America’s Health Insurance Plans (AHIP) wants Congress to go slow with the transition from the ACA to whatever is coming next, the CT Mirror reports.

President-elect Donald Trump is increasing pressure on congressional Republicans to vote at the same time to both repeal and replace the Patient Protection and Affordable Care Act (PPACA), according to the Wall Street Journal.

Hospitals in Medicare accountable care organizations (ACOs) outpaced non-ACO hospitals in reducing the rate at which patients discharged to skilled nursing facilities (SNFs) needed to return to the hospital, according to a new study from Brown University. The findings were published in the January issue of Health Affairs.

The FDA has approved Arymo ER (extended-release morphine sulfate tablets C-II, Egalet Corporation) for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

The Federal Trade Commission (FTC) and the New York State Attorney General have charged Wisconsin-based Quincy Bioscience, manufacturer of the dietary supplement Prevagen (apoaequorin), with making false and unsubstantiated claims that the product

A steady decline over more than two decades has resulted in a 25% drop in the overall cancer death rate in the United States. The reduction equates to 2.1 million fewer cancer deaths between 1991 and 2014. The findings come from Cancer Statistics 2017, the American Cancer Society’s annual report on cancer incidence, mortality, and survival.

Twenty years ago it took 12 years after the average drug’s original patent was filed to go through the approval pipeline to eventually be launched. Today, however, it takes—12 years.

The Senate will take its first steps toward repealing the Patient Protection and Affordable Care Act (PPACA) by the end of the week, according to a Reuters report.

The Republican strategy of repealing the Patient Protection and Affordable Care Act (PPACA) before devising a replacement plan has the support of only one in five Americans, according to a new survey by the Kaiser Family Foundation.

Out-of-pocket expenditures are thought to be a significant barrier to receiving cancer preventive services, especially for individuals of lower socioeconomic status.

The FDA has accepted a supplemental biologics license application (sBLA) for atezolizumab (Tecentriq, Genentech) and has granted the product priority review for the treatment of patients with locally advanced or metastatic urothelial carcinoma who are ineligible for cisplatin chemotherapy, and who are either previously untreated (first-line) or have disea

U.S. hospitals are reducing bloodstream infections related to catheters by implementing rigorous safeguards that also save millions of health care dollars each year, according to a new study led by the Cedars–Sinai Medical Center in Los Angeles, California.

The efforts by government and private insurers to reign in drug increases is one of the reasons that this could be a banner merger and acquisition (M&A) year for biopharma companies, according to the consulting company EY’s M&A Outlook and Firepower Report 2017.

One of the ideas Republicans are considering as they contemplate dismantling the ACA is to scrap the benefits, but keep the tax revenues for the program rolling into federal coffers, according to the Wall Street Journal.

Senate Democrats have demanded an ethics probe into Tom Price, President-elect Donald Trump’s pick for Secretary of the Department of Health and Human Services, following a report that he traded in health care company stocks while supporting legislation in Congress that could affect those shares, according to an article posted by the Reuters news service.


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.