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The vast majority of Part D plans follow a tiered cost-sharing structure with incentives for members to use less expensive generic and preferred brand-name drugs. Cost-sharing has increased since 2006, but the Kaiser Family Foundation reports in “Analysis of Medicare Prescription Drug Plans in 2011 and Key Trends Since 2006” that there was barely a change between 2010 and 2011.” The foundation reports that since 2006, median cost sharing for a 30-day supply of nonpreferred brand name drugs in stand-alone prescription drug plans (PDPs) increased by 42 percent, from $55 to $78. Preferred brand costs increased 50 percent, from $28 to $42. But since 2010, cost sharing has been stable.

About half of PDP enrollees and over 75 percent of MA-PD plan enrollees are in plans that charge 33 percent coinsurance for specialty drugs. Compared to 2009, this share is down modestly for PDPs but up substantially for MA-PD plans. In contrast, only 4 of the 35 national or near-national PDPs charged a 33 percent coinsurance rate for specialty tier drugs in 2006.

Contributing Voices
John Marcille

It's all about choice these days. Different routes, same destination. In this case, it's reading Managed Care when and where you like, and if you own an iPhone or an iPad, you can do that with our new app available at the Apple Store.

Search for "Managed Care," "P&T," "Biotechnology Healthcare," or "MediMedia," or just click here:
http://itunes.apple.com/us/app/medimedia-managed-markets/id496230488?mt=8

Contributing Voices
Steven Peskin, MD

After grand rounds this morning at the University Medical Center at Princeton, the director of the recently created transitional care program, Kathleen H. Seneca, MSN, was speaking with one of our nephrologists about the purpose of the program. It fills the transitional gap for people discharged from the hospital that do not qualify (in terms of reimbursement guidelines) for home care, but would benefit from additional education, care planning, and hands-on instruction.

Contributing Voices
Steven Peskin, MD

Leaving the gym on an unseasonably warm night, I struck up a conversation in the parking lot with a vascular surgeon acquaintance. He recounted a technically demanding procedure that he had done the day before with a reported 10 percent risk of stroke and a 3 percent mortality risk.

Contributing Voices
David Kibbe

Health and Human Services (HHS) just released data on 2010 health expenditures, reporting that we, as a nation, have now reached the $2.6 trillion mark, consuming 17.9% of our GDP. Reaching that new mark required 3.9% annual growth vs. 3.8% in 2009. On the surface, the rate of growth seems less alarming than the insurance premium trends of 7%, 8%, and more that have been common year after year over the past decade. Yet the reality is that the changes are really like comparing apples and oranges, as the aggregate figures provided by HHS include a number of factors that mitigate the apparent modest rate of increase. Often, to really see where we are, we need to see where we were. In 1978, as I started my graduate studies in health care economics and finance, health care expenditures were approximately $250 billion in the U.S. I still remember my mother, a hospital nursing administrator, showing me the financial records of a hospital that could fit on one large table in approximately five large filing containers. There was already growth and complexity in health care compared even to the prior decade, but compared to today, it was a simpler, less expensive world, to be sure. So, now today, 34 years later, we have a health care economy that is 10 times that size.

Contributing Voices
Al Lewis

Editor's note: The article that the author refers to appears below this one.

There have been unsavory rumors flying around the internet that disease management as practiced today may not be all that effective. I’m not going to reveal who started these rumors but her name rhymes with Archelle Georgiou. This person says disease management is “dead.” Since there are still many disease management departments operating around the country apparently oblivious to their demise (and disease management departments are people too, you know), I suspect this commentator was using the word "dead" figuratively, as in: “The second he forgot the third cabinet department, Rick Perry was dead." (Another example of presumably figurative speech in the death category would be: "After he denounced gays while wearing the Brokeback Mountain jacket, you could stick a fork in him.")

Contributing Voices
Archelle Georgiou, MD

In 1995, Dr. Michael Rich published an article in the New England Journal of Medicine (NEJM) that fueled the start of an industry. In a randomized, controlled trial, he showed that an investing in proactive disease management (DM) activities could decrease the cost and improve the quality of life for patients with congestive heart failure.

The premise of disease management seemed intuitive:

Contributing Voices
Paul Terry

Having just finished reading Walter Isaacson’s brilliant rendition of Steve Jobs’s life and career, I’ve considered whether there are health care marketplace lessons to be garnered from his central casting in the extraordinary tech wars for primacy over the past 25 years. I’d commend this biography to anyone who loves great writing and insightful analysis of the human condition, along with the foibles of growing a business.

Contributing Voices
Steven Peskin, MD

What do these characteristics bring to mind?

  • Flexible appointment scheduling
  • Advanced electronic communication
  • Care coordination
  • Counseling and education
  • Electronic prescribing
  • Electronic health record with patient portal

If you thought Level 3 Medical Home, you were correct. If you thought retainer (concierge) practice, you would also be correct. To me, it seems eminently rational for people who have sufficient discretionary income to choose to use it to obtain more rapid access to a personal physician of her/ his choosing through a retainer (concierge) practice.

Contributing Voices
Steven Peskin, MD

The drumbeat of EBM — Evidence Based Medicine — seems less vigorous in the wake of enthusiasm for new models of care — Medical Homes and Accountable Care Organizations — and reimbursement based on performance, outcomes, or episodes of care.

A good definition of EBM from Sackett, et. al:

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