Governments unlikely to act on health care reform without public pressure

The news headline said it best — Governments unlikely to act on health care reform without public pressure Although this headline is from The Canadian Press, it could just as easily been a headline about US healthcare reform. The Centers for Medicare & Medicaid Services (CMS) recently announced initiatives designed to help health care providers improve … 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

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

Is the US healthcare system too litigious or too careless?

In a recent study published in Health Affairs, researchers at the University of Utah and the Institute for Healthcare Improvement found that errors “occurred in one-third of hospital admissions”. Moreover, they “found at least ten times more confirmed, serious events than … other methods.” Commenting on this study, Health Affairs Editor-in-Chief Susan Dentzer said: Without doubt, we’ve seen … 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

The true costs of prior authorizations

At a recent meeting, I was just pondering whether prior authorizations really save insurance companies money. As defined by MedicineNet.com, “prior authorizations” are a cost-containment procedure that requires a prescriber to obtain permission to prescibe a medication prior to prescribing it” [my emphasis]. Insurance practices, like prior authorizations, clearly cost physicians money in terms of the amount … Continue reading