Things keep rolling along nicely for UnitedHealth Group, and possibly for the rest of the managed care industry as well. UnitedHealth posted a 36 percent increase in net profit in the second quarter. Net income went to $809 million, compared to $596 million for the same period last year, according to the Wall Street Journal. As the first major health insurer to report earnings, UnitedHealth is often seen as a harbinger for the industry.... More on UnitedHealth. Not everyone's enamored of the nation's second biggest health insurer. Consumer groups, for instance, have turned thumbs down to a merger of UnitedHealth and PacfiCare Health Systems. The California Medical Association also has doubts. "The merger troubles us. It places Wall Street's demand for profits ahead of Main Street's interest in good health care," Jack Lewin, MD, CMA's president, tells the Associated Press.... Many Americans believe in the urban myth that the "medical industry is withholding the cure for cancer from the public in order to increase profits," according to a survey published in the journal Cancer. Twenty-seven percent surveyed described that statement as true.... A new version of the Academy of Managed Care Pharmacy's Format for Formulary Submissions is available through the organization's Web site. The new format provides further clarification to manufacturers of the needs of health system formulary decision makers. "What health systems need is the comparative analysis of the product and the attending economics in a format that can be manipulated to make it relevant to their patient populations," says Richard Fry, director of programs for the Foundation for Managed Care Pharmacy, which provides training in the proper application of the new format.... Association health plans got a boost and a belt recently. The House voted 263–165 on July 26 to allow AHPs, which enable trade associations to pool their members in order to purchase insurance across state lines. AHPs would be regulated by the feds. Legislation allowing AHPs has made it through the House before, but not the Senate. President Bush insists that AHPs would work by allowing small companies to skirt hundreds of state regulations and mandates currently in place. Consumer groups argue that people would lose the protections that state oversight affords. In addition, a report issued by Georgetown University on the day the House voted says that AHPs would make businesses more vulnerable to scams. Stay tuned.
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.