Many patients facing the prospect of having knees or hips replaced use the “I can’t live with this pain anymore” method of making the decision. That is, they put it off until they can’t put it off any longer. Thanks to work by researchers at Duke University, knee-replacement operations might become a thing of the past (http://tinyurl.com/knee-cart). They are trying to create artificial joint cartilage. Better for patients and, hopefully in time, better for cost management.... Black women are much more likely to have high blood pressure than black men or white men and women, according to a study in the journal Circulation: Cardiovascular Quality and Outcomes. The study looks at about 70,000 people in the southeastern United States, a.k.a. the “stroke belt.” The overall rate of high blood pressure is 57%, but it’s 64% for black women.... Patients at high risk for lung cancer will be able to get low-dose computed tomography (LDCT) screening without being charged a copayment or a deductible, thanks to a ruling by the U. S. Preventive Services Task Force. The task force gave LDCT a B recommendation. High-risk patients are people ages 55 to 80 who have smoked at least 30 packs of cigarettes a year, and former heavy smokers who have not smoked for 15 years.... Researchers tracking about 6,500 women ages 65 to 79 in the United States find that those who have a history of heart disease had nearly a 30% increase in developing cognitive difficulties than women without heart problems, according to a study in the Journal of the American Heart Association (http://tinyurl.com/heart-dementia). Many types of heart disease and vascular disease are associated with declining brain function.
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.