Legislation & Regulation
Richard Mark Kirkner
Verma, CMS say bringing step therapy to Part B will save plans and beneficiaries money. Critics see perverse incentives and circumvention of normal rulemaking.
Viewpoint
Erik Johnson
As plans and providers collaborate to manage post-discharge care, they will also need to take heed of the nonclinical variables. Limitations in performing activities of daily living (ADLs) and social determinants of health have as great an impact on health care spending among the elderly as the presence of chronic conditions.

News Wire

Several Health Insurers Now Consider DBS Therapy for Epilepsy a Covered Indication
Vials Being Rationed, Only One Manufacturer
Non-Invasive Therapy for Patients Who are Nonresponsive to Antidepressants
Disease Occurs in 1 in 5,000 Male Births in the U.S.
The main goal of Atul Gawande’s effort: Make health care intelligible.
Cover Story
Timothy Kelley
Is MA a ripoff of taxpayers, a godsend for integrated, cost-effective care, or somehow both? You can’t take a stand on this question from 30,000 feet. So let us guide you through the valley of details.
Viewpoint
John S. Linehan, JD
Drug manufacturers have relied on coupons to promote access to branded drugs by reducing patients’ out-of-pocket costs. Insurers and PBMs, on the other hand, have opposed coupons because they undermine the effectiveness of cost-sharing requirements and benefit designs that incentivize cost-effective drug prescribing and purchasing choices.
CURRENT ISSUE February 2019

EXACTLY HOW MEDICARE ADVANTAGE PLANS ARE PAID

Senior Contributing Editor Timothy Kelley was once the Editor of this publication, so he knows his stuff. A good thing, too, because the payment system for Medicare Advantage fends off understanding. But Tim does it in way that should be helpful to both novices and experts. Meanwhile, Contributing Editor Jan Greene takes on hormone replacement therapy (HRT), which has been a fraught issue in women’s health care for decades. Jan untangles the current issues of bioidentical HRT and compounding. Other features look at the state of women’s health care in general (not good), and how financially beneficial Medicare Advantage has been to insurers up until now (very). These are standouts in an issue loaded with insightful analysis and outstanding, jargon-free reportage. Take a look. It’s one of our cover-to-cover successes.

UPCOMING MEETINGS

New Orleans, LA
March 11-12, 2019
New Orleans, LA
March 11-12, 2019
Philadelphia, PA
April 16-17, 2019
Washington, DC
April 28-May 01. 2019
Las Vegas, NV
April 29-May 02. 2019
Alexandria, VA
May 08-09, 2019
Legislation & Regulation
Richard Mark Kirkner
The FDA commissioner has an 11-step ‘action plan’ to get biosimilars out of a repeat mode of unrealized potential. But issues like interchangeability still need clarifying if biosimilars are to have a major effect on drug expenditures.
SPECIAL REPORT: BIOSIMILARS
Thomas Reinke
Biosimilars are saving money but not in the U.S., where companies have used a variety of stalling tactics. Now Pfizer and others are accusing Johnson & Johnson of withholding rebates to fend off biosimilar competition to Remicade.
Q&A
Interview by Peter Wehrwein
The price of biologics can ruin cancer patients financially, this leading oncology expert reminds us. Biosimilars may help, but we need more of them on the market.