Employers typically want to offer the most cost-effective health benefit package, even if employees feel more of a financial pinch. There has been concern that generalized cost sharing increases under high-deductible health plans (HDHPs) could have some undesirable effects, such as reducing use of medications that are excluded from the deductible.

But a new study from Health Services Research suggests that when employees switched from an HMO to an HDHP that included modest drug copayments, there was minimal change in medication availability or minimal reduction in the use of essential medications for diabetes, hypertension, COPD, and asthma. The researchers wrote, “Drug utilization is largely sustained following a switch to HDHP coverage when enrollees receive standard tiered copayment pharmacy benefit packages.”

The researchers examined data from claims for more than 3,300 adults enrolled at Harvard Pilgrim Health Plan for 9 months before and 24 months after an employer switched them from an HMO to an HDHP. This group was compared with 20,534 matched HMO members. The groups had similar three-tiered drug copayments.

Overall, both groups demonstrated a gradual increase in mean daily medications available (DMA) over the three study years, with the average level of medication use slightly lower in the HDHP group. Overall prescription spending for both groups showed comparably increasing rates.

Use of all prescription drugs in entire study cohort

Source: Reiss SK, Ross-Degnan D, Zhang F, Soumerai SB, Zaslavsky AM, Wharam JF. Effect of switching to a high-deductible health plan on use of chronic medications. Health Serv Res. 2011 Oct;46(5):1382-401. Permission to reproduce charts has been granted by the publisher.

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.