Adding pharmacists to the primary care team right in doctors’ offices might help patients with chronic diseases manage their risks better, a new University of Alberta study suggests. The blood pressure of patients with type 2 diabetes dropped significantly when pharmacists were included in the on-site clinical examination and consulting process. Nearly 54 percent of patients who had received advice from a pharmacist were more likely to reach blood pressure treatment targets.... Urologists who own their practices ordered more imaging than urologists who receive a salary, according to data from the National Ambulatory Medicare Care Survey. More than 1 in 5 urology visits resulted in imaging, with nearly twice as many self-employed urologists ordering imaging tests than urologists employed by a health care institution (24.2 percent vs. 13.2 percent). Findings are in the December issue of the Journal of Urology.... After three months in operation, enrollment in high-risk pools has been anemic, with just 8,011 enrolled nationwide. The Patient Protection and Affordable Care Act established the Pre-Existing Condition Insurance Plan for people with pre-existing conditions until 2014, when private insurers are required to accept all applicants. Richard Popper, director of insurance programs at the Department of Health and Human Services, says, “It takes a while for advocates and stakeholders to realize there’s this new plan.” Meanwhile, come January 1, HHS will give consumers choices of plans with different costs and deductibles, hoping to draw more interest and enrollees.
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.