Price of Preventing Premature Births Skyrockets With New Drug. <br/><a href=" US News</a> | <a href=" Business News</a> Copy The March of Dimes is teaming up with the leading maternity experts to lobby for KV Pharmaceuticals to reconsider its decision to boost the price of a drug that prevents premature birth from $10 a shot to $1,500 a shot. The drug company gained exclusive rights to produce a progesterone shot used to prevent premature births in high-risk mothers from the Food and Drug Administration in February, and soon after announced that they would list the drug at a price 150 times higher than the cost of the non-branded version women have been using for years.
The shot has been available in unregulated form from specialty compounding pharmacies for years for $10 a pop for years, but now, marketed as Makena, the drug will cost $1,500 per dose -- an estimated $30,000 in total per pregnancy. Massachusetts stakeholders’ consensus on principles of payment reform. Governor to Hospitals: End Building Boom Now. Wp_2011_02. Do the elderly need help managing their prescriptions? Written By: Jason Shafrin - Jan• 10•11 According to this study, I would certainly say yes! “The study reviewed pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins, and 1.48 million patients taking angiotensen converting enzyme inhibitors (ACE inhibitors) or rennin angiotensen receptor blockers (ARBs) between June 1, 2006 and May 30, 2007… During a three-month period, patients filled prescriptions for an average of 11 medications representing an average of six different drug classes, the researchers said. ’More striking, during this 90-day time frame, 10 percent of these patients filled prescriptions for 23 or more medications . . . and 11 or more different drug classes, had prescriptions written by four or more prescribers, filled these prescriptions at two pharmacies and made 11 or more visits to those pharmacies,’ they said.”
Co-Pay Coupons for Patients, but Higher Bills for Insurers. What happens when Medicare controls costs too well. Posted at 9:00 AM ET, 11/29/2010 By Ezra Klein There's one school of thought that says Congress is incapable of controlling costs in Medicare, and then there's, well, this: Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.
How about a checkup from geriatric specialist Michael Trahos? One of the dirty little secrets of the health-care system is that Medicare has done a much better job controlling costs (pdf) than private health insurers. The problem is that Medicare can't control costs too much better than private insurers or, as you see from the article above, doctors will simply abandon Medicare. This isn't well understood. Meanwhile, the SGR formula actually has cut costs in Medicare dramatically. Marginal Revolution: We need more supply-side health policy. Arizona’s Medicaid Cuts for Transplants Is Seen as Sign of Financial Times. Doctors say Medicare cuts force painful decision about elderly patients.
Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks. How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he'll see you. "It's not easy. Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress. And that's not even taking into account a long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1.
This month, the Senate passed its fourth stopgap fix this year - a one-month postponement that expires Jan. 1. The Perennial Quest to Lower Health Care Spending by Uwe E. Reinhardt. Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field. The first major conference on health policy I ever attended, organized by The National Journal in Washington sometime in the late 1970s, focused on the rising cost of health care, which then absorbed close to 8 percent of gross domestic product and was threatening the unimaginable: to claim 10 percent or more of G.D.P. Governors, senators, members of Congress, business executives, the heads of trade associations and leaders of unions representing health care workers made presentations, and all of them agreed that the growth of health care spending had to be curbed -– by what now is called “bending the cost curve.”
So then, as now, the nation bravely set upon the mission of reducing the left-hand side of the dreaded health care equation — that is, National Health Care Spending = National Health Care Incomes — without the temerity of touching its right side. Health Care: The Disquieting Truth by Arnold Relman. The medical loss ratio game « Actuarial Opinions. The Department of Health and Human Services largely rubber-stamped the NAIC’s recommendations for medical loss ratios. Recall these are the rules behind calculating that health insurers spend 80 cents of the premium dollar on providing medical services (85 cents for group health plans). Insurance Journal summarizes here. Unhappy are the insurance agents. They wanted commissions left out of the formula, since that essentially caps their income. You can hear their complaints here. Though I wouldn’t be surprised if they find a way to, at least in some states, add placement fees.
