What Health Insurers Don’t Want You to Know
In a recent article, “Coding & Billing: 10 Things Insurers Don’t Want You to Know”, Karlene Dittrich, CBCS, lists 10 things health insurers don’t want you to know. These 10 things include: Insurance companies may not be focused on quality care or what’s best for their customers. Insurance companies are required by law to pay … Continue reading
Cancer Drug Use and Spending to Rise Sharply by 2013
What are the implications of increased drug use and spending? In a recent report by Medco, while the overall drug trend in 2010 remained low at 3.7%, the costs for specialty drugs “accounted for 16.3% of plan costs but was responsible for a remarkable 70.1% of drug trend” with diabetes contributing the most to those … Continue reading
The value of friends in a battle: Terry Kalley and the Genentech Avastin battle with the FDA
On December 16, 2010, the FDA issued a press release regarding the Genentech drug Avastin. The headline to the release says it all: FDA begins process to remove breast cancer indication from Avastin label: Drug not shown to be safe and effective in breast cancer patients On Genentech’s side are Washington lawyers, lobbyists and a national … Continue reading
What can make health insurers back down from a fight?
Blue Cross and Blue Shield of North Carolina has just launched a major multimedia campaign in an attempt to improve its image. In its website, BCBS portrays goats and asks us to choose a scape goat for rising healthcare costs: The attempt by BCBS of North Carolina to shore up its reputation comes at an interesting … Continue reading
96% say only the attending physician should be making clinical decisions regarding the patient
Do you agree or disagree with the following statement: When physicians prescribe a particular medication, they evaluate which drug is likely to work best for the individual patient — based on their knowledge of the patient’s illness and treatment history, other medical conditions, drug-to-drug interactions, and drug-disease interactions. Only the prescribing physician has enough clinical … Continue reading
More than 3/4 believe that drug switching is occurring without physician consent
I recently conducted a survey on drug switching, which occurs when a patient from the drug originally prescribed by his or her physician is switched to an entirely different chemical entity. Drug switching (aka therapeutic substitution) is not the switching of a branded drug for its generic equivalent. Rather, it occurs when your pharmacist, health plan or … Continue reading
Is drug switching fraudulent?
If you hand a pharmacist a prescription from your doctor for X drug, but the pharmacist gives you Y drug instead, is that fraudulent? The Merriam-Webster dictionary defines fraud as “intentional perversion of truth in order to induce another to part with something of value”. In the example above, the pharmacist has knowingly given you … Continue reading
Unseen costs of prior authorization
Prior authorizations are often used as a cost containment tactic by payers — and it works in reducing the amount that the payer must pay for the PA drug (i.e. in financial terms, the line item goes down). However, decreases in the line item are showing up somewhere else. At a study conducted at the … Continue reading
Take my drug switching survey
Drug switching (aka therapeutic substitution) occurs when your pharmacist, health plan or health insurer gives you a drug that is different from the one that your doctor prescribed. Switching from a brand name drug to its chemically equivalent is generic substitution and is generally allowed by law. However, switching to a drug that is not … Continue reading
Improving patient adherence saves money
The news headline says it all: CVS Caremark Study Finds Medication Adherence Leads to Lower Health Care Costs, Even After Accounting for Increased Prescription Drug Spending. The study analyzed pharmacy and medical claims data of 135,000 patients with congestive heart failure, diabetes, hypertension and dyslipidemia to determine the direct effect of adherence on costs. The … Continue reading
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