For all the sturm und drang, experts foresee neither a hurry-up nor a halt for 2018, just a fairly steady continued rise at roughly last year’s higher-than-inflation pace. The Drug Price Forecast, for example (based on hospital and nonacute settings, but not retail pharmacy), reports that that means a tidy year-over-year increase of 7.61%.
PBM consultant Linda Cahn says that if Amazon gets into the PBM business it could insist that drugmakers simultaneously submit the net discount price for each of their drugs for the subsequent six months. Amazon could then publicize every drug’s actual price, by drug and by therapeutic category.
Federal and state officials have moved this year to impose some preparedness requirements on providers that will have an effect in 2018 and years beyond. For instance, CMS’ finalized emergency preparedness rules for health care providers that serve Medicare and Medicaid patients went into effect last month.
Value-based care can’t be done one slice at a time, new value-based models will take aim at variations in care, the patient may gain a stronger voice, the tail could wag the dog, and value-based care will create haves and have-nots. Some predictability from the federal government would be welcome.
A year ago you probably couldn’t find a Las Vegas bookmaker willing to give odds that the ACA would still be the law of the land in 2018. Turns out that repealing Obamacare and crafting a replacement acceptable to various factions of the GOP is not so easy.
Whether in a red or blue state, the state commissioner jobs do require decent working relationships with insurance companies, particularly in precarious times as insurers threaten to leave some areas with no ACA coverage because of poor market conditions or dithering in Washington, D.C.
Blame for the epidemic has focused on drugmakers, drug wholesalers, and physicians who prescribed opioids too liberally. This fall, fingers pointed at health insurers. Investigative reporting showed that coverage policies that restricted access to less addictive medications might have helped fueled the epidemic.
Opioids remain the go-to products because they target the mu opioid receptor, which has been shown to be the most effective pathway to reduce pain. The holy grail for drug developers is an agent that stifles pain without producing the euphoria and addiction of opioids.
CMS chief Seema Verma wants to reshape the entitlement program that covers about 62 million people. Verma endorses “community engagement”—work or community service— as a condition for “able-bodied” people to get Medicaid coverage and accused the Obama administration of the “soft bigotry of low expectations” for opposing such a requirement.
For instance, in the case of Sanford Health’s acquisition of Mid Dakota Clinic in North Dakota, the agency challenged the deal, claiming that the merged entity would control 75% or more of primary care and other health services in the Bismarck–Mandan metropolitan area.
This professor of pharmaceutical economics in the University of Minnesota College of Pharmacy says that the rising level of health care spending is unsustainable. He argues that drug price increases should be reviewed and PBMs should be regulated. “We need [a] bona fide rate regulation review body that can meaningfully evaluate the information presented by drug companies.”