The American Medical Association and the Pharmaceutical Research and Manufacturers of America are fine with the AMA's policy restricting physicians from receiving gifts from pharmaceutical sales representatives — they just want to see it better implemented. A source told the Wall Street Journal that drug company executives "want their employees to adhere to the [AMA's] ethics guidelines" while AMA officials recognize "that doctors must not demand to be courted" in unethical ways.... Some state Medicaid programs are finding that generic drugs can cost more than brand-name pharmaceuticals. The Wall Street Journal reports that the strange twist stems from a 1990 federal law that requires drug companies to discount brand-name drugs deeper than generic drugs must be.... The nation's largest pharmacy benefit manager is scheduled to be put up for sale this summer. Merck plans to sell part of Merck-Medco for between $6 billion and $15 billion. The PBM generates half of Merck's sales, but just a small fraction of its profits.... If companies build a system where employees can enroll for benefits online, people will use it, a Hewitt report says. Where Internet enrollment was offered last year, 70 percent of employees did so online — up from 36 percent in 1999.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.