Generic drugs are being dispensed in doctors' offices by devices that function much like automatic teller machines that banks use, under a program sponsored by Blue Cross Blue Shield of North Dakota. What the company is calling its Generic Delivery

Network has been launched in physician offices in Fargo and Grand Rapids with the aim of reducing costs attributed to the growing use of brand name prescriptions.

"These generic samples are paid for by the health plan without copays or deductibles as an inducement to have the member start on generic medications if they are appropriate," says Jon Rice, MD, vice president for medical management at the health plan.

The Generic Delivery Network relies on machines that dispense samples. Supplied to the health plan under a contract with a company called MedVantx, the machines dispense generic medications in nine therapeutic categories.

Doctors are assigned an identification number, says Rice. "That number and the patient information (either through the patient registration system or by scanning) is entered. This gives the doctor access to the medications in the machine. Appropriate labels for the medication and for the medical record are printed after the medication's bar code is scanned to confirm that it matches the request."

Rice says the health plan has installed four machines in some of the network's busiest primary care offices.

"These machines serve about 25 physicians," says Rice. "We are doing this as a pilot to see if and how prescribing practices change. Our generic utilization rate is already quite high. We are hoping this will drive it higher."

Physicians seem to like this experiment. "They have been very accepting and encouraging of having the machines available," says Rice. "They provide samples of products they would not otherwise have available in their offices, are very efficient (takes about 20–30 seconds), and it allows them to practice effective medicine."

Joel Haugen, MD, at the Dakota Clinic, can attest to that. "For the first time, our patients have immediate access to clinically appropriate generic medications."

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.