I’ve been a bit mesmerized by Medicare drug coverage in the last week or two and I’ve let a lot of stuff build up in my "draft folder" — so I’m going to do brief comments on many of the most interesting things I’ve seen come up. These will be way less verbose than usual! So in no particular order:
1) TECHNOLOGY: ePrescribing was mandatory in the House version of the Medicare Bill (thanks to Newt Gingrich’s influence). But it ends up being optional in the final version to make sure that the AMA has no reason not to be on board for its passage.
2) TECHNOLOGY: Boston Scientific is close to having its new drug coated stent Taxus approved. When that happens it’ll probably be in the lead for a couple of years over its rivals from J&J and Guidant in the $5bn stent market. Various studies suggesting that stent-based angioplasty may not be the best option for cardiac patients continue to be ignored in the real world.
3) HEALTH PLANS: California Blue Cross has gone back to the origins of IPA-based HMOs by creating a new HMO that selects providers based on their cost-effective behavior, and then passes the savings onto consumers by charging them lower premiums. Whether this can survive in the market place is uncertain, but Mark Weinberg, Len Schaffer’s number two, has been talking about creating low cost plans aimed at the uninsured for some time now. It’ll be interesting to see if the costs are low enough to encourage the uninsured to sign up. Meanwhile Paul Ginsburg’s team at HSC report that health plan and payer attempts to segment providers by cost-effectiveness into "tiered" plans (i.e. where the patient is steered to the low cost providers in the network via co-pay incentives) have been very limited and unsuccessful thus far.
4) PHARMA: Consulting company Decision Resources has a report out suggesting that the Breast Cancer drug market will grow from around $2 billion now to over $6 Billion in 2012. Most of the growth will be due to increased use of hormone therapy. Coincidentally it looks like the proposed reduction in reimbursement for oncologists doing infusion in their own offices (and selling the drugs on to plans and Medicare) will be reversed if the Medicare bill passes.
5) HEALTH PLANS: Consumer-directed health (CDH) plans are growing in take-up but rather slowly. They appear to be attractive to the healthier population within employer groups and although there are claims that they are saving employers money, I’m not sure they are not just cream skimming money from the employer’s insurance pool into the employees MSAs! If my suspicions are right employers will be looking at their overall impact more carefully as CDH options grow from being gimmick of the month to a real option. Of course one employer reaction might be to force all employees into them, essentially forcing employees to pay more out of pocket to cover the "donut hole" gap between what’s put in the MSA and the total out-of-pocket for which the employee is responsible.
6) TECHNOLOGY: The steady fusion of devices, drugs and procedures is making life complicated for regulators and payers. Forbes has an interesting take on when the FDA approves a device, but Medicare (via CMS) doesn’t allocate separate reimbursement for using the device in a procedure that already has a defined DRG. While CMS is reviewing how it deals with this situation, because of the overall FFS nature of Medicare, a new innovation that costs more up front may not be reimbursed even if it will save money over time. As more devices get more complicated and sophisticated, CMS’ ability to keep up in this cost-effectiveness–regulation–reimbursement triangle will be stretched.
That lot should keep you busy for while. I’ll be back to saying lots about a little, rather than vice-versa, next week.