The retail prices of the 50 pharmaceutical products most prescribed to the elderly increased almost three times the rate of inflation last year, says a Families USA study. Prices for the medications jumped 7.8 percent, compared to the 2.8 percent rise (energy costs excluded) in the Consumer Price Index.... The New York State Department of Insurance leveled stiff penalities against Aetna U.S. Healthcare and United Healthcare over the plans' failure to inform members properly about how to appeal claim denials. Aetna was fined $1.5 million; United $1 million, and both have promised to reexamine claims that had been denied between mid-1994 and late 2001.... Poor publicity resulting from stories about denied appeals and other high-profile mistakes made by managed care organizations has led the American Association of Health Plans to hire the William Morris talent agency to help improve the industry's image in TV and movies. The AAHP wants to counter the negative image of the industry that's become part of popular culture, though organization officials doubt that there will be an overnight turnaround.... One good way to start such a public relations effort may be to get the word out about a new program by Blue Shield of California. On July 8, the insurer launched a health plan for Mexican migrant workers and their families. Jim Arriola, head of cross-border operations for Blue Shield, tells the Contra Costa Times that the plan will "provide better access to care for a segment of our society that is encountering a lot of challenges and difficulties in the health care system."
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.