Posts tagged ‘drugs’

MedSpan Musings — Tips for better payer market research


2015 08 25 rodin the thinker for MedSpan MusingsMedSpan Musings — Tips for better payer market research  

The benefit covering a drug is not always obvious
When discussing benefit coverage of drugs with payers, remember that some health plans at first cover drugs under the medical benefit and then transfer those costs each month to the pharmacy benefit. Be sure to probe for this approach and its implications for drugs administered in physicians’ offices and alternate sites of care.
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October 12, 2015 at 5:51 PM Leave a comment

Payer 101: Three things every healthcare market researcher should know


How much do you know about the U.S. health insurance landscape?

In this post, we’ll discuss three basic aspects of U.S. health plan payers: type, geography, and size. Understanding these aspects will help you design a study sample that is representative of your market.

Continue Reading July 29, 2015 at 4:07 PM 2 comments

Here’s a MedSpan Research tip!


Clinical pharmacists are a good deal for drug companies’ market research. Consider clinical pharmacists as respondents when needing clinical insights regarding a new drug. Remember that health plan and some hospital-based clinical pharmacists specialize by drug class. Other hospital-based clinical pharmacists specialize by patient care unit (e.g., emergency department, ICU).

Continue Reading July 2, 2015 at 2:13 PM Leave a comment

Compensation Specialists Via Episodic Payments Lowers the Cost of Care, According to Study


Compensating oncologists via episodic payments lowers the cost of care significantly compared to FFS payment.

Continue Reading March 30, 2015 at 3:08 PM Leave a comment

Welcome back!


Well, it’s been a while since we’ve posted to our blog.  While we enjoy sharing thoughts with everyone, client work has taken priority.  We’ve just been too busy.

While our client work has not slowed down, we have missed our blog too much.  Therefore, we will continue sharing ideas with others to promote positive discussion.

Over lunch recently, a colleague asked me which sectors of the healthcare industry are growing quickly.  In contrast to the 1990s, when many segments were rapidly expanding, we could only identify one: healthcare IT.  Manufacturers of new drugs, medical devices and imaging technologies are fighting for market share in crowded fields with diminishing reimbursement. 

For example, a drug company just received FDA approval for another blood pressure medication.  A relatively costly branded medication is entering a very crowded market niche that offers a wide variety of generic alternatives.  How will this manufacturer gain enough market share to earn a return on its investment in research and development?  From a societal standpoint, why should payers reimburse the cost of this therapy when the primary issues with managing blood pressure are dietary management and therapy compliance?  No matter a drug’s clinical advantages if patients do not take their drugs for more than 6 to 9 months at a stretch.

Healthcare innovation is in a trough.  Many of the diseases that present obvious opportunities for new products have been addressed.  But, as always, the creativity of dedicated scientists will persist, resulting in new ideas and advances. 

In the meantime, how do we address healthcare’s other priority: reducing the cost of care?  Over the next few days, we’ll share some ideas.  Some of the ideas are variations on traditional approaches.  Others are simple but require the industry to go in a different direction.  We look forward to sharing our thoughts and hearing your feedback over the coming days.

March 1, 2011 at 10:43 AM Leave a comment

The Big Bad Drug Industry?


A recent study by the Kaiser Family Foundation found that spending in the US for prescription drugs was $234.1 billion in 2008, nearly 6 times the $40.3 billion spent in 1990. Although prescription drug spending has been a relatively small proportion of national health care spending (10% in 2008, compared to 31% for hospitals and 21% for physician services), it has been one of the fastest growing components, until the early 2000’s growing at double-digit rates compared to single-digit rates for hospital and physician services.  

Since 2000, the rate of increase in drug spending has declined each year except for 2006, which was the year Medicare Part D was implemented. By 2008, the annual rate of increase in prescription spending was 3%, compared to 5% for hospital care and 5% for physician services. From 1998 to 2008, prescription drugs contributed 13% of the total growth in national health expenditures, compared to 30% for hospital care and 21% for physician and clinical services.  

 

Annual prescription spending growth slowed from 1999 (18%) to 2005 (6%).  The key reasons for this slowing of prescription drug spending are: 

  • Increased use of generic drugs
  • Increase in tiered copayment benefit plans
  • Changes in the types of drugs used
  • A decrease in the number of new drugs introduced.
This profile raises the question as to why the drug industry has been a major focus of the healthcare reform effort.  Sure, some drugs cost more than $100,000 per dose.  That is significant, even for people with insurance coverage, and not easily understood by many consumers and healthcare professionals.  But given the limited portion of healthcare costs due to drugs, the significant rate of introduction of generic drugs, the lack of a significant drug pipeline outside of oncology and other, select disease states, there seems to be limited room for better managing these costs.
 
Instead, the lack of a significant pipeline outside of oncology therapies should be a major concern.  Pharmaceuticals offer the potential to improve outcomes while offsetting hospital and other healthcare costs.  The United States should support research efforts into new therapies while encouraging appropriate choice of drug therapy and compliance with indicated therapy regimens.  Such concepts as the patient-centered medical home and value-based insurance design should make inroads.  Appropriate provider and patient education will encourage even better therapy choice and enhanced compliance.
 
  

 

Let’s focus our energies in areas where cost savings and improved outcomes can be gained as there is significant room for improvement in the United States.  Let’s not excessively beat up those who are seeking to improve healthcare outcomes in a cost-effective way.

 

June 9, 2010 at 2:17 PM Leave a comment


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