Massachusetts is trying to get a federal exemption to alter its Medicaid program; patients waiting for disability benefits get stuck in a huge backlog; and companies are preparing to increase collection and use of real-world evidence.
The Medicaid program in Massachusetts will test a new model for drug coverage that includes negotiating discounts for drugs and excluding some drugs. According to Kaiser Health News, Medicaid programs are required to cover almost all FDA-approved drugs, but Massachusetts is requesting a federal exemption to pick which drugs it covers based on the needs of the state’s Medicaid beneficiaries. If the proposal is approved, it is expected that other states will quickly follow, but critics of the plan worry it could reduce access to medications for low-income people.
In the last year, 10,000 people died while waiting to get disability benefits, according to an investigation by The Washington Post. The federal government has a backlog of 1.1 million disability claimants waiting for a judge to decide whether they are eligible for a monthly payment and Medicare or Medicaid. In 2012, the national average for the number of days someone had to wait for a disposition to appeal a rejection for federal disability benefits was 353 days, which grew to 596 days in the summer of 2017. A combination of a stagnant budget, a rising number of people receiving retirement and disability benefits, and a lack of supporting staff has contributed to the soaring wait times and the huge backlog.
As the healthcare industry increases its use of real-world evidence, partly driven by the passage of the 21st Century Cures Act, organizations are increasing their internal staff dedicated to this kind of data collection. Outsourcing-Pharma.com reported that pharmaceutical, biotechnology, and contract research organizations are planning to increase staffers who collect real-world data by 25% by 2020. Companies expect data from personal health devices and wearables to grow.