About 1 in 6 Americans report paying more than 10 percent of their total family income for health insurance premiums, says the latest report from the Agency for Healthcare Research and Quality. Of those with employer-sponsored insurance, 16 percent spend 10 percent or more of their income on premiums and out-of-pocket expenses. Of those with public insurance, 16 percent spend 10 percent or more of their income on out-of-pocket expenses (and 84 percent do not).… Advising adult patients to get vaccinated for the flu, especially during the 2009–2010 pandemic, would seem to make a lot of sense. But a study in Preventive Medicine suggests that 64 percent of adults did not receive any provider-issued influenza vaccination recommendation. Adults who were advised to get vaccinated were 14.1 to 32.1 percentage points more likely to get vaccinated than adults who did not receive a recommendation…. A merger between Medco and Sanofi will help the French drug manufacturer navigate the American payer and regulatory landscape. Sanofi’s research and development will benefit from the merger, gaining a perspective on the views of health insurers and governments that are seeking evidence of a drug’s demonstrated benefits before paying for it. Sanofi will benefit from Medco’s voluminous claims data, which it collects by providing pharmacy benefits to millions. Medco will be a consultant to the drugmaker on comparative studies for both experimental and approved drugs.
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.