Agents routinely charge these in nonstandard auto markets (where the hard-to-insure find policies with low limits and low premiums). Also, more people will be buying individual policies, so while commission rates may fall, agency revenues may actually increase. You may think I am not too sympathetic to the agents’ plight, and you’d be right. How bloated? Yeah, we pay twice as much as anybody else for an appendectomy. Two Surveys Spotlight Health-Care Cost Variations - Health Blog.
By Katherine Hobson The prices of health-care goods and services are tough to suss out. Two surveys out today attempt to bring some clarity to how costs stack up, both between different countries and among U.S. providers that might be just a few blocks apart. The International Federation of Health Plans — comprised of about 100 health insurers across 30 countries — is out with its annual country-by-country survey of the unit cost to its members of different medical products and services.
The U.S. has been repeatedly shown to spend the most per capita of industrialized countries on health — $7,290 in 2007 — without getting the best results. So it probably won’t surprise anyone that per-product and per-service costs are generally higher here too. But what may be surprising is the huge variation in the U.S. Or, look at prescription drugs. For the purposes of the IFHP survey, the price was what was actually charged to the insurer.
Bonus: 23 Web Sites to Help You Figure Out Health-Care Prices. Why the US spends more on health care. The figure below is from a National Institute for Health Care Management Expert Voices article by Eric Jensen and Lenny Mendonca of McKinsey & Company. If you can’t make out the fine print, click to see an enlarged version. It’s worth some careful scrutiny. Anything jump out at you? At first I was amazed to see that outpatient care represents such a large portion of total spending (41%) and a huge fraction of spending above what would be expected given the nation’s wealth (68%). Don’t be fooled. The report upon which the Jenson/Mendonca article is based has a nice figure that illustrates this: Yes, a lot is going on in hospitals. The article goes on to tell us why outpatient care costs so much. Per visit cost shave been surging due to more care being delivered in each visit, a shift toward more complex and expensive procedures including CT and MRI scans, and absolute price increases for equivalent procedures.
So, it may still be fair to call hospitals the 800 pound gorilla. The Idaho Fee Schedule: An Opening Skirmish in the Cost Containment Wars - Workers Comp Insider. With a population around 1.5 million and a land mass the size of New England, Idaho is probably not the first state that comes to mind in the national struggle to contain medical costs. Nonetheless, orthopedists in Idaho have managed to attract the attention of the federal government in their effort to increase rates of reimbursement for services.
The feds are not happy with the Idaho docs. The first problem came with the workers comp fee schedule. The "Resource-Based Relative Value system" set a price of $88 for most orthopedic procedures. The 65 or so orthopedists in Boise got together and decided to refuse to treat workers comp cases. Emboldened by their success, the docs refused to accept Blue Cross patients under the prevailing fee scheme. As we have blogged rather frequently, Massachusetts has the lowest fee schedule in the nation. In Idaho it's different. War on Docs? In the coming months, the battle of Idaho will move into the great metropolitan areas of our country.
How Medical Suppliers Block Innovation, Elevate Costs. Reader Francois T highlighted a story at Washington Monthly that I recommend highly to readers. It illustrates how the intersection of corporate pursuit of profit and regulatory backfires can produce tidy oligopolies that pursue rent-seeking behavior with impunity. From his e-mail: A well-intentioned move by Congress in 1986, followed by another one in 1996 converted Group Purchases Organizations (non-profit collectives formed by medical facilities that hoped to keep a lid on prices by banding together to make bulk purchases of supplies and devices at a discount) in for profit quasi-monopolies that now has a near total stranglehold on the medical device market in the USA.Needless to say that all the negative consequences of such a state of affairs (stifling of innovation, reduced competition, impossibility to access the hospital markets for smaller players, excessive prices paid by…us!
An extract: GPOs started to come under scrutiny. Consumer Risks Feared as Health Law Spurs Mergers. Now, eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives. They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or . Consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve — by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care, in order to retain their cost-saving bonuses.
“The new law is already encouraging a wave of mergers, joint ventures and alliances in the health care industry,” said Prof. Thomas L. Greaney, an expert on health and antitrust law at St. Louis University. Hospitals have taken the lead in forming these new entities. Peter W.