Harvard Pilgrim’s program gives rebates to beneficiaries if Repatha doesn’t help them avoid a heart attack or stroke. It’s just the latest in a growing number of outcomes-based pricing agreements in which an insurer can get a discount from a drugmaker if a drug doesn’t help patients as much as expected.
Price, 62, with pure white hair, rimless glasses, and an easy, slightly cherubic smile, comes across like a friendly, family doctor, not the ambitious, politically-minded orthopedic surgeon that he is. He calls the ACA “useless” because of the high deductibles.
The CEO and chairman of Aetna has a penchant for pulling headline-grabbing moves lately, including a high-profile departure from the industry’s leading trade association, America’s Health Insurance Plans, and an attempt to acquire another big-five insurer, Humana, then pulling out when the Justice Department opposed it.
After penning a book that slams greed, waste, and confusion in health care, Elisabeth Rosenthal, MD, is in a position to push back as editor-in-chief of the increasingly influential Kaiser Health News.
The president and CEO of Chicago-based HCSC made tough decisions to raise premiums and narrow networks. But, at least for now, HCSC plans to stay in the ACA exchanges while other insurers are jumping ship.