Health insurers are trying a wide variety of methods to link drug costs to the value medications deliver to patients. Value-based payment strategies bear watching for two reasons. First, they are aimed at controlling the high costs of prescription medications, and, second, they could usher in new ways of pricing all medications.
The idea that insurers should link a drug’s value to price is not new, but it is gaining traction, at least among private health plans. One proposal calls for paying for drugs based on the quality-adjusted life year, or QALY, a measure used to quantify the value of treatment. Continue reading
There are plenty of aging-related stories on the horizon for 2015. Here are just some issues and ideas to get you started:
The once-a-decade White House Conference on Aging is scheduled for sometime in mid-2015 – a date is yet to be finalized. It’s the 50th anniversary of Medicare, Medicaid, and the Older Americans Act, as well as the 80th anniversary of Social Security. The conference will focus on four key areas:
- Retirement security
- Healthy aging
- Long-term services and supports
- Elder justice
Look for plenty of updates on the conference by spring.
Issues include financial security, affordable housing, aging-in-place and community-based support services. According to Leading Age Magazine, boomers are poorly prepared when it comes to savings. How are the 50- and 60-somethings in your community preparing for retirement? Or are they? Continue reading
When writing about medical studies, reporters should always ask researchers about any financial relationships with drug companies or device manufacturers. That was one of the main lessons from a panel on conflicts of interest on Saturday at Health Journalism 2014.
Starting in September, sunshine provisions in the Affordable Care Act will require drug companies to disclose most payments to doctors. Some companies have already started to publicize their financial relationships with doctors. But most medical journal articles do not give accurate information on researchers’ potential conflicts of interest, said panelist Susan Chimonas of the Institute of Medicine as a Profession at Columbia University.
“You shouldn’t be uncomfortable asking these questions,” Chimonas said. “They owe you this information. They owe everyone this information.” Continue reading
Image by Amanda M Hatfield via flickr.
Perhaps the federal Centers for Medicare & Medicaid Services (CMS) learned a lesson over the past few weeks when it tried to make changes in its Part D prescription drug program. The lesson: Don’t mess with Part D in an election year.
On Monday, CMS withdrew its proposal to revise the Part D program, a proposal that drew widespread criticism from congressional Republicans and Democrats and from groups of patients, among others. Those in opposition said the proposal would undermine Part D, which members of Congress called a successful and popular program. More than 36 million elderly and disabled Americans get prescription drug coverage through Part D.
“Late last week, more than 370 organizations representing insurers, drug makers, pharmacies, health providers and patients urged CMS to withdraw changes it had proposed for Medicare Part D,” wrote David Morgan of Reuters. “The Republican Party had already begun to look for ways to leverage popular anger over the changes into campaign attacks on Democratic incumbents who could be vulnerable in November’s election showdown for control of Congress.” Continue reading
A plan from the federal Centers for Medicare & Medicaid Services to eliminate protections for certain classes of drugs ran into stiff opposition on Wednesday when both Democrats and Republicans criticized the plan during a hearing of the House Energy and Commerce Committee.
Committee members questioned Jonathan Blum, principal deputy administrator of CMS, on the CMS plan to end the protected status for three classes of drugs (antidepressants and immunosuppressants in 2015 and possibly ending protected status for antipsychotics in 2016). Blum explained that CMS wants to foster competition and lower prices and that the proposal is not designed to limit the types of drugs that CMS covers, according to an article by Jennifer Corbett Dooren in The Wall Street Journal.
But perhaps the bigger issue involved whether the Part D proposal would allow CMS to get involved in price negotiations for medications. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, bars CMS from negotiating with pharmaceutical companies over the price of medications for Medicare beneficiaries. This provision of the 2003 law that established Medicare Part D, the prescription drug benefit, is known as the non-interference clause. Continue reading
Image by Amanda M Hatfield via flickr.
Patient care advocates, drug companies, and both Republicans and Democrats are arguing against a proposal from the federal Centers for Medicare & Medicaid Services to eliminate protections for certain classes of drugs, including those for depression and schizophrenia.
Reporting on the proposal last week, Katie Thomas and Robert Pear wrote in The New York Times, “Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs.”
CMS estimates that the proposal will reduce overuse of some drugs and result in cost savings of $720 million by 2019, according to an AP article by Ricardo Alonso-Zaldivar.
Opponents say the proposal could result in increased hospital and physician services if patients can no longer get or afford the medications in six classes of drugs: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants. Antidepressants and immunosuppresants would lose protected status in 2015 and antipsychotics would lose it in 2016. The other three classes (anticonvulsants, antineoplastics and antiretrovirals) would continue to be protected in 2015 pending further review by CMS, the proposal said. Continue reading