CMS proposed new protections for Medicare beneficiaries in Medicare Advantage and prescription drug plans by providing more regulation on door-to-door marketing and cold-calling, as well as new proposed requirements pertaining to broker/agent commissions. The proposal goes beyond what the health care insurance industry recently endorsed as necessary regulatory changes to the program for development. “This is an important step to ensure beneficiaries can rely on information being provided to make Medicare coverage decisions that are right for them,” says Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP). AHIP is reviewing the new regulations and is developing detailed comments… The age of a business may affect a manager’s decision to offer health benefits, according to a new report from the Henry J. Kaiser Family Foundation. The report suggests that for smaller and mid-sized establishments, the likelihood of offering coverage is positively associated with the age of the business. Insurers may want to give special focus to the issues faced by small businesses just starting up or in the early years of operation. Special subsidies or products for these businesses may be needed to encourage these businesses to purchase, and their workers to enroll in, health plans. The analysis is based on data from the insurance component of the Medical Expenditure Panel Survey… A recent study published in the British Medical Journal suggests that blood glucose self-monitoring is not cost-effective. In a randomized, controlled trial, 184 people with newly diagnosed type 2 diabetes were placed in either a self-monitoring group or in a control group that did no self-monitoring. Researchers found no significant difference in HbA1c, body mass index, or use of oral hypoglycemic drugs. However, patients in the self-monitoring group had higher on depression in the study’s well-being questionnaire.
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.