Medicare officials plan to launch a pay-for-performance demonstration project next year for solo and small physician practices. The initiative will be a pay-for-reporting program in its first year in order to provide baseline information on the approximately 800 participating practices in Arkansas, California, Massachusetts, and Utah, according to the Centers for Medicare & Medicaid Services. After that, practices will be able to earn yearly incentives of up to $50,000, with a $10,000 maximum per physician.... Meanwhile, Mark McClellan says that higher-income Medicare beneficiaries should pay higher premiums to ensure the program's financial viability. McClellan, former CMS administrator, notes that beginning next year, beneficiaries with annual incomes of $80,000 will be required to pay a surcharge for the first time. That will affect 4 percent of beneficiaries, or 1.8 million individuals, and McClellan thinks that is a good first step. Policymakers should increase the surcharges even more, he says.... This one sneaked up on everybody, apparently. A quarter of Fortune 1000 companies are expected to have on-site clinics by the end of 2007, says Watson Wyatt Worldwide. About 15 percent have them now. "The trend has caught on so quickly that there is little comparative data: Watson Wyatt didn't even ask the question until this year," reports the Washington Post. Those that have the clinics are raving. Employees are more likely to seek preventive care when the doctor is just down the hall. The clinics also cut down on work time lost when employees go to a doctor outside the building.... The world's largest retailer will put consumer-directed health care to the test in the big way come Jan. 1, 2007. Wal-Mart Stores is set to offer new employees high-deductible plans as a "massive test" that it hopes will result in lower costs by "making individuals responsible for spending decisions," reports the Wall Street Journal. New employees will be able to enroll in a health plan with an $11 monthly premium and a $1,000 deductible, or a plan with a $17 monthly premium and a $3,000 deductible. Wal-Mart expects to contribute as much as $2,400 to the HSAs annually, says the Journal.
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.