Calif. Bill Aims To Limit Which Rx Drugs Are Listed in High-Cost Tiers

Drug cost tiering is common to control the use of expensive pharmaceuticals by passing on the higher expense with higher co-pays and/or deductibles.  

Examples of United Health Care Plans  and Medicare Advantage  Plans

California Healthline, Thursday, February 19, 2015

California lawmakers are considering a bill (AB 339) that aims to keep prescription drug costs down by limiting which medications insurers can include in the highest-cost drug tier, Capital Public Radio's "KXJZ News" reports.

Details of Bill

AB 339, by Assembly member Richard Gordon (D-Los Altos), would prevent insurers from placing all of the prescription drugs to treat a certain condition in the highest-cost tier of a drug formulary.

According to Gordon, insurers often place high-cost medications into such specialty tiers, which forces patients to pay a larger share of the prescription drug's price. For example, Gordon explained that if "all of the HIV drugs are in a very expensive top-tier category, that would appear to be discriminatory" (Bartolone, "KXJZ News," Capital Public Radio, 2/18).

In addition, the bill would require:

• All health plans offered, renewed or amended after Jan. 1, 2016, that cover outpatient prescription drugs to offer coverage for medically necessary medications that do not have a therapeutic equivalent; and
• The California Department of Managed Health Care and Department of Insurance to define by Jan. 1, 2017, a "specialty prescription drug" category that would be subject to limitations (AB 339, 2/13).

Health Insurer Reaction

Nicole Kasabian Evans with the California Association of Health Plans said the bill could be misleading, noting that patients pay higher shares of specialty drugs because they often are very expensive.

She said, "Bills like this give a false sense that drug costs are going to be reduced, when in reality costs are just shifted from your out-of-pocket costs to premiums."

Health insurers also contend that out-of-pocket costs already are capped under the Affordable Care Act. They say a better way to address high prescription drug costs would be to have drugmakers be more transparent about how prices are set ("KXJZ News," Capital Public Radio, 2/18).

Source: California Healthline, Thursday, February 19, 2015

Another View of American Health Care by Uwe Reinhardt, PhD

We published an article yesterday (February 14, 2015) which included a link to the Affordable Care Act. This was not meant to be an endorsement.  I have focused on the pitfalls, inadequacy of the ACA and, the outright sabotage of our health system, rather than improving and reducing cost.  Despite the stated goals of  HHS, and CMS to slow down health cost escalation and reduce cost, the ACA increases bureaucracy ad overhead.

Uwe Rheinhardt, PhD has been a whistleblower on the  U.S. health scene.  He minces no words. Does anyone listen, or this just wishful thinking ?  Healthcare is not is only area of study.  He has taught courses in economic theory and policy, accounting, and health economics and policy. Reinhardt's scholarly work has focused on economics and policy and includes more far-reaching topics such as cost-benefit analyses of the Lockheed L-1011 TriStar^[5] and the Space Shuttle.^{[citation needed]} He currently is the professor of Economics 100 and Economics 332 at Princeton University.

Research

Reinhardt's most recent^[when?] research has focused on hospital pricing, systems of health care around the world, Medicarereform, and health care spending. His work has appeared in Health Affairs, The New England Journal of Medicine, JAMA, and The British Medical Journal.^[6]

Administration[edit]

In the 2009 Frontline show "Sick in America", Reinhardt criticized the United States for spending 24% of every health care dollar on administration, and pointed out that Canada spends less than half of the U.S. amount and Taiwan spends significantly less than Canada.^[10] Reinhardt faulted the seeming U.S. preference for an unwieldy "mishmash of private insurance plans" for the inefficiency.^[10] He said if the U.S. could spend half as much on administration, it would save more than enough money to cover all the uninsured.

My Fitness Pal

Investor John Doerr On What Makes MyFitnessPal Successful

Many mobile apps have failed to gain traction. Fitness Pal stands out as a successful mobile health app. 

