Tag Archives: cost sharing

Trump administration likely to face legal challenges to its double punch at ACA

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

The Trump administration dealt a one-two punch to the Affordable Care Act on Thursday. Trump’s executive order would give Americans the option of buying lower-cost health insurance, but also could usher back the bare-bones insurance options that the Affordable Care Act was designed to eliminate.

In addition, Trump directed the U.S. Department of Health and Human Services to end the cost-sharing reduction payments (CSRs) to health insurers required under the ACA effective immediately. The payments always have been controversial, and the Trump administration, in justifying its action, noted that House Republicans earlier successfully challenged them in court. Continue reading

Webcast: How value-based insurance design breaks down financial barriers to care

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Covering health care requires writing about the cost of care. Determining if costs are rising or falling and by how much is an integral part of the beat. After all, cost control is one of the primary concerns behind health care reform.

Mark Fendrick, M.D.

Mark Fendrick, M.D.

But A. Mark Fendrick, M.D., the director of the Center for Value-Based Insurance Design at the University of Michigan, suggests it’s time to shift the discussion from how much the United States spends on care to how well we spend money on health care. Focusing closely on costs leads health systems to use a one-size-fits-all approach to cost sharing, and requiring consumers to pay more for needed services may have a perverse effect of becoming a barrier to care, he explains. Conversely, VBID encourages a more clinically nuanced approach to financial incentives that involves setting consumers’ out-of-pocket costs for health care services and medications to motivate patients to do what research proves will help keep them healthy.

Fendrick will explain V-BID and the role it should play in the health care system during an AHCJ webcast, “How value-based insurance design breaks down barriers to care,” on Aug. 14, 1-1:30 pm ET.

V-BID seeks to align patients’ out-of-pocket costs, meaning their copayments, deductibles, and premium payments, with the value of health services, the center says. “This approach to designing benefit plans recognizes that different health services have different levels of value. By reducing barriers to high-value treatments (through lower costs to patients) and discouraging low-value treatments (through higher costs to patients), health systems that incorporate the concepts of V-BID can improve patient outcomes,” it says. Continue reading

Here’s why specialty pharmaceuticals need value-based insurance design

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Image by Bill Brooks via flickr.

Image by Bill Brooks via flickr.

This spring, Gilead Sciences Inc. introduced Solvaldi, a drug that could cure the liver virus that causes hepatitis C. The drawback, however, was the cost of $84,000 or about $1,000 per pill, as Julie Appleby reported at Kaiser Health News.

“And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug – and who pays for it,” she wrote.

Bernard Munos wrote in Forbes that the cost of one recently introduced cancer medication was $66,000 and another was $90,000.

At such high prices, consumers may be unable to afford these medications and insurers may not cover them. If insurers do cover these high-priced drugs, they may require patients to pay the typical copayment of 30 percent or more.

In a new report from the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC), researchers argue that insurers need a new approach to paying for specialty medications. Continue reading