CMS warns that the slowing economy may force it to reduce Medicare reimbursements to hospitals and doctors.... Texas Insurance Commissioner Jose Montemayor has extracted $9 million in fines and "tens of millions of dollars" in restitution to physicians from health plans accused of not complying with Texas's prompt-payment law. In New York, meanwhile, the state medical society sued six health insurers for breach of contract, claiming that they use stalling tactics to delay payments to physicians.... Louisiana officials are putting together a bare-bones plan aimed at snaring at least some of the 34,000 state employees who do not take the state's coverage choices. Worker contributions for the low-cost plan could be as low as $50 a month.... California Gov. Gray Davis has signed SB 37, which requires health plans to cover all routine medical costs associated with a patient's involvement in clinical trials for cancer treatment.... The disabled make up 17 percent of Medicaid enrollees, but use 77 percent of its behavioral health expenditures, according to the U.S. Substance Abuse and Mental Health Services Administration.... If you want a peek at the future, get to know the name Aetna HealthFund. The insurer's new product, to be offered next year, is a combination PPO and health savings account. The savings would be used for deductibles and care not covered by the PPO. It places responsibility for health care choices on the insured — a concept that employers are giving a long look.
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.
The results can be tragic. Patients with addictions are unlikely to wait the hours or days it takes health insurers to approve the medications they need. Insurers are changing their practices, but not without some outside pressure.