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Forbes: Addressing the Systematic Problems of Rising Health Care Costs in America
Even with the 2016 Presidential campaign mercifully coming to an end, there is more drama to come. While there will be many epicenters, perhaps none will impact the daily lives of more citizens than the impending drama in the health care industry. While not referring to the Affordable Care Act, Herbert Stein’s truism, “If something cannot go on for ever, it will stop”, is apropos. The combination of double digit increases in premiums (they will rise 22 percent on average for the benchmark silver plan in 2017), and declining insurer participation in the marketplaces, cannot go on for ever. The next Congress and Administration will, consequently, have to do something. READ ARTICLE HERE Real Clear Health: Big Pharma Alta Vista
According to the latest report from the Altarum Institute, "moderate 2016 health spending growth continues a slow downward trend." Unfortunately, this doesn't fit the narrative of those who want to talk about runaway trains -- especially for pharmaceuticals. Here are the numbers: Hospital spending represents 32 percent of American healthcare spending, 20 percent goes to physician and clinical services, 15 percent goes to "other health spending," and 10 percent is for prescription drugs. Here's the headline -- Pharmaceuticals represent 10 percent of American healthcare spending. A dime on the dollar: That’s a smaller percentage than almost every nation in Europe. READ ARTICLE HERE American Action Forum's "The Daily Dish" - Prescription Drug Pricing
The rollout and cost of new drugs like Sovaldi, the pricing revelations at Turing Pharmaceuticals, and the Epipen episode have fed two related phenomena: a) concerns about drug pricing and b) problematic proposals to address these worries. Seventy five percent of Americans say they want more government action on drug prices, but to my eye we simply have not witnessed the sort of fundamental market failure that would justify proposals for aggressive government intervention. READ ARTICLE HERE Forbes: Private Prescription Drug Negotiation - The Key to Successful Public Policy
The first important fact to consider is that, with the exception of life-saving specialty drugs which often enter the market at a high price and quickly fall down to industry averages, prescription drug price growth is no faster than that of inflation (just under 2%). In fact, prescription drug spending as a percent of National Health Expenditures has remained steady at about 10% since the 1960s. But just because drug price growth isn’t really increasing, that doesn’t mean it doesn’t feel like prescription drugs are becoming more expensive. Burdensome restrictions on insurance plan design mandated by the Affordable Care Act (ACA) have incentivized insurers to limit what drugs they cover and increase the patients’ share of the drug price by raising out-of-pocket expenses. In 2016 the average deductible for a silver-level plan was over $3,000. Limited formularies, higher coinsurance and copay, and higher deductibles mean that patients pay more money for more drugs more often than they would under insurance plans with more freedom of plan design, even though the actual sale price of most drugs has increased relatively little. READ ARTICLE HERE Forbes: All Americans Must Benefit From The Golden Age Of Medicine
In the history of medicine, this may be the most exciting and productive period. At the same time, we are about to make major changes in our government that may give us the opportunity we need to take advantage of this renaissance. We are on the cusp of new drugs to fight cancer, potentially turning it into a chronic, rather than a fatal, condition. In recent years, hundreds of new medicines for heart failure, rare genetic disorders, Hepatitis C and HIV/AIDS have been extending lives and even curing debilitating diseases forever. This is a big change from a decade ago, when we suffered a disturbing decline in innovation and productivity. Since then, America has made massive investments in R&D and brought research scientists and practicing physicians together to produce remarkable medicines. READ ARTICLE HERE Health Affairs Blog: Social Determinants of Population Health
It is now widely recognized that the health outcomes of populations often are determined more by social factors than by medical care. Much of the most innovative recent work on social determinants and population health demonstrates the value of partnerships across sectors, with health care systems partnering with community-based organizations ranging from housing authorities to nutrition support programs and beyond. These partnerships have proven themselves to be essential to populations enrolled in alternative payment models such as accountable care organizations (ACOs), and ACO leaders are beginning to recognize the need to integrate services both within and without the health care sector. Thus, health care systems are exploring how to collaborate with social service providers to keep patients away from costly care and improve health outcomes. READ ARTICLE HERE |
