MANAGED CARE July 2000. ©2000 MediMedia USA
Maine's new drug price-control law could face legal action from the pharmaceutical industry. The Pharmaceutical Research and Manufacturers Association is keeping lawyers in Washington and in Maine, and will decide whether to sue before the end of the summer. The bill mandates stiff fines against drug companies that "exact or demand unconscionable prices," and is based on a legal precedent that forbids profiteering from food.... Now that Medicare pays HMOs on a risk-adjusted basis, are some plans being penalized for careful management? That's a possibility raised by an American Association of Health Plans policy analyst in the May/June issue of Effective Clinical Practice. W. Pete Welch, Ph.D., says that the risk-adjustment system, which is based on previous admissions, rewards plans that hospitalize liberally, while plans that take a more conservative approach are unfairly compensated, though their populations may be equally sick.... Quicker post-op discharge of bypass patients often shifts costs to nursing homes or home health care facilities, rather than encouraging overall cost-of-care reductions, according to a presentation at the American Association for Thoracic Surgery.... At the annual meeting of the American Society of Hypertension, researchers tallied failure to control hypertension at $964 million in direct and indirect costs.