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What We're Reading: Investigating PBMs; A Guide to Medicare-for-All; Reality of Precision Medicine
Not only do pharmacy benefit managers profit thousands of percent using spread pricing, but the spreads are growing; support for Medicare for all is growing among Democrats in Congress, but it's still unclear how such a drastic chage would impact the complex American healthcare system; while precision medicine has great potential, it still has far more failures than successes, but that isn't usually discussed.
How PBMs Use Spread Pricing
Pharmacy benefit managers (PBMs) make part of their profit on spread pricing, in which companies mark up the difference between the amount they reimburse for a drug and what they charge clients. A new investigation from Bloomberg showed that not only do PBMs profit thousands of percent using this tactic, but the spreads are growing. Spread pricing is most common with generic drugs that cost pennies compared with brand-name drugs. While use of generic drugs has been promoted to control rising drug costs, spread pricing may be undercutting those expected savings, according to critics of the tactic.
Questions Remain for Medicare-for-All Idea
Senator Bernie Sanders, I-Vermont, does not stand alone—more Democrats are embracing his idea of Medicare for all. While the idea is gaining momentum among Democrats in Congress, as well as the general public, it’s unclear how such a drastic change would impact the complex American healthcare system. Politico pulled together a guide to Medicare for all that answered questions as simple as “what does it actually mean?” as well as more complex ones, such as “what happens to doctors?”
How Precise is Precision Medicine?
The future of healthcare is a system in which doctors can match patients with the best drug for them and their disease by targeting genetic mutations. While future potential is far from the reality of today, that isn’t always explained. An opinion piece in The New York Times explained that the number of people who can currently be helped with precision medicine is still very small, and successes remain rare. One study found that precision medicine failed to help 93% of 1000 patients treated, while 2 others reported failure to shrink tumors 92% and 95% of the time. Unfortunately, the failures are not always discussed or covered, which can paint a misleading picture of precision medicine.
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
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Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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