Weekly Standard: The Complicated Dynamics of Insurance Companies and Drug Prices
What constitutes a "fair" price for a drug? Unsurprisingly, that depends on who's asking the question, as well as who's answering. To get a price that can actually be construed as fair, it is essential that these are not the same entity. Many insurance companies would prefer that the Institute for Clinical and Economic Review, or ICER, be tasked with determining fair prices. That makes perfect sense, given that they created ICER in the first place and continue to fund it. ICER received its initial seed money a decade ago from the Blue Cross Blue Shield Foundation, and much of its subsequent funding has come from the insurance industry. It has become a prominent force in the healthcare marketplace and payers use its key offering, the ICER Value Assessment Framework, to guide their decisions on which drugs and medical services to cover and how much to pay. READ ARTICLE HERE Wall Street Journal: Lilly's Bet on Alzheimer's
Drug-discovery failures are sometimes as important as the successes, and one such notable disappointment arrived on Wednesday. Eli Lilly & Co. reported another defeat for an experimental Alzheimer’s treatment, once thought to be a potential breakthrough against the disease. READ ARTICLE HERE Forbes: Why the Approach to Drug Pricing Has to Change
Products are displayed for sale at the pharmacy counter inside a Walgreens store in downtown Chicago on Oct. 18, 2016. Photographer: Christopher Dilts/Bloomberg As CEO of one of the world’s largest pharmaceutical companies, I believe that we need a new perspective on drug pricing: As an industry, we must shift to a model that focuses on value and outcomes delivered, both to patients and to health systems. READ ARTICLE HERE New York Times: How Health Care Hurts Your Paycheck
If there is a coherent theme to this year’s election, it is the growing economic frustration of working Americans. While trade has been the chief scapegoat, a major culprit has received much less attention: the rising cost of health insurance. Recent news of large price increases for plans on the Affordable Care Act’s insurance exchanges was the latest example of an unsustainable trend. But those exchanges sell insurance to only about 12 million individuals. Most people with private health insurance, about 150 million individuals, receive coverage through employers. And for those people, prices have been rising for years. READ ARTICLE HERE Wall Street Journal: Insulin Prices Soar While Drugmakers' Share Stays Flat
Insulin prices are soaring, creating pain for patients whose lives depend on the injectable drug—yet most of the revenue from the increases isn’t going to the drug manufacturers, it is largely being collected by middlemen. The major manufacturers of insulin-- Eli Lilly & Co. of Indianapolis, Novo Nordisk A/S of Denmark and Sanofi SA of France—are collecting about the same or less than they did several years ago. The price increases reflect the growing role of middlemen known as pharmacy-benefit managers who collect a fee based on list prices. This convoluted payment system for drugs in the U.S. encourages high list prices and steep behind-the-scenes discounts. That formula offers some bill payers lower overall costs while uninsured patients and those with certain health plans pay more. READ ARTICLE HERE MIT News: Decoding the Medical Cost Mystery
In Miami, health care providers spent about $14,423 per Medicare patient in 2010. But in Minneapolis, average spending on Medicare enrollees that year was $7,819, just over half as much. In fact, the U.S. is filled with regional disparities in medical spending. Why is this? One explanation focuses on providers: In some regions, they may be more likely to use expensive tests or procedures. Another account focuses on patients: If the underlying health or the care preferences of regional populations varies enough, that may cause differences in spending. In recent years, public discussion of this issue has largely highlighted providers, with the implication that reducing apparently excessive treatments could trim overall health care costs. READ ARTICLE HERE Forbes: EU vs US Cancer Care: Your Get What You Pay For
A recent report suggests that cancer patients in England are suffering from serious lack of access to vital treatments due, in part, to problems with the drug assessment and approval process. The UK and other European health systems use central health technology assessment (HTA) to decide whether to cover a given treatment, but these processes are ultimately designed to help manage healthcare budgets – not get the best outcomes for patients. In cancer care, however, you get what you pay for. READ ARTICLE HERE |