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This Week in Health Care Reform - October 9th, 2015

Drug prices continue to send shockwaves across the health care landscape; the new medical coding system goes live; the bill protecting the integrity of the small group market gets signed into law; and, telehealth expands, despite lingering uncertainty.


Week in Review

Rx Tipping Point: While a lot of the attention has understandably focused on the outrageous launch prices of so many new drugs as they make their way to market, pharmaceutical manufacturers have quietly been raising the price tags on many of their long-established medicines.  For instance, Pfizer has increased what it charges for 133 of its brand name drugs in the U.S. this year, while Merck has raised the price of 38 of its drugs.  What’s only now beginning to garner attention, though, is how routine a strategy this has been for these companies.  Whatever the justification, many drug companies appear to have integrated these price increases into the normal course of business as a way of boosting revenue.  The issue has started to make headlines in recent weeks, as vulnerable patients find themselves in danger of having their life-saving medicines priced out of reach.  While some experts level accusations of ‘profiteering’ at the pharmaceutical industry, others have begun to draw a line in the sand, saying that they will no longer prescribe drugs that lack cost-efficacy.   Whatever next steps are taken in the effort to bring these escalating costs under control, some believe that we’re finally reaching a tipping point. 

Last Thursday, the long-awaited new medical coding system finally went live.  Given the enormity of the endeavor – which saw the current iteration of the International Classification of Diseases (ICD) explode from 4,000 to 72,000 in one fell swoop – it’s understandable that there was more than a little trepidation.  However, at least in the early going, the worry seems to have been largely for nothing.  Still, experts predict minor hiccups in the days and weeks ahead, but it’s hard to argue that, 32 years since the last update, clearly our health care system was overdue.

PACE Signed: Having cleared both chambers of Congress in recent weeks, the bill granting states the flexibility to maintain their current definition of the small group market (employers with up to 50 workers) headed to the President’s desk for his signature.  That bill, the “Protecting Affordable Coverage for Employees” (PACE) Act, found little resistance in either the House or the Senate, lending credibility to the possibility of a thaw in political tensions surrounding tweaks to the health care law.  Regardless, the President signed the bill Wednesday night, protecting the small group market from anticipated disruption and ensuring millions of American workers and their families continue to enjoy access to affordable care.

Telehealth Growth:
Despite mounting evidence linking the increased utilization of telehealth to increased access, better outcomes, and lower costs, uncertainty persists, particularly when it comes to the allocation of resources.  Nevertheless adoption rates have ticked up, albeit slightly, as more organizations get comfortable with telehealth’s ability to expand both their reach and the kinds of services that can now be offered.

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