The proportion of Americans reporting treatment for diabetes who took oral medications to treat their condition rose from 60 percent in 1997 to 77 percent in 2007 — a 28 percent increase. During that period, the proportion taking insulin to control their diabetes fell from 38 percent to 24 percent, according to the Agency for Healthcare Research and Quality (AHRQ). It’s understandable, because it is more convenient to take a pill than to give oneself an injection. Less painful, too.

AHRQ’s analysis also revealed a shift in the three most commonly prescribed oral medications during that period. Sulfonylureas were the most prescribed oral antidiabetic in 1997 and still were in 2007, with 5 and 7.6 million people with diabetes using this class of drug. The biguanides (prescribed to 2.1 and 10.4 million, respectively) and thiazolidinediones (prescribed to 0.5 and 4.6 million, respectively) followed.

Although the sulfonylureas were the most widely used class of oral antidiabetes agent in 1997, the proportion changed by 2007.

In 2007, the proportions of people who used the three most commonly prescribed oral medications changed this way: sulfonylureas declined from 51 percent to 40 percent; biguanides rose from 21 percent to 55 percent; and thiazolidinediones increased from 5 percent to 25 percent.

The mean cost per user for all types of antidiabetic medications in constant dollars for 2006–2007 ($944) was nearly twice that in 1997–1998 ($500). In contrast, the mean expenditure per user for sulfonylureas and biguanides decreased from $298 and $381 in 1997–1998 to $211 and $297 in 2006–2007, respectively.

Thiazolidinedione costs rose during that period — from $1,013 in 1997–1998 to $1,121 in 2006–2007. The mean expenditure per user for persons using new antidiabetic medications stood at $1,297 for non-insulin injections and $577 for oral combinations in 2006–2007.

Percentage using orals, insulin, or non-insulin injections, 1997 and 2007 / Per-user expenditures on antidiabetic medications, 1997–1998 and 2006–2007

Source for both graphs: Agency for Healthcare Research and Quality. Statistical brief #293, September 2010

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.