Eliminating the cost-sharing payments (CSRs) to insurers to hold down out-of-pocket costs for low-income people who purchase individual health plans may wind up actually increasing overall federal spending by driving up premium subsidies to cover higher price plans.
Family medicine doctors spend more than six hours interacting with electronic health records (EHRs) during a typical day, which usually lasts 11.4 hours, according to a study by the University of Wisconsin and the American Medical Association.
Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of the costs incurred during infancy in 2013. The average expenditure for preterm infants with major birth defects was $226,840, compared with $42,620 for those born preterm without major birth defects.
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.
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.”
Nonquantitative treatment limitations may be why care for mental health and substance abuse disorders isn’t keeping up with coverage gains.
Hemlibra demonstrates how far antibody science has progressed. Genentech’s drug, approved late last year, connects two clotting factors to prevent the devastating bleeds in hemophilia patients with inhibitors. The high price may be offset by avoided costs in patients with factor VIII inhibitors.
Starting this year, many PBMs rolled out a new type of cost-share program that will not count copay assistance dollars toward a patient’s deductible and out-of-pocket maximum. This might put some patients in a bind. Patients face big, unaffordable drug bills when the assistance maximum is reached, but before they have met their deductibles. Adherence to the specialty drug could fall off sharply if patients hit the copay program limit and cannot afford therapy.
Broadening the Hospital Readmissions Reduction Program so that it is hospital-wide and not just focused on the five conditions currently included in the program would mean that safety-net hospitals would be hit with higher penalties. However, there may be ways to level the playing field if the switch ever takes place.
Transforming health care is harder than it looks. That’s partly because of a proliferation of pilot programs and point solutions that touch different parts of the elephant but fall short of actually unifying the vision. The time has come to make our way from volume to value.