Advanced practice nurse practitioners (APRNs) want the Obama administration to make insurers accept them as legitimate primary care practitioners in the state health insurance exchanges. They say that despite laws in 17 states that allow them to practice independently, health plans still hesitate to include them in their provider panels. “As many more millions of uninsured or underinsured seek primary care services through these exchanges, they will need access to qualified primary care providers. That will not happen if private insurers continue to exclude or restrict APRNs from their provider networks,” says Karen Daley, president of the American Nurses Association.... Efforts to beef up the ranks of primary care physicians have gone online. A program called Physician Retraining & Reentry aims to help retired specialists brush up on their primary care skills and treat patients without having to return to medical school. Enrollees need to have a valid medical license.... The debate about how often mammographies should be given and to what demographic hasn’t been decided yet. About two thirds of breast cancer deaths in a longitudinal study between 1991 and 2007 occurred in women who had not had mammography. Their average age was 49. The findings, in the journal Cancer, are at odds with a controversial recommendation by the U.S. Preventive Services Task Force that routine mammographies begin at 50.... Severely obese children will burden health care spending in years to come unless something isn’t done to address recent trends, says the American Heart Association. About 4%–6% of children and adolescents in the United States fall into this category. In a 17-page statement, the AHA warns that “if left unchecked, it will have a profound effect on those it afflicts and will place a significant economic and clinical services burden on the future health care system.” Severely obese children over 2 have a body-mass index that’s 20% higher than the 95th percentile for their age and sex.
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.