The High Cost of Charging Older People Much Higher Premiums

http://www.commonwealthfund.org/publications/blog/2016/aug/the-high-cost-of-charging-older-people-much-higher-premiums?omnicid=EALERT1090805&mid=henrykotula@yahoo.com

An estimated 11 million young adults ages 19 to 34 currently lack health insurance. Health insurers covet this age group as enrollees for their generally healthy status and lower cost risk. Bringing more of these uninsured young people into the Affordable Care Act (ACA) marketplaces would bring more balance to the marketplace risk pools, which some insurers complain are dominated by less healthy people.

One option for attracting young people being floated in policy circles is lowering premiums for this group by raising the limit on how much more insurers can charge older people relative to young people. The ACA bans insurers from charging people higher premiums on the basis of health or gender, but insurers are allowed to charge older adults up to three times what they charge young adults. This provision helps protect insurers from the greater potential health costs of older adults. Some have suggested that insurers be allowed to increase this so-called age band from 3:1 to 5:1 or higher, or allowing states to set their own age bands.

Unintended Consequences

http://altarum.org/health-policy-blog/unintended-consequences

Altarum InstituteAltarum Institute

How does it feel knowing the clinical decisions our physicians make affect their pocketbook? MIPS, or the Merit-based Incentive Payment System, is now the law of the land. MIPS attempts to incentivize physicians based on quality measures, use of electronic health records, practice improvement approaches and cost of care. The Centers for Medicare and Medicaid (CMS), is tasked with working out the details of the program, which aims to take us from a system where physicians are incentivized to “do something” to patients to one in which “quality” is the predominate goal.

Here’s my quandary: As a Geriatrician, I have practiced a lower cost approach to care my whole career. I try to avoid acute hospitalization, medications and procedures in my frail older patients. Why?  Because my experience, as well as a growing body of evidence-based literature, supports this approach. I should be wholeheartedly embracing this new approach to physician incentives. So, why do I feel sick when I think about it?

Is There a Cure for High Drug Prices?

http://www.consumerreports.org/drugs/cure-for-high-drug-prices/

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The cost of prescription drugs for tens of millions of Americans rose $2 billion last year, and all signs point to a continued rise. At stake is nothing less than the ability of Americans to afford the medicines they need. Can we stop the madness?

5 Reasons Prescription Drug Prices Are So High in the U.S.

http://finance.yahoo.com/news/5-reasons-prescription-drug-prices-172518972.html

Blame it on “government-protected” monopolies.
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The “most important factor” that drives prescription drug prices higher in the United States than anywhere else in the world is the existence of government-protected “monopoly” rights for drug manufacturers, researchers at Harvard Medical School report today.

The researchers reviewed thousands of studies published from January 2005 through July 2016 in an attempt to simplify and explain what has caused America’s drug price crisis and how to solve it. They found that the problem has deep and complicated roots and published their findings in JAMA, the journal of the American Medical Association. The study was funded by the Laura and John Arnold Foundation with additional support provided by the Engelberg Foundation.

“I continue to be impressed at what a complex and nuanced problem it is and how there are no easy solutions either,” said lead study author Dr. Aaron Kesselheim, a professor who runs the Program on Regulation, Therapeutics and Law at Harvard Medical School and Brigham and Women’s Hospital. “As I was writing, the enormity of the problem continued to shine through.”

Five key findings in the JAMA review:

Showdown Looming on High Drug Prices?

http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/59898?xid=fb_o_

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Government intervention helped fuel the steep rise in prescription drug costs by granting monopolies to drug manufacturers and by mandating coverage in government-funded healthcare programs, authors of a review concluded.
In the U.S., per-capita spending on prescription drugs reached $858 in 2013, more than double the average for 19 other industrialized nations. Prescription spending accounted for 17% of the total cost of personal healthcare services.

The cost and complexity of drug development have contributed to the higher prices. However, the federal government essentially blocked the two most effective means of controlling prescription costs by delaying access to generics and placing constraints on government agencies’ ability to negotiate prices with drug manufacturers, Aaron S. Kesselheim, MD, JD, of Brigham and Women’s Hospital and Harvard Medical School, and co-authors wrote in the Aug. 23/30 issue of the Journal of the American Medical Association.

