More public universities are requiring students to have health coverage, according to the Associated Press. This may not have too much of an effect on insurers. "In most cases students are covered to age 25 under their parents’ insurance," says Arthur N. Leibowitz, MD, a former chief medical director at Aetna who now runs a company, Health Advocate, that helps consumers get a handle on managed care. Many of the hundreds of thousands of students covered by health insurers are graduate and foreign students, he adds.... The price tag for the Medicare prescription drug benefit keeps growing. Figures released by the Congressional Budget Office on March 4 say that the benefit will cost 849 billion over a 10-year period ending in 2015, up from the $720 billion figure released in February which, in turn, was up from the $534 billion projection of December 2003 which, in turn, was up from the approximately $400 billion projection bandied about before the legislation was passed. Phew! Looking for a silver lining? Well, the CBO’s recent projection does not include expected savings that could actually make the cost lower than the Bush administration’s current estimate of $724 billion over those 10 years. We’ll see.... We’re living longer, according to an examination of more than 2.4 million death certificates from 2003. The certificates, about 93 percent of those issued that year, were examined in a report by the CDC’s National Center for Health Statistics. Mortality rates declined in categories such as heart disease, cancer, stroke, HIV, and chronic respiratory disease. The average age for U.S. residents increased to 77.6 years.... Diabetes-related hospitalizations are a huge drain on health care finances, according to a study by the Agency for Healthcare Research and Quality. Preventing such events could save the United States about $2.5 billion. In 2001, 30 percent of people who were hospitalized for diabetes, wound up having two or more hospital stays. Costs for those patients averaged $23,100, compared to $8,500 for patients who were admitted once.
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.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.