Spending on endocrine and diabetes therapies could surge nearly 70 percent in the next two years, according to Medco Health Solutions. Diabetes treatments were the second leading contributor in total dollars to prescription drug spending growth in

2006, trailing only cholesterol drugs. Spending on diabetes treatments increased 14.5 percent from 2005 to 2006, and the use of diabetes drugs increased 5.1 percent, according to the Medco report.

A number of factors are fueling this rise: The aging U.S. population, greater incidence of obesity, and newer, costlier medications.

The report says these factors as well as more frequent use of new drug combinations will push spending growth rates on diabetes medications upward 16 percent to 20 percent annually.

"Diabetes, and in particular, type 2 diabetes, is becoming much more prevalent among people of all ages, imposing a growing burden on health plans who pay for their care. It is creating a significant health care concern in America," says Medco's Chief Medical Officer Robert S. Epstein, MD. "While prevention of type 2 diabetes needs to be a national priority, drug treatments can help prevent the onset of complications from diabetes that lead to hospitalizations, more complex treatment, and dramatically higher costs."

The report says that new treatments for diabetes will drive unit costs higher as newer drugs are increasingly prescribed as first-line therapy. New injectable treatments and oral diabetes medications that act on new clinical targets have become available recently. Novel diabetes treatments in the development pipeline will also help push costs upward.

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.