Health care opinion leaders so far think Medicare Part D is a success, though changes are needed to the program, according to a survey by the Commonwealth Fund. Between June 1 and June 19, 1,246 health care experts were solicited online, with 180 responding.

Commenting on the survey, Karen Ignagni, of America's Health Insurance Plans, calls the drug benefit "one of this country's most remarkable success stories...." Though she, too, believes that more can be done.

"Now that the first-ever Part D enrollment period has ended, how much do you agree or disagree with the following statements?"

Percent saying agree or strongly agree

Enacting Medicare Part D was, on balance, good for beneficiaries

The current benefit structure, which includes a coverage gap, will, on balance, help beneficiaries who are most vulnerable to high drug costs

Making Medicare drug coverage available through private plans only was, on balance, good for beneficiaries

"Please select which change, if any, would be your highest priority."

Percent saying agree or strongly agree

Fill in the coverage gap by some combination of increased copayments and additional government funding

Eliminate the assets test needed to qualify for a low-income subsidy

Allow plans to offer coverage through the coverage gap as an option to the enrollee, with an additional premium, without pushing back the catastrophic coverage threshold

Raise the income level needed to qualify for a low-income subsidy

None of these

Source: The Commonwealth Fund Health Care Opinion Leaders Survey, July 2006

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.