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What We're Reading: Tying Medical Organization Recommendations to Insurance Coverage


What we're reading, October 11, 2016: USPSTF recommendations maybe shouldn't be tied to insurance coverage; growing dispute over homeopathy research; and the harm of pharmaceutical companies' copay assistant programs.

Task force recommendations for preventive services shouldn’t be tied to insurance coverage, experts are arguing. According to NPR, with the implementation of the Affordable Care Act, recommendations from the United States Preventive Services Task Force are tied to insurance coverage as insurers have to cover the costs. However, former members of the task force believe the system in place leaves it vulnerable to lobbying that can corrupt the process. For example, Mylan has been lobbying to have the EpiPen deemed a preventive service, which would make price increases invisible to patients, but not to insurers.

When has something been studied long enough? Two researchers are disagreeing about whether homeopathy, a controversial arm of complementary medicine, should continue to be studied despite studies already showing it doesn’t work, according to STAT. The part of the National Institutes of Health charged with researching alternative medicine is also skeptical about homeopathy. However, Americans spent $3 billion on homeopathic remedies in 2007 and the FDA allows them to be sold without requiring proof the products can meet their claims. Now critics are saying regulatory agencies should go further.

Pharmaceutical companies’ copay assistance programs for expensive drugs may seem helpful, but Peter A. Ubel, MD, and Peter B. Bach, MD, wrote about the consequences in an article in the Annals of Internal Medicine. Unfortunately, copay assistance programs reduce public outcry over price hikes because they diminish price pressures. Plus, as an artificial price support, patients have less incentive to act consumer savvy. One solution to the problem could be requiring that pharmaceutical companies offer copay assistance to all patients and for all products.

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