Just… wow. Healthcare has a lot of rabbit holes but as the head of the Department of Health and Human Services, copay accumulators should be understood at a basic level. I’m not asking about alternative funding and to draw up a case study. Just that accumulators can’t be used in Medicare. Basics. Heck a simple “I don’t know but will have my staff respond” would work. And maybe he doesn’t have to understand them for the agency to work on them but it does give you a sense of the importance of the issue if the head isn’t well briefed on them.
When the biosimilar story is really just David v. David. Abbvie contracted the heck out of Humira and was able to keep almost all the scripts with the brand despite biosimilar competition (including interchangeables.) Until CVS came in on April 1 and changed the rules. Within 1 week the numbers radically changed. Like having biosimilars go from 5% of the market to 36%. Don’t worry about CVS and the rebate loss (as if?)… they cobrand the biosimilar with Sandoz.
Whole patient. NPR captured the latest with the Chronic Care Management Program. Most Medicare beneficiaries have chronic conditions. Since 2015 there has been a Medicare program to pay providers to better manage patient health to keep them out of the hospital, etc. But only 4% of eligible providers participate. Why? $62. That’s the average they get to develop a patient plan, coordinate treatment and check in with patients. Once a system is developed, it is said to take less than 30 minutes per month but that’s a lot of work to set up.
The example in the story about a woman who looks forward to the weekly check in call is such a reminder about the world we live in and how important community is. I read it back to back with this story in the NYT about social prescribing (sign up for a dance class, take up gardening, etc.).
Medicaid Unravel. On Sunday John Oliver took on Medicaid and then later in the week the NYT covered what we’ve seen in a year of MORE THAN 20 million people losing Medicaid coverage. Many remain uninsured. About 5 million kids lost coverage. And you have the bureaucracy and technical errors.
Reduce, reuse, recycle (stories). Tax season story … Pharmaceutical makers often are based in other countries and declare profits/losses in ways that are advantageous to them.