Almost 90 percent of Americans know that antibiotics can treat bacterial infections, but a third also believe that they can fight viral infections as well, according to a poll done by the Pew Charitable Trusts for the Centers for Disease Control and Prevention. This type of information is followed closely by public health policy experts in light of the soaring growth of antibiotic superbugs. . . . The number of accountable care organizations (ACOs) will nearly double next year, the Centers for Medicare & Medicaid Services predicts. There are currently 153 ACOs that contract with Medicare. That could grow to 300 next month as new contracts are approved. . . . The preterm birth rate continues to drop, with the 2011 rate the lowest in 10 years, according to the March of Dimes in its 2012 Preterm Birth Report Card. The 2011 rate of 11.7 percent marks the fifth year in a row the preterm birth rate has dropped. About 64,000 fewer babies were born prematurely in 2011 than were born in 2006. Still, there’s a long way to go: More than 500,000 are born too soon. . . . A link between statins and surviving cancer is being explored. Patients taking these anticholesterol drugs were 15 percent less likely to die of cancer than were people not taking statins, according to a Danish study published in the New England Journal of Medicine. The study didn’t look at whether the statins prevent cancer, only at what happens after diagnosis. . . . One of the things health insurance experts will be watching as the Affordable Care Act goes into effect is the number of self-insured employers. Now there’s a benchmark, thanks to a study by the Employee Benefit Research Institute, which examines the growth of self-insurance. In 1998, 41 percent of employees belonged to such plans. In 2011, the study finds, that number jumps to 59 percent. Companies that self-insure can offer uniform benefits across state lines, which can ease the administrative burden and lower expenses. They can also avoid state-mandated benefits. Many large employers jumped at these perks, and increased enrollment in such plans was fueled almost exclusively by companies with 1,000 or more workers. In the meantime “The percentage of workers in self-insured plans in firms with fewer than 50 employees has been close to 12 percent in most recent years examined in this analysis,” says the study.
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.