The FEHBlog recently noted articles on rising vaccine costs. The New York Times reported yesterday that even certain generic drug prices have been rising sharply. “Dr. Aaron Kesselheim, a professor of health economics at the Harvard School of Public Health, noted, “’Studies show it is not until you have four or five generics in the market that the prices really are down.’” Pricing problems occur when competition drops off.
By late 2013, a number of generic manufacturers had largely stopped producing and distributing digoxin, then a cheap medicine whose use had declined, leaving only two companies dominant in the market. Both businesses — the Lannett Company and Global Pharmaceuticals, a division of Impax Laboratories — are small companies whose bottom line can rise and fall on the sales of a single drug.
Then this January, the Swiss manufacturer Covis began selling an “authorized generic.” Such medicines are made according to the specific formula of the company that makes the branded drug and holds the original patent (GlaxoSmithKline in the case of digoxin), and tend to be more expensive than a typical generic.
In late 2013, one of the companies began a price increase, and the others soon followed, records show. “It’s quite difficult to pinpoint who was the catalyst, but we are seeing a big step up,” said Anthony Raeside, an analyst at EvaluatePharma.
Reuters reports on a UnitedHealthcare study that applied an upfront bundled payment approach to oncologists. The bundled payment approach controlled the doctor’s charges, but oncology drug prices continued to skyrocket. “It was not clear if the chemotherapy costs rose because drug prices rose or because doctors administered more treatments.” In any event, that result was surprising to the insurer.
The core of the program, called MolecularHealth Corporate Oncology Program For Employers, or COPE, is the company’s TreatmentMAP process. Through TreatmentMAP, cancer tumors are analyzed to determine their genes and biomarkers and the program then creates an actionable report for the treating physician to get the patient “on the best treatment for them at that time with their particular disease,” explains Housman. “And if a treatment is not available, work with them to find what clinical trial options are available with that particular disease. So it’s really personalized to that patient’s particular tumor.” Safety and efficacy data of the suggested therapies is also incorporated into the treatment map, which carries a list price of $5,000.
Modern Healthcare reports that the Centers for Medicare and Medicaid Services recently released a monster proposed rule concerning Medicare Part B payments for doctors’ service in 2015. The proposed rule includes a significant expansion of Medicare Part B coverage of telehealth services.
Added to the list of [Medicare Part B] covered telehealth services by the proposal are annual wellness visits, both for an initial visit, and for subsequent visits, if they include a personalized prevention plan of service.
It also proposed to add to the list telehealth sessions for psychoanalysis, family psychotherapy, both with and without the patient being present; and for “prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service.”
The CMS rulemakers also propose to allow payments for telehealth services afforded to patients in “rural census tracts” even if those tracks are within metropolitan statistical areas. Census tracts are composed of smaller census blocks and block groups and have on average about 4,000 inhabitants. Populations of the 388 MSAs in the U.S. and Puerto Rico vary widely, from about 50,000 to nearly 20 million inhabitants.
Health Data Management reports that FAIR Health, the non-profit that helps health plans set out of network pricing, has offered details on the use of its online consumer healthcare cost lookup system.
Finally, Fierce Health Finance reports that for profit hospital chains like Tenet and HCA are aggressively entering the urgent care center business in order to compete with the pharmacy chains.