A recent drug trend report issued by Medco Health Solutions paints a surprising picture of how difficult it is to get little Johnny to sit still in class or concentrate long enough to tie his shoes. The report, reviewing utilization and drug costs, describes a startling disparity between antibiotics, asthma, allergy, and behavioral medications.

Spending on drugs that are primarily used to treat attention deficit hyperactivity disorder (ADHD) surged 369 percent for children under age 5. In children over age 5, utilization of medication to treat ADHD rose 40 percent, with drug costs rising 183 percent. Further, 9 percent of all children taking one medication were taking an agent to treat a behavior-related condition.

"This analysis provides a striking commentary on the state of pediatric treatment in this country, as well as the costs shouldered by parents whose children live with these conditions," says Robert Epstein, MD, chief medical officer at Medco Health Solutions. "Early detection and appropriate treatment of these conditions is extremely important, but the emphasis is on 'appropriate' with an eye on cost-effective therapy, as well."

The report reviewed the prescription data of 300,000 children ages 19 and younger in four major categories of behavioral medications used to treat a variety of conditions, including ADHD, depression, autism, and conduct disorders.

Children continue to predominantly use antibiotics, allergy, and asthma medications, but the rate of increase in utilization and cost for these categories has been more moderate over the past four years. Antibiotics showed no change in utilization, allergy medication use rose 3 percent, and asthma medication use rose 12 percent.

ADHD medication spending outpaces antibiotics, allergy, and asthma treatments, 2000-2003


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.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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.