Ted Slafsky

Contrary to the highly misleading picture painted by critics, the 340B drug discount program is working as Congress intended and helping millions of underserved Americans receive better healthcare every year.

The pharmaceutical industry has gone to great lengths to misconstrue how the program functions in an effort to vilify safety-net hospitals. These are the urban and rural facilities across the country that care for all patients, regardless of their ability to pay.

Michael Flanagan
Michael Flanagan

Uncertainty regarding health insurance exchanges is not going away. Changing enrollment deadlines and newly insured populations have brought challenges to payers and providers. Success will require staying competitive on price, network quality, and access.

Princeton’s Uwe Reinhardt, PhD, renowned health care economist, sits down with Managing Editor Frank Diamond to discuss the economic effects of the Affordable Care Act, wellness programs, and the state of health care in the United States in general.

Craig Keyes
Craig Keyes

I saw my doctor last month for an annual physical. I cannot imagine a better primary care physician; he’s so thorough, so kind. After an exhaustive review, he said all seemed pretty much “ship shape,” but he had to add one dig: “Hey, I was glad to hear you finally went for your screening colonoscopy. Thing is … I can’t find any evidence that it actually happened. No claim, no entry into the electronic medical record, nothing. Did you end up having the procedure?”

Busted!! It’s true that I went to have the procedure, and I shared this with my doctor. What I didn’t tell him was that I left before it was performed.

The U.S. offers the highest advances in medicine and technology, yet only 55% of patients receive nationally recommended guidelines of care for their health needs. There are many contributing factors, but gaps in care that go unattended top the list.

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.