Prime Therapeutics, Walgreens to form pharmacy alliance

http://www.startribune.com/prime-therapeutics-walgreens-to-form-pharmacy-alliance/391668561/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33586061&_hsenc=p2ANqtz-9d7iwEibFZJhiCy1h9AlZtlpbUsiu3vnoBo60-Y6XqHsa_BjvyfXFttdlW1O7LJuq7BXesmeLO57bnx7tal-1aewPieg&_hsmi=33586061

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Prime Therapeutics deal would integrate pharmacy, Blue plan.

Eagan-based Prime Therapeutics has formed a strategic alliance with drugstore giant Walgreens that would combine the companies’ specialty and mail-order pharmacy businesses.

In addition, health plan subscribers with pharmacy benefits managed by Prime Therapeutics would have preferred access to Walgreens pharmacies as part of the agreement announced Monday.

Financial terms were not disclosed, but Prime officials believe it could spur growth that pushes the firm beyond its position as the country’s fourth-largest pharmaceutical benefits manager (PBM).

Prime Therapeutics is owned by 14 Blue Cross and Blue Shield insurance companies, so the agreement with Walgreens brings together two of the country’s strongest brands in health care, said Jim DuCharme, the chief executive of Prime Therapeutics, in an interview.

“Nobody in the industry has integrated and connected the health plan — the Blue plan — with the retail pharmacy network, with the PBM, for unification of data, technology and overall drug cost reduction,” DuCharme said. “So, that’s probably the most unique feature of this strategic alliance.”

Health insurers hire PBMs to manage the pharmacy benefit portion of health plans. That means everything from negotiating prices with drug companies to structuring formularies that stipulate patient co-payments for different medications.

PBMs assemble a network of retail pharmacies where health plan subscribers can get their prescriptions at the lowest cost. The companies also directly fill prescriptions for patients through mail-order pharmacies as well as specialty pharmacies focused on high-cost and complex medications.

Christie boasts N.J. Medicaid expansion success under Obamacare

http://www.nj.com/politics/index.ssf/2016/08/christie_medicaid_expansion_report.html

Gov. Chris Christie on Monday boasted the success of expanding the Medicaid program in the state, arguing the “naysayers” have been “proven wrong” and that 566,000 additional New Jerseyans have insurance coverage.

It’s been three years since Christie announced he planned to buck his party and embrace President Obama’s Medicaid expansion under the Affordable Care Act. He was one of only a handful of GOP governors to embrace the changes.

“There were many naysayers,” Christie said during a Statehouse news conference.

“We made a deal with the federal government. If they keep their deal, we’ll keep our part of the deal,” he said. “I am for Medicaid expansion … but I am not for Medicaid expansion at any price.”

‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly

http://khn.org/news/americas-other-drug-problem-copious-prescriptions-for-hospitalized-elderly/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=33586061&_hsenc=p2ANqtz–bdRi0dTgQHu8uQ2ZulMR4yf3sqzJr1Sth8fzdGhdBCCWQUjWv6mmzHR3SYxmWe2x3oTFceHM_ETsw6MSh6jG6n9qT_Q&_hsmi=33586061

Harriet Diamond at the UCLA Medical Center in Santa Monica, California, on Thursday, May 5, 2016. (Heidi de Marco/KHN)

An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.

“This is America’s other drug problem — polypharmacy,” said Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica. “And the problem is huge.”

2016 Edelman Trust Barometer – Leadership in a Divided World

Click to access 2016-Edelman-Trust-Barometer-Global-_-Leadership-in-a-Divided-World1.pdf

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A timeline of eye-popping drug prices

http://www.usatoday.com/story/news/2016/08/25/timeline-eye-popping-drug-prices/89335852/

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The firestorm over steep price increases for the EpiPen — which can rescue people having life-threatening allergic reactions  — is just the latest in a long line of controversies over high prescription drug prices. A decade ago, much of the concern over prescription drug prices involved new high-tech cancer drugs, used by only a few thousand patients a year. In recent years, the prices for decades-old generic drugs have soared, as well, as pharmaceutical companies purchase the rights for drugs with no competition.

Here’s a recap of some of the most eye-popping prices.