The IMS Institute for Healthcare Informatics reported a 2.3 percent increase in spending on prescription medications in 2010. That is markedly lower than the rate reported in 2009 — 5.1 percent. The total dollars spent on medications reached $307.4 billion last year — or real per capita spending of $898, up $6 from 2009.

The overall volume of prescription medications consumed reached historically low levels in 2010. Findings were reported in IMS’s The Use of Medicines in the United States: Review of 2010.

The report says commercial third-party insurers were used by patients to pay for 63 percent of dispensed prescriptions, down from 66 percent five years ago. The number of prescriptions filled under a Medicare Part D plan totaled 871 million, or 22 percent of the total. The average patient copayment was $10.73 in 2010, down 20 cents from 2009 because of greater use of generic medications.

Comparing spending for 2010 and 2009 reveals that protected brands, which historically have caused volume-based increases in spending, saw a volume-based decline.

Increased spending because of price levels of protected brands was $16.6 billion in 2010, but this was partially offset by rebates, to the tune of $4.5 billion.

The report says total spending on new brands has declined in the last five years, even as newly launched products brought significant new therapy options to patients. Brands that in the prior year had sales of $32.1 billion were exposed to generic competition in 2009 and 2010, the highest two-year total ever.

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.