Review Article
Bruce W. Sherman, MD, FCCP, FACOEM
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Barbara Antuna, MD

Barbara Antuna, MD

Efforts to improve patient communication must become a priority. Too often, the language we use in health care is a kind of code that serves billing and other purposes. Jargon may be an efficient and precise way for insiders to communicate, but it is impossible for patients to understand.

President Trump turned his push for the American Health Care Act in a zero-sum game: Either the House passes the AHCA today or Obamacare stays, the Wall Street Journal reports. Trump is done negotiating, White House Budget Director Mick Mulvaney told wavering House members last night.

Medical Directors Forum
Eneida O. Roldan, MD, MPH, MBA

Eneida O. Roldan, MD

The Triple Aim hit a nerve with medical directors and health care managers of all kinds. That’s because it is a concise way of summarizing the disparate issues that anyone trying to manage the delivery and cost of health care must deal with.

When Harvard Pilgrim Health Care recently unveiled value-based contracts for two expensive medications, etanercept (Enbrel) and teriparatide (Forteo), the news caused a stir

Managed Care Outlook
Coronary heart disease deaths will decline by 30% between 2010 and 2020 because of improvement in “cardiovascular health metrics” (avoidance of smoking, more physical activity, and so on). But this less-deadly era of CVD is going to be a more costly one, with direct medical costs more than doubling by 2030 to $918 billion from $396 billion in 2012.

“It won’t lower premiums, and until it does, I’m going to be a ‘no,’ even if it sends me home,” Republican Rep. Mark Meadows of North Carolina said yesterday about the coming vote on the GOP’s American Health Care Act.

Managed Care Reader Poll
In an online survey of readers conducted in late January and early February, 20% of the 113 respondents indicated that they believed that biosimilars will be highly effective in lowering drug costs, and the reader ratings of their effectiveness skewed toward positive.
Jan Greene
For four years, businesses that wanted to reimburse employees for their health insurance premiums rather than buying their coverage for them were told that that was no longer allowed under the ACA. But the health reimbursement arrangement (HRA) is back, brought back to life by provisions tucked into last year’s 21st Century Cure Act.
Howard Wolinsky

Eileen Wood

While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.