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This Week in Health Care Reform - August 5th, 2016

A new study finds that some generic biologics are as good as their pricier equivalents; CMS announces regional participants for its new primary care initiative; and, efforts continue to regulate the practice of telemedicine.

Week in Review

Biosimilars: As covered last week, there’s growing interest in not just how biosimilar drugs can be used to treat a host of afflictions, but how these nearly identical (generic) variants of biologic drugs can also be used to combat the escalating prices of these treatments.  And, it would seem, not a moment too soon.  Spending on biologics has nearly doubled over the past five years with these medicines representing an increasingly large chunk of the prescription drug market.  In fact, according to one analysis, biologics alone have accounted for 54 percent of the growth in prescription drug spending since 2010.  A new study arrives just as stakeholders look to this class of drugs to provide much-needed savings to a health care system increasingly under threat of being overwhelmed by high-priced drugs.  That analysis suggests that at least one group of biosimilars appears as safe and effective as their considerably more expensive, brand-name counterparts.  Whether or not biosimilars are successful in helping to bend the cost curve remains to be seen.  Regardless, they inject a level of competition that, along with transparency and value, experts maintain would only serve to benefit consumers and our health care system – an argument that will need to be repeated as pharmaceutical manufacturers prepare their counterattack on the issue of drug prices.
Earlier this year, the Administration announced that it would be launching the largest-ever initiative aimed at reimagining primary care delivery in this country.  By giving doctors more flexibility and rewarding outcomes, the program, called Comprehensive Primary Care Plus (CPC+), was set up to transform primary care delivery by shifting the focus away from traditional fee-for-service and towards a more comprehensive model that emphasizes access, care management, coordination, and engagement.  This week, the Centers for Medicare & Medicaid Services (CMS) announced which markets had been selected to participate in the pilot CPC+ initiative.  Kicking off in January of next year, CPC+ will be made available in various regions across 16 states
While telehealth stakeholders continue to champion its widespread application, urging lawmakers to do what’s within their power to facilitate its adoption, experts urge caution, calling for a balanced, forward-thinking embrace of new technologies in the health care space.  So far, regulators have responded, taking a measured approach to policymaking with an eye on creating a regulatory environment that’s both responsible and responsive.  Elsewhere, proponents are pushing to widen telehealth’s reach by suggesting that nurse practitioners and other providers should be allowed to take advantage of its practice by easing licensure requirements to include telemedicine.

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