There’s a lack of competition among health insurers, according to the American Medical Association. A new survey by the physician group says that a vast majority of commercial health insurance markets are dominated by one or two health insurers and that 99 percent of health insurance markets are highly concentrated, according to results published in Competition in Health Insurance: A Comprehensive Study of U.S. Markets.… Roughly 3.4 million people visited emergency departments looking for relief from an aching back, according to the Agency for Healthcare Research and Quality’s “News and Numbers” report. That’s an average of 9,400 per day. The report also says that adults ages 18 to 44 were most likely to require emergency department care (1,569 visits per 100,000), but people ages 65 to 84 were the least likely to visit an emergency department for the condition. However, that younger population was less likely to need hospitalization, while the senior population had the highest rates of hospitalization (130 hospital stays per 100,000 versus 607 per 100,000 people).… The Medicare Payment Advisory Commission recommended that Congress update physician payments in 2012 by 1 percent. The commission also voted unanimously to recommend a 1 percent update to both hospital inpatient and outpatient services. The recommendations will be included in the commission’s March 2011 Report to Congress on Medicare Payment Policy.
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.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.