Research released today shows that from 2016 through 2018, self-insured employers and commercial health insurers in 49 states and the District of Columbia paid 247% more, on average, than what the Medicare program would have paid for the same inpatient and outpatient hospital services.
Researchers from RAND analyzed hospital claims data from 3,112 hospitals in every state except Maryland, which was excluded because the state has an all-payer rate setting model in which hospitals charge prices that are equal to what Medicare and private insurers pay, the report explained. The claims totaled $33.8 billion and came from self-insured employers, six state all-payer claims databases and health plans from 2016 to 2018. Continue reading →
The Trump administration has been talking tough on drug prices for many months and, of course, pharmaceutical companies and other organizations have pushed back because they mostly oppose controls on the free market for prescription drugs.
For health care journalists covering these proposals, it’s essential to remain skeptical of any group that offers support or opposition and, as always, follow the money. Continue reading →
Over the past six months, journalists for the Columbus Dispatch have written more than 40 articles about the murky world of pharmacy benefit managers (PBMs) in Ohio. This week, they wrote one of the most important stories in this ongoing series, “Ohio firing pharmacy middlemen that cost taxpayers millions.”
In this article, they explained that the Ohio Department of Medicaid was changing the way it pays for prescription drugs by, “giving the boot to all pharmacy middlemen” because the Medicaid program wants to shift away from what’s called the “spread pricing” practice. Continue reading →
Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.
Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services Director Seems Verma are crisscrossing the country to tout the Trump administration’s plan to combat prescription drug prices. They promise that America’s Patients First, released by the president and HHS on May 11, will address significant roadblocks to lowering drug costs.
People age 65 and older account for 34 percent of all prescription medication use and 30 percent of all over-the-counter drugs purchased, according to this Medscape article. Azar, a former drug company executive, recently spoke with reporters and other stakeholders to promote the plan, saying that high prescription costs seriously threaten too many Americans’ health and wellbeing. Continue reading →
President Donald Trump has spoken about the cost of drugs frequently. Though not always clearly and consistently, he has called for government negotiation of prices. Drug prices also have caught Congress’s eye, although we’re not quite sure what (if anything) legislators are willing to do about it.
Paul Levy, former chief executive of Boston’s Beth Israel Deaconess Medical Center, recently made a compelling argument in a blog post about why value-based pricing for hospital services ultimately will fail.
In “The Game That Shows Why Value-Based Pricing Is Doomed” on AthenaInsight, Levy argues that the incentives in value-based pricing are all wrong. As a payment model, value-based pricing promotes selfishness but at the same time requires all parties to cooperate, he writes.
It’s not often that anyone criticizes value-based care, and why would they? That would be like opposing the use of grocery coupons. Continue reading →