A lot of people appear willing to pay pharmacies for medication therapy management (MTM) services, according to a survey reported in Consultant Pharmacist. Participants in three Florida cities and were asked if they would be willing to pay for certain services based on the proportion of the payment that would be out of pocket, and about 70 percent said they would pay the traditional 20 percent copayment.

Survey questions focused on common services that pharmacists are capable of performing for an ambulatory population. “Willingness to pay” was based on common payment levels that patients are accustomed to paying when insurance is involved.

Willingness to pay was measured on a five-point Likert scale, ranging from “strongly agreeing” with the statements in the survey to “strongly disagreeing.” The payment levels of 0 percent, 20 percent, and 100 percent were used to mirror other medical and professional expenses and comparable insurance coverage for those services. Michael J. Schuh, PharmD, MBA, an ambulatory pharmacist in the department of pharmacy at the Mayo Clinic– Jacksonville and lead researcher, noted an inverse relationship between out-of-pocket expense and willingness to pay, i.e., willingness to pay increased as out-of-pocket payments decreased.

“In the population I see clinically, they are more educated, better off economically, and don’t mind paying $100 to $200 for the service out of pocket,” says Schuh.

Respondents had been asked what topics they sought help for from their pharmacist. These topics were insurance (49 percent), general health (24.7 percent), side effects (19.6 percent), over-the-counter medications (17.5 percent), drug interactions (13.4 percent), and dosing (5.2 percent).

Source: Schuh MJ, Droege M. Cognitive services provided by pharmacists: Is the public willing to pay for them? 2008. Consul Pharm. 23(3):223–228

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.