Apple AAPL +0.52% and Google GOOGL +0.96% carry more than 100,000 health apps in their app stores. Most struggle to stand out, or sustain the interest of their user, let alone turn a profit. So, when sports apparel powerhouse Under Armour UA -0.26% shelled out $475 million for weight loss app MyFitnessPal, it signaled that pay-offs could be huge for apps that get it right—and their backers.

 

Mike Lee founded MyFitnessPal in 2005, when he and his fiancee wanted to lose a few pounds before their wedding. Lee, and later his brother Albert, bootstrapped their start-up, before raising $18 million in a series A round led by Kleiner Perkins Caufield & Byers in 2013. KPCB partner John Doerr, who has long followed the health care industry, joined the board. MyFitnessPal was profitable when it raised money—a big plus for Doerr, and had 40 million downloads. (Although he quickly adds that MyFitnessPal fell in the red as it started hiring.) It now boasts more than 80 million registered users, who can track their calorie intake by clicking from a list of five million food items.

“You have to start with consumer love,” Doerr tells Forbes. One of Lee’s first moves was to form a “customer happiness team” to respond to user comments. Every month, MyFitnessPal invited customers to share their experience. One user, for example, liked it because it allowed him to track foods that caused his eczema to flare up. “Customers became walking billboards for us,” said Lee in a videotaped interview with Doerr. Doctors like it too. In a ranking of top 100 health apps by HealthTap, based on recommendations from 65,000 doctors in its network, MyFitnessPal came on top for iOS.

MyFitnessPal generated revenue from ads, but also became a marketing and sales channel for partners, such as Withings for its wireless scale, and fitness tracker Fitbit, turning into a lead generator for such devices. “It became valuable for devices,” says Doerr, who did not disclose MyFitnessPal’s revenues. The company was about to offer a premium weight loss product for paying customers when Under Armour came knocking. 

Still, Doerr admits keeping consumers engaged is a struggle. There may not be a winning formula for that yet, but MyFitnessPal shows that a deceptively simple approach can be effective. Proof? “We know that people have lost over 200 million pounds,” he says.

What defies conventional wisdom is that My Fitness Pal requires an active input from users. This is in contradistinction in the use of PHR (personal health records)  Consumers rebel against active entry of data, preferring their PHR to be populated by their physician.

My Fitness Pal reports on several metrics in additon to weight. They include

• Progress  scroll down for complete list
• 
  
• Weight
• Neck
• Waist
• Hips
• Nutrition
• Net Calories
• Calories
• Carbs
• Fat
• Protein
• Saturated Fat
• Polyunsaturated Fat
• Monounsaturated Fat
• Trans Fat
• Cholesterol
• Sodium
• Potassium
• Fiber
• Sugar
• Vitamin A
• Vitamin C
• Iron
• Calcium
• Fitness
• Calories Burned
• Exercise Minutes

Social Media

My fitness Pal also provides a community section on the web site as a 

semi-interactive group to provide emotional support to encourage compliance.

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Young adults are driving vaccine skepticism in the U.S.

Who are the vaccine skeptics? 

On the heels of the Disneyland vaccine outbreak, that's what everyone wants to know. As with just about every other major issue facing the country, the temptation is to divide it along familiar left/right political divides. It may seem natural that Republicans, who tend to be skeptical of mandates and government intrusions, would be most opposed to vaccination policies. Or that Democrats, distrustful of big businesses like pharmaceutical companies, would harbor the most skepticism.

Measles Rash

But as it turns out, we're asking the wrong question. Public opinion polling shows that vaccination attitudes don't differ much by party affiliation. Or by income, or even education. But there is one important demographic factor: age.

Millennials -- 18 to 29-year-olds -- are about twice as likely as senior citizens (65+) to say that parents should decide whether their kids get vaccinated, rather than having it mandated by law. Republicans and independents are more likely to say this than Democrats, but here the split is not as stark.

More strikingly, 21 percent of millennials say it's likely that early childhood vaccinations are linked to autism, compared to only 3 percent of those aged 65+. There's little variation by political party on this question.

The Pew Research Center, which polled the first question, posits that "One possible reason that older groups might be more supportive of mandatory vaccinations is that many among them remember when diseases like measles were common." Having come of age in an era when measles was declared eradicated, millennials have no generational memory of time when hundreds of thousands of Americans were stricken with the disease each year. Not to mention polio, or smallpox.

Vaccines are partially a victim of their own success. They've done such a great job of wiping out deadly diseases that it's easy to become complacent. Largely liberated from having to worry about measles outbreaks, or tetanus, or polio, we're able to fret over whether vaccinations comport with an "all-natural" lifestyle. But we've forgotten that the incredible success of vaccination programs is what afforded us that luxury to begin with.

It may take more California-style outbreaks to jolt our memory.

Christopher Ingraham, 

Reporter — Washington, D.C.  Washington Post

Health Reform--What's In it For Me ?

The quick answer is, that depends.

February 15, 2015 Open enrollment ends for 2015

The Affordable Care Act has raised questions that were unforeseen for patients and providers.  It's stated goal was to provide affordable care for all.

In 2010 the conventional wisdom was there were 40 million Americans (according to HHS)who were uninsured and the plan would more or less provide an avenue for people to find suitable and obtainable insurance coverage for themselves and their families.   According to a recent statement at Whitehouse.gove/healthreform about 10 million Americans have been added to the insurance pool.  

The affordable care act is not socialized medicine. Term is often used in a pejorative manner in the U.S.

It utilizes a multitude of private insurers, establishing a rigid set of requirements to be eligible to participate in the new system. Many of the changes involve standard and requirements for eligiblity. It is built upon an already complex system, chaotic in many ways which can be compared to a Gordian knot.  I compare it to a golf ball with an inner core of elastic material wound into the shape of a ball.  Upon that core is now another layer of material made up of composite and plastic material.

Federal and State Health Information Exchanges provide the portal into health insurance for the unemployed, disabled and other persons who are uninsured due to previous limitations of prior existing conditions. It also eliminated the 'cap' on maximum coverage, and reimbursement exclusions for certain type of healthcare, some of which are .

 Health insurance marketplace In the United States, health insurance marketplaces,^[1] also called health insurance exchanges, are organizations set up to facilitate the purchase of health insurance in each state in accordance with Patient Protection and Affordable Care Act (ACA, known colloquially as "Obamacare"). Marketplaces provide a set of government-regulated and standardized health care plans from which individuals may purchase health insurance policies eligible for federal subsidies.

The HIX uses a complex set of algorithms to determine the amount of subsidy an applicant can expect for a plan  There are tiers using different insurance companies, medicaid, and levels of deductibles, and co-pays. Initially the HIX online was UNUSABLE for prospective enrollees. The re-design is  better. 

For more information see..... Health Care That Works

2015 is the second iteration for HIX enrollment. The target audience is smaller, and more difficult to enroll. These are the people who  cannot afford the premiums even with the subsidy. The site offers a question / answer format with animation. It is well designed for consumers with attention-getting design.

Health Care, Analytics and Big Data

The evolution of electronic health records and health information exchanges is producing large amounts of data on disease, treatments, demographics and treatment outcomes. The data is beginning to expose unknown relationships between different diseases in the same patients.

An unlikely investigator is a  physicist from Vienna Austria.   Stefan Thurner is a physicist, not a biologist. But not long ago, the Austrian national health insurance clearinghouse asked Thurner and his colleagues at the Medical University of Vienna to examine some data for them. The data, it turned out, were the anonymized medical claims records—every diagnosis made, every treatment given—of most of the nation, which numbers some 8 million people.

Thurber reports in an article he authored in Quantia.

Network maps reveal hidden molecular connections between disparate diseases.In a recent paper in the New Journal of Physics, Thurner and his colleagues Peter Klimