Jul 6, 2018 | Managed Care Friday
1. 26: Percent of plan premium dollars, according to a poll of 19 regional insurers, that goes to physician services, 25% to inpatient, 21% to outpatient facility care, and 10% to Rx, but pharmacy varies by plan and over the last few years has definitely taken a larger chunk of the total premium dollar, driven by specialty pharmacy cost. Today, the annual trend in specialty pharmacy net of rebates is 15-20% (e.g. the PMPM on total drug costs), say some sources, compared to the 9-11% it was a few years ago, whereas whereas for traditional (non-specialty drugs) the trend is in some cases...
Jun 29, 2018 | Managed Care Friday, Part D, Payers
As a reporter for nearly 15 years and 3 with a community newspaper in Swampscott Massachusetts, it is a difficult thing to hear about the Maryland tragedy. The investigative research team members here are, at our core, reporters, and we all extend our prayers to the newspaper’s family. 1. Where There’s Smoke: People with schizophrenia are 3 times more likely to smoke than other people and tend to smoke more heavily in an effort to control their symptoms related to their mental illness, according to the Mental Health Foundation. Of note, Rhode Island’s BCBS insurer just partnered with...
Jun 15, 2018 | Managed Care Friday
1) 2040: The year when Alzheimer’s disease will consume about 25% of the Medicare budget, according to a new study, aided in part by addiction to smart phones that can cause plaque buildup in the brain, the same plaque linked to Alzheimer’s. Brain scan of people in their 20s showed high levels of buildup due to excessive iphone use. The findings and outlook have implications for policymakers as well as families and employers given the massive direct and indirect cost of the disease. Read neurologist reaction by clicking here 2) Genetic Test Plus: Testing for Cadasil, a hereditary stroke...
Jun 8, 2018 | Managed Care Friday
1) 425: Dollars that several surgeons told us they are charging Anthem patients upfront before cataract surgery to cover anesthesia services since the insurer no longer considers anesthesiologists or nurse anesthetists medically necessary for administering and monitoring sedation during the eye procedures. Kids under 18 aren’t impacted but adults are and one practice here in my state told us the policy has changed patient behavior – in some cases the patient flat out refuses and leaves rather than doing the procedure, others ‘have got wind of the charge’ and ‘cancelled’ the procedure,...
Jun 1, 2018 | Managed Care Friday
1. 350 Million: The total dollars that five drugs cost Texas managed care plans in the fourth quarter of last year. Abilify (antipsychotic) Vyvanse (stimulant) Nexium (GI), Invega (antipsychotic) and Norditropin (growth hormone) were the five most expensive drugs here. In contrast, through the smaller fee for service program, Ibrance, an antineoplastic systemic enzyme inhibitor, was the most expensive drug at just $2 million, followed by Abilify and three stimulants. In terms of utilization, ibuprofen, amoxicillin (the penicillin) and the bronchial agent Albuterol used to treat Asthma were...
May 25, 2018 | Managed Care Friday
1. 24 to 7: No, this is not my prediction for the next Super Bowl score (Patriots over the Giants), but rather the number of people in millions who suffer from Cataracts in the U.S compared to the 7.7 million with diabetic retinopathy. In contrast, 2.7 million suffer from glaucoma, and 2.1 million from age-related macular degeneration. Eye disease prevalence is a national and global health concern that is higher in risk for chronic health conditions, accidents, social withdrawal, and depression. 2. Drug Testing Limits: Regence BCBS, starting in July will only allow payment for specific codes...
