Good news for employers can be found in a study by Hewitt Associates that reports that health insurance costs increased by 9.2 percent this year. That's the first single-digit increase since 2000. The report contained not-so-good news for employees. Their contributions to health care premiums increased 65 percent, from $877 per individual in 2002 to $1,444 this year.... Humana has agreed to pay $40 million (as well as an additional $18 million in legal fees to the plaintiffs) in a settlement of a class-action lawsuit filed by more than 700,000 physicians. The suit says that Humana delayed or denied payment of claims for medical services rendered by the doctors. Humana is the latest of the 10 health insurers named in the suit to reach a settlement.... Do as I say, not as I do? Medical malpractice claims paid by insurers and hospitals on behalf of doctors in their employ must be reported to the National Practitioner Data Bank. Now, however, a report by the Office of Inspector General says that between 1997 and 2004, agencies under the Department of Health and Human Services failed to report 474 instances in which they paid medical malpractice claims. HHS Inspector General Daniel Levinson sums up the problem by noting that "underreporting of the department's own medical malpractice cases lessens the usefulness of the National Practitioner Data Bank and undermines departmental efforts to regulate private and public sector compliance." Indeed.
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.