AARP will expand its relationship with UnitedHealth Group and create a new relationship with Aetna to provide health insurance plans designed to meet the needs of its 38 million members and others who are over age 50. The new program is called AARP Health Aid. The agreement with UnitedHealth Group will include Medicare supplemental insurance, Medicare Part D plans, indemnity insurance products, and Medicare Advantage offerings. The Aetna agreement will include a PPO and a high-deductible insurance policy that could be used with a health savings account. When the products become available next year, AARP will be the largest provider of private insurance to Medicare recipients.... Savings from using the mail order option offered by PBMs help the member, but results in minimal cost reductions for the insurer, according to a recent study in the Journal of Managed Care Pharmacy. Researchers at the University of Texas–Austin reviewed claim records from two state-funded health plans. "The savings associated with mail order don't necessarily filter down to the sponsor. In this instance, the member realizes all the savings," says Michael Johnsrud, PhD, RPh, an associate director of the Center for Pharmacoeconomic Studies, University of Texas–Austin.... Nearly two thirds (63 percent) of 450 major employers in the United States that cover more than 8 million employees plan to make aggressive multiyear steps to help employees improve their health by increasing education efforts, implementing condition management programs, and using data analysis and other cutting-edge programs to improve health and productivity while holding participants accountable for their behaviors, according to a recent Hewitt Associates study. Less than 40 percent plan to maintain their current focus on health care benefits — primarily concentrating on annual cost mitigation.
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.