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This Week in Health Care Reform - July 10th, 2015

Ripples continue to emanate out in the wake of the Supreme Court’s latest health care law ruling; new and pricier drugs threaten to upend the system; and, digital advances in health care usher in a wave of change.


Week in Review

Post-Ruling: Regardless of your opinion on the Supreme Court’s decision late last month, ruling on behalf of the Administration and upholding the subsidies extended to consumers signing up for coverage via the federal exchange, it would appear that the divisive health care law’s legal standing has, once again, been affirmed.  So, where does the law go from here?  That’s the question many experts have begun to address, mapping out the obstacles still remaining as implementation continues, albeit with one major impediment now having been cleared out of the way.  While some feel that the road ahead doesn’t go through Congress, it’s hard to deny that the politics surrounding the law will undoubtedly continue to exert influence on what happens next, at least in the near term.  In the immediate aftermath of the ruling, Republican lawmakers vowed to continue their efforts to unravel the health care law, with the Senate possibly looking to shoehorn piecemeal repeal votes into their already crammed floor schedule.  Whether or not they’re successful, there are some that think it’s time the GOP changes tack, maybe with an eye on next year’s Congressional and Presidential elections serving as their new North Star. 

Rx Prices:
You’d be forgiven for admitting to some degree of fatigue when it comes to the issue of escalating drug prices.  The past year-and-a-half, has seen the headlines dominated by exhaustive coverage of the ravages that Gilead Sciences’ breakthrough hepatitis C drug, Sovaldi, has exacted on budgets across the country.  Worryingly, though, it’s beginning to look like that drug merely represented the tip of the spear.  Already this month a pair of new drugs has been approved by the FDA and, as many feared, look to continue this unsustainable trend in prescription pricing.  A new cystic fibrosis drug called Orkambi, from manufacturer Vertex, will reportedly cost patients $259,000 annually.  Separately, Swiss pharmaceutical giant, Novartis, also won regulatory approval for its new heart drug, Entresto.  Pricing details for that drug have yet to be released, but Novartis is projecting $5 billion in annual global sales for the possible blockbuster.  While it’s worth noting that these drugs, much like Sovaldi, offer patients benefits that their predecessors couldn’t, and may in fact be helping Americans live longer, they’re also pushing more of them dangerously close to financial ruin.  And, new evidence points to the problem being more of an epidemic than a few isolated cases.  In its just released Exchange Pulse Report, pharmacy benefit manager, Express Scripts, shows that spending on high-cost specialty medications on the exchanges is not just significant, but growing.  Meanwhile, a separate analysis from PricewaterhouseCoopers highlights how the skyrocketing cost of specialty drugs is outpacing trends seen in traditional drugs.  As stakeholders across the health care spectrum seek alignment on issues of access and affordability, it’s become increasingly clear that the issue of drug prices remains the greatest threat to our system.

Digital Change:
Technology continues to work its way into and throughout our everyday lives, as consumers and as patients.  In fact, a new report indicates just how ubiquitous digital advances have become in our role as the latter.  According to Tractica, telehealth visits are projected to increase from 19.7 million in 2014 to 158.4 million per year by 2020.  Globally, the telehealth market is expected to nearly triple by then, too, according to a separate analysis.  Valued at $2.2 billion this year, it’s believed that the global telehealth market will reach $6.5 billion in value by the end of the decade.  With its increased utilization already being recommended for the elderly and the young, telehealth represents the next wave in health care delivery, leading some to wonder what might account for this trend and what, exactly, doctors would like to see going forward?

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Looking Ahead

New projections point to the steady migration to Medicare Advantage by Medicare beneficiaries.  With the shift in focus from fee-for-service to a more coordinated, value-based model of care, it’s not hard to see why.  A new study published by the American Journal of Managed Care highlights the good work being done by one of these plans in the Medicare Advantage space, CareMore, whose model has been shown to be successful in reducing costs and improving outcomes by providing direct care to some of the frailest elderly patients.

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