The direct-acting virals revolutionized the treatment of hepatitis C. They also ushered turbocharged pricing. At least patients—and society—got a major health benefit in return.
Richard Mark Kirkner
Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care?
Mimi Chen

Biosimilars are supposed to save us money, but whose money are they saving?

Recent updates to the Medicare reimbursement policies, the passage of the president’s Bipartisan Budget Act of 2018, and analyses of these changes from various consultants have unveiled the chaos that is biosimilar reimbursement.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

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News Wire

Lenses automatically darken in bright light
Researchers found no association between clinical value and cost
Test performed in the primary care setting may improve access to screening
Drug is first and only approved specific reversal agent for a novel oral anticoagulant
Regimen showed significant improvement in overall survival in trial versus Sutent
The number of children ages 1 to 17 admitted to hospitals for an overdose of opioids nearly doubled from 797 patients between 2004 and 2007 and 1,504 between 2012 and 2015. The oldest children in the study in Pediatrics, those between 12 and 17, accounted for over 60% of patients admitted for opioid overdose.
Thomas Reinke
The randomized controlled trial reigns supreme, but the FDA is working on ways to incorporate real-world evidence into its approval processes.
Peter Boland
Victoria Sweet, MD
In Slow Medicine, Victoria Sweet, MD, pulls the reader into a different reality, one that harkens back to an earlier era of one-on-one medicine, when physicians and patients commonly shared a bond of trust and familiarity. That era has faded with the emergence of systems of care and performance targets.

Social Determinants of Health Should Be Addressed, But That Will be Difficult

Our cover story explores the many issues and challenges involved, and looks at some success stories. For instance, the partnership of the ProMedica Health Care System in Toledo and philanthropist Russell Ebeid seems to be making real, concrete changes for the better in that city.

Still, it won’t be easy for providers and payers to tackle the “upstream” causes of poor health. Do they even want to? The story notes that clinicians are reluctant to add patient social needs to their responsibilities: social problems, let alone solving them, are not their area of expertise; the health care system already has more than enough to do in the medical realm without expanding its territory to take on social problems and needs; and there’s limited evidence that health care interventions can influence social determinants.


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These eight questions show that the use of an LBM or a PAP should be just one of the potential results of your laboratory benefit management program, not the program itself. You shouldn’t have to pay for services you already provide yourselves or add a middleman that’s not necessary.
The winners among the Part D preferred pharmacy networks are willing to trade lower prescription profit margins for larger market share. CVS pharmacies are preferred in plans that enrolled 8.5 million people in 2018, compared with the fewer than 300,000 people enrolled in CVS retail pharmacies in 2017.
Frank Diamond
Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach.