A community for people who want to remain as healthy as possible as we age.

America’s big spending on health care doesn’t pay off

(The Economist) AMERICA remains the world’s most profligate spender on health care, according to a report published on November 4th by the OECD, a club of 34 mostly rich countries. In 2013 America spent, on average, $8,713 per person—two and a half times as much as the OECD average. Yet the average American dies 1.7 years earlier than the average OECD citizen. This longevity gap has grown by a year since 2003. Americans have the same life expectancy as Chileans, even though Chile spends less than a fifth of what America spends on health care per person.
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Health care law results in $2.4 billion in consumer rebates on premiums since 2011

(Centers for Medicare & Medicaid Services) The Centers for Medicare & Medicaid Services (CMS) released a new report … showing that consumers have received more than $2.4 billion premium rebates  since 2011 because the Affordable Care Act requires that health insurance companies spend at least 80 percent of premium dollars on health care.  For 2014 alone, over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family. Those rebates are in addition to improvements in quality and affordability savings consumers have received as the share of insurance companies in compliance with the requirements has increased.
“Thanks to the Affordable Care Act, there are now programs in place to give consumers maximum value for their premium dollar,” said Kevin Counihan, CEO of the Health Insurance Marketplace.  “We are pleased that the tools created under the health care law are working as intended to give consumers access to high-quality health insurance coverage and keep cost affordable.”…
[The newly announced] results show that an increasing number of consumers are in plans where they are receiving more value for their premium dollars up front because their premium rates were set to reasonably reflect insurers’ spending on medical care and quality improvement activities.
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Study: Health Plan Buyers Will Save Money If They Shop

(Kaiser Health News) Millions of consumers who are enrolled this year could pay higher rates if they stay in the same health plan next year, according to a study released [last] Wednesday by the Kaiser Family Foundation.
The KFF analysis found that in nearly three-quarters of counties in 36 states served by healthcare.gov, the lowest-priced silver plan this year will not be the lowest priced next year. People in those plans could save money on premiums by switching to a different silver plan in 2016. (KHN is an editorially independent program of the foundation.)
If they don’t switch, their premium would increase an average of 15 percent before any tax credit is included. More than 80 percent of consumers on the federal marketplace receive a tax subsidy to lower their costs.
Most consumers who previously enrolled on healthcare.gov who don’t actively shop by Dec. 15 will be automatically renewed in the same or a similar plan beginning Jan. 1. Open enrollment on the marketplaces began Nov. 1 and ends Jan. 31.
The lowest-cost silver plan is the most popular selection in the Affordable Care Act marketplaces.
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Continuing the shift from volume to results in American healthcare

(Centers for Medicare & Medicaid Services) Almost a year ago, the Administration announced a vision for the future of the Medicare program, including clear goals and a timeline for shifting Medicare payments from volume to value. CMS is continually working to turn this vision into reality through annual rulemaking and the CMS Innovation Center, building on bipartisan ideas, initiatives and legislation from both Congress and the states…
We have seen some positive results from models that the Innovation Center is testing. Savings in the Pioneer ACO Model were so significant – and coupled with positive results on improved quality of care and better patient experience – that the independent CMS Office of the Actuary certified that expansion of the model as it was tested in the first two years would reduce net program spending under Medicare. We have also incorporated elements of the Pioneer ACO Model into the Medicare Shared Savings Program, which reaches more beneficiaries in more areas of the country. We are actively evaluating other models to see if they meet this bar and have applied lessons and feedback from the Innovation Center models throughout the Medicare program.
One of the most promising trends we’re seeing is the significant improvement in patient safety and decreased adverse incidents in the hospital setting.
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Health insurance now ranks with America's most hated industries

(CBS News) When it comes to America's most-hated industries, there are a few perennial favorites. Cable guy, anyone?
But one much-maligned industry is dipping ever further in Americans' estimation, slipping to where it's neck-and-neck with two other poorly regarded businesses, the U.S. Postal Service and fixed-line phone service. It's so bad that this industry has only two others ranked below it, pay-TV providers and Internet service providers.
Which industry is slipping farther down the list? That's health insurance, according to the American Customer Satisfaction Index, which interviews about 70,000 consumers annually to get their views on everything from soft drinks to gas stations. To be sure, the health insurance industry has been through a turbulent year as the rollout of the Affordable Care Act divided Americans over issues ranging from government costs to high deductibles.
"The usual suspects have been plaguing the industry, but it's getting worse," ACSI director David VanAmburg said. "High premiums -- no one likes paying high premiums -- slow claims processing and higher deductibles" are among the issues that get consumers upset…
The parts of health insurance that consumers most dislike include call centers, which receive the lowest ratings out of all customer experience benchmarks, and choice of plans.
The latter may be one area where people covered by the ACA are coming out better than Americans covered by their employer's plan. That's because the ACSI found customers who have bought individual plans -- and have picked from one of several choices -- have a higher satisfaction level than group policy holders.
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Barriers to Health Care Increase Disease, Death Risk for Rural Elderly

(Oregon State University) A new study of adults ages 85 or older has found that rural residents have significantly higher levels of chronic disease, take more medications, and die several years earlier than their urban counterparts…
The research confirms some of the special challenges facing older populations in rural or remote areas, who often have less access to physicians, long distances to travel for care, sometimes a lower socioeconomic and educational level, and other issues. It also reflects health problems that might have been reduced if they were treated earlier or more aggressively, researchers say.
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How the Affordable Care Act is Helping to Build a Stronger, Healthier Rural America

(Norah Deluhery, Director, Center for Faith-Based and Neighborhood Partnerships) Keeping our rural communities healthy is key to building a stronger America. That’s why … I’m proud of the new affordable health insurance options that are available because of the Affordable Care Act, helping to give rural families piece of mind across the country…
Before the ACA, many rural Americans struggled to find affordable healthcare, paying nearly half of all medical costs out of their own pockets. Many self-employed farmers, ranchers, and rural small business owners—some of the most critical contributors to strong rural economies—did not have access to the affordable insurance options that many people get through their employers. Too often, getting quality care in a rural community came with a hefty price tag. But today, more than 70% of all Marketplace enrollees can get covered for $75 a month or less with tax credits.
If you live in rural America, you’re now less likely to have to go far for quality care. Since 2011, this Administration has made innumerable investments in rural health, and thanks to the ACA, Americans have better access to doctors, nurses and comprehensive prevention and wellness services close to their homes.
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Some health-care systems want to sell you insurance as well as treat you

(Washington Post) In addition to treating what ails you, a number of health-care systems aim to sell you an insurance plan to pay for your medical expenses. With some of the most competitively priced policies available on the marketplaces, “provider-led” plans can be popular with consumers. But analysts say it remains to be seen how many will succeed long-term.
It’s not surprising that health systems are getting into the insurance business. Doing so funnels more patients to the organization’s hospitals and doctors. And it makes sense that combining clinical and claims data under one roof could lead to better-coordinated, more-cost-efficient patient care…
The provider-led marketplace plans are priced very competitively, says John Holahan, a fellow at the Urban Institute’s Health Policy Center. A forthcoming study by the center that looked at 63 areas in 21 states found provider-led plans to be the least expensive in a number of places.
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How Pfizer has shifted U.S. profits overseas for years

(Reuters) Drugmaker Pfizer's plans to take over Allergan have faced a political backlash in the United States over fears a deal would lead to the company shifting its headquarters and taxable profits to Ireland…
Ireland's tax rate is 12.5 percent, a fraction of the 35 to 40 percent levied in the United States.
President Barack Obama has described inversions as unpatriotic and last year changed some tax rules to make inverting less attractive. Allergan investors fear the U.S. treasury department may scupper a deal with additional measures…
Pfizer has used transactions between companies within its group to allow an Irish subsidiary based in Ringaskiddy - Pfizer Ireland Pharmaceuticals - to buy the rights to patents developed in the United States and then use them to make drugs which are sold back to U.S. affiliates.
Even though the Irish and other overseas units pay $3.2 billion a year in royalties to use such patent rights, the higher prices at which Pfizer in the United States imports manufactured drugs from affiliates means almost all the profits from these drugs are reported overseas.
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AstraZeneca's Tagrisso to cost $12,750 for a month's supply

(Reuters) AstraZeneca's new lung cancer pill Tagrisso, which won early U.S. approval on Friday, will cost $12,750 for a month's supply.
A company spokeswoman said on Tuesday the wholesale acquisition cost was comparable to other targeted oral lung cancer therapies, such as Pfizer's Xalkori and Novartis' Zykadia.
AstraZeneca has previously said it believes Tagrisso could generate peak sales of $3 billion a year, making it a key product in the group's growing oncology portfolio.
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J&J nabs an early OK for 'breakthrough' multiple myeloma blockbuster contender Darzalex

(FierceBiotech) Johnson & Johnson ($JNJ) scored an early FDA approval for its "breakthrough" blockbuster contender daratumumab, earning a swift OK as a new treatment for multiple myeloma four months ahead of the PDUFA date. The drug will be marketed as Darzalex…
Daratumumab is given once a week for the first two months of treatment, then the infusions wind down to once monthly in the second 6 months of the year, says a spokesperson for J&J. For the first full year--with a total of 23 doses given at a cost of $5,850 per infusion--the average monthly wholesale acquisition cost is $11,212, says J&J, or $135,550 for the first year. In year two, and any year thereafter, patients receive a total of 13 doses, for a monthly wholesale cost of $6,337, or $76,044 annually. J&J also offers programs to limit patient's out-of-pocket costs and will be offering payers discounts during price negotiations.
Focusing on the group of patients getting the top dose, investigators reported … last August that the drug scored an impressive 36% overall response rate among 42 patients with late-stage multiple myeloma--a step up from the 29% overall rate that was reported at ASCO earlier in the year.
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Global drug spending to hit $1.4 trillion in 2020: IMS

(Reuters) Global spending on medicines will reach $1.4 trillion in 2020, driven by increased healthcare access in emerging markets and high-priced new drugs for cancer and other diseases, according to a forecast by IMS Health released on Wednesday.
That is up from about $1.07 trillion this year, representing a compound annual growth rate of 4 to 7 percent over the next five years, the "Global Medicines Use in 2020" report compiled by IMS Institute for Healthcare Informatics found.
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Expensive new Hep C drugs may be cost-effective even for early disease

(Reuters Health) Treating hepatitis C with expensive new medicines at the earliest signs of liver damage improves patients' health and is also cost-effective, a new computer simulation suggests.
"Going into this, I expected to find it did make sense to wait until there was a limited amount of liver disease, but what we found to our surprise is that it makes sense to start treatment at the earliest change in the liver," said senior author Dr. James Kahn, of the University of California, San Francisco…
While other studies found the new drugs to be cost effective, the new study looked at whether that's true at each stage of liver damage. Some insurers won't let patients take the drugs until their liver disease is advanced.
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Value-Based Pricing Will Help With High Prescription Drug Costs

(MedPage Today)  Value-based drug payments are one part of the solution to the rising price of prescription drugs, several speakers said at a forum on drug pricing hosted by the Department of Health and Human Services.
The Centers for Medicare and Medicaid Services (CMS) would like to hear more ideas about how to implement value-based payments for this kind of treatment, according to CMS Acting Administrator Andy Slavitt.
"As a purchaser, the logical question for us is 'Are we getting good value for consumer and taxpayer dollars?" Slavitt said at the forum here last Friday. "Just as we pay for quality in care delivery, how should we create incentives which take the entire health and outcome of the individual into account? What's the best way to pay for targeted therapies when they work for some patients and not for others?"
Under value-based payments, insurers and other payers reimburse for drugs based on patient outcomes and similar factors, rather than paying a set price.
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Docs, and patients, should remember to use generics

(Reuters Health) Prescribing generic medicines instead of brand name drugs whenever possible cuts costs, improves patient adherence and improves health outcomes, according to a new recommendation from the American College of Physicians.
“Generic medications are cheaper and patients are more likely to get those prescriptions filled,” said Dr. Amir Qaseem of the American College of Physicians, who coauthored the recommendation.
“This is for both physicians and patients,” Qaseem told Reuters Health by phone.
Despite what some patients and even doctors may believe, generics are consistently as effective and safe as their brand-name counterparts, he said.
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Doctors Call for an End to Prescription Drug Ads

(Adweek‎) American Medical Association has called for an end to direct-to-consumer advertising of prescription drugs and medical devices.
The AMA, which represents about 250,000 physicians nationwide, reversed its previous stance on the issue following a vote at the group's annual meeting in Atlanta.
"Today's vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices," said AMA board chair-elect Patrice Harris in a statement. "Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate."
The AMA's vote has no binding power. Such a ban would require congressional authorization. Still, the AMA maintains a powerful lobbying presence in Washington, and today's vote is seen as the first salvo in an effort to turn prescription drug ads into an election issue in 2016.
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