A U.S. General Accounting Office report says 11 percent of state licensure actions against physicians that were reported to the National Practitioner Data Bank had inaccurate or misleading information.... Payments made to physicians jumped 5.2 percent in 1999, while accounting for 32 percent of health care cost increases that year. A study by the Center for Studying Health System Change also notes that prescription drug spending was associated with 44 percent of the 1999 increase.... More than 90 percent of physicians consider a drug's cost before prescribing it for patients who pay for it out of pocket, but only 30 percent do the same when patients have a drug benefit, according to findings published in the Annals of Internal Medicine.... Retail prescription sales through mail order grew 27 percent from mid-1999 to the middle of last year, according IMS Health. More than 7 of every 10 prescriptions distributed through the mail were branded products, compared with 59 percent at traditional retail pharmacies.... Seventy percent of benefits administrators named rising health care costs as their top priority in a Deloitte & Touche survey.... The National Committee for Quality Assurance now offers purchasers customized health plan report cards. Seven private employers and the U.S. Office of Personnel Management are the first to try the online program, which gives employees detailed accreditation and HEDIS data about the plans that are available to them.... Three insurers — Group Health Cooperative, Premera Blue Cross, and Regence Blue Shield — have re-entered Washington State's individual market, which had been without private insurers for more than a year.... Name change department: Empire BlueCross and BlueShield is now Empire HealthChoice, Alabama's Health Partners HMO becomes the Oath, Advance Paradigm is now AdvancePCS, and the National Wholesale Druggists' Association has taken the curious moniker of Healthcare Distribution Management Association.
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
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.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
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.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.