- Hypertrophic Cardiomyopathy (HCM)
- Eyecare
- Urothelial Carcinoma
- Hemophilia
- Heart Failure
- Vaccines
- Neonatal Care
- NSCLC
- Type II Inflammation
- Substance Use Disorder
- Gene Therapy
- Lung Cancer
- Spinal Muscular Atrophy
- HIV
- Post-Acute Care
- Liver Disease
- Asthma
- Atrial Fibrillation
- COVID-19
- Cardiovascular Diseases
- Prescription Digital Therapeutics
- Reproductive Health
- The Improving Patient Access Podcast
- Blood Cancer
- Ulcerative Colitis
- Respiratory Conditions
- Multiple Sclerosis
- Digital Health
- Population Health
- Sleep Disorders
- Biosimilars
- Plaque Psoriasis
- Leukemia and Lymphoma
- Oncology
- Pediatrics
- Urology
- Obstetrics-Gynecology & Women's Health
- Opioids
- Solid Tumors
- Autoimmune Diseases
- Dermatology
- Diabetes
- Mental Health
Benefit designs continue to evolve and influence
NATIONAL REPORTS—In a continuation of a trend of using financial incentives to influence individual patient decisions about the medications they purchase and take, state workers in Georgia soon will pay a $100 copay for certain name-brand drugs.
NATIONAL REPORTS-In a continuation of a trend of using financial incentives to influence individual patient decisions about the medications they purchase and take, state workers in Georgia soon will pay a $100 copay for certain name-brand drugs.
"Prescription benefit designs have evolved over the years from a single copay to two tiers-generics and brands-to three-tier-generic, preferred brand and non-preferred brand-as well as others, according to Lou Hutchison, president of HealthTrans in Greenwood Village, Colo. "The three-tier, the most common structure currently, has seen increases in the amounts [$5/$10/$25 to $10/$25/$50] and the Georgia situation, where the $100 copay applies to non-preferred brands, is simply a continuation of this trend."
The Georgia employee $100 copayment takes a drastic step toward virtually removing the concept of a drug "benefit" and is a sign of the state moving toward a new model of cost shifting directly to the employee more than ever before, according to Phil Patrick, president of PharmaStrat Inc., a pharmaceutical market research and consulting firm focused on reimbursement. "While our research shows that copayments have continued to rise, a $100 copayment for drugs with proven clinical efficacy in important disease states is almost unheard of," Patrick says.
The Georgia State Health Benefit Plan is a self-funded plan and faced a projected deficit of $46 million in 2006, according to Julie Kerlin, spokeswoman for the Georgia Department of Community Health. "The changes in pharmacy copays and increases in employer and employee premiums were necessary to ensure the financial viability of the plan," Kerlin says.
Kerlin points out that when reviewing the year-over-year trends, "the department has slowed the rate of growth in pharmacy expenditures from 12.9% in 2004 to a projected 2.5% in 2006."
Bridging the Diversity Gap in Rare Disease Clinical Trials with Harsha Rajasimha of IndoUSrare
November 8th 2023Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare.
Listen
35th World AIDS Day Marks 20 Years of PEPFAR: Challenges and Strategies to Combat HIV/AIDS
November 29th 2023PEPFAR, having invested $100 billion and saved 25 million lives in the global fight against HIV/AIDS, faces Congressional hurdles in its reauthorization due to abortion debates. Despite widespread support and no evidence of abortion-related activities, the legislative process is at a standstill. Members of PEPFAR and authors of a recent editorial stress the significance of PEPFAR and advocate for integrating behavioral and social science into healthcare programs to achieve UNAIDS targets and address barriers in HIV/AIDS testing and treatment.
Read More
Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series.
Listen
Study Raises Concerns Over Insurance Barriers to HIV Prevention Medications
November 29th 2023Despite its efficacy, PrEP remains underutilized compared to the need for it. High costs are among the barriers to PrEP use, along with limited knowledge among clinicians, lack of health insurance, stigma, and underestimation of personal HIV risk.
Read More
