More than a third of Americans who need to be screened for colon or breast cancer have not been screened, according to the latest report from the Centers for Disease Control and Prevention. But overall, more people are being screened than ever before. “We are encouraged by a significant increase in colon cancer screening rates over recent years,” says CDC director Thomas Frieden, MD.... In the UK, the new coalition government will eliminate a layer of financial managers and ask physicians to decide how the bulk of the National Health Service’s £105 billion annual budget should be spent.... The Centers for Medicare and Medicaid Services is proposing changing the way physicians are paid for treating patients with synthetic skin grafts. The change involves the 90-day global period of service — once a physician applies the first treatment, Medicare cannot be billed for subsequent treatments within a 90-day window. There are two treatments — Dermagraft and Apligraf. Dermagraft typically involves eight treatments during those 90 days. Apligraf has just a 10-day global period of service. Its treatment generally calls for five doctor visits over 12 weeks, so doctors are able to bill for each visit. Doctors who use Dermagraft get around the billing restriction by using a “modifier-58,” which tells CMS to ignore the 90-day billing window. CMS plans to reduce the global period of service for both skin substitutes to zero, allowing doctors to bill for each visit.
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.