken or should we look forward to an end of pharmacy payers as we know them?
Biologics In Development
Katherine T. Adams
Regeneron’s aflibercept (Eylea) injection in patients with diabetic macular edema demonstrated greater improvement in visual acuity than either of two Genentech biologics, bevacizumab (Avastin) and ranibizumab (Lucentis).
Managed Care Outlook
Even the 23 states not signed up for Medicaid expansion under the ACA are implementing ACA-related changes that require states to streamline Medicaid enrollment and renewal processes, and transition to a uniform income eligibility standard, according to a report by the Kaiser Commission on Medicaid and the Uninsured (http://tinyurl.com/Medicaid-2015).
Q&A
John Marcille

Jeff Goldsmith, PhD

Always controversial. “The idea that ACOs work and multiply and somehow evolve into capitation is just a mass hallucination. It isn’t going to happen.” What is happening, he says, is one of the most favorable contracting environments insurers could ask for.

Meetings

Medical Devices Summit Boston, MA February 19–20, 2015
3rd Annual Summit to Improve Adherence and Enhance Patient Engagement Philadelphia, PA March 9–10, 2015
Value-Added Solutions for Enhanced Customer Experience Philadelphia, PA March 9, 2015