Middle-aged and older Americans with heart disease who cut back on their prescribed medications because of cost were 50 percent more likely to suffer heart attacks, strokes, or angina than those who did not report cost-related medication underuse, according to the lead author, Michele Heisler, MD, MPA, and colleagues in a study conducted at the Veterans Affairs Ann Arbor Healthcare System in Michigan.

The study is significant because it is the first nationally representative longitudinal study to demonstrate that patients with serious chronic illnesses experience adverse health events when they restrict their use of prescription drugs due to cost. The downturns in patients' health were observed over a two- to three-year period, suggesting that cost barriers to prescription drug use may have important short-term effects on older patients' health and well-being.

"Managed care organizations need to be a little more creative about incorporating patients' clinical need for the medication. Insurers need to make sure that the people who most need the medicine are not experiencing cost barriers to taking it," says Heisler.

"Physicians need to be sensitive to the effect cost has on patient adherence as well," continues Heisler. "We need to be asking patients and making sure cost is not such a burden."

After controlling for risk factors for poor health outcomes, 32 percent of adults who had restricted medications because of cost pressures reported a significant decline in their self-reported health status during their follow-up interviews compared to 21 percent of adults with no cost-related underuse. Patients' reports on their health have been found to strongly predict other serious life events, including mortality, according to the study. Researchers found that people with arthritis and diabetes who said they had restricted drug use due to cost did not report that the condition had worsened, unlike the cardiovascular patients.

Medication underuse due to high cost results in higher rates of cardiac events

Incidence of adverse health events among patients with serious chronic illnesses , adjusted for risk factors

SOURCE: MEDICAL CARE, "HEALTH EFFECTS OF COST-RELATED MEDICATION RESTRICTION" 2004 JUL;42(7):623-5.

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.