Physicians should learn how to talk to patients about money, according to a new study from Wake Forest University School of Medicine, especially as health insurers force people to base more treatment decisions on out-of-pocket costs. “Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket,” says Mark A. Hall, JD, a professor of law and public health and coauthor of the study. Doctors generally avoid asking patients about health insurance and finances, because they want what is best for their patients and what’s best may not always be the most affordable. The researchers say patients are counting on physicians to help guide them to the best treatment decisions — medically and financially.... Harvard Pilgrim, Tufts, and Grand Valley topped the U.S. News & World Report 2009–2010 rankings of commercial, Medicare, and Medicaid HMO and POS plans. The rankings are based on data collected and analyzed by the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body.… Findings from the STARD (Sequenced Treatment Alternatives to Relieve Depression) trial suggest that for second- and third-line treatment, no second generation antidepressant was superior to another in terms of effectiveness or of the overall incidence of harmful effects. Second generation antidepressants include serotonin and norepinephrine reuptake inhibitors. From a payer’s perspective, choice of antidepressant may be less important than close medication management in providing effective and tolerable treatment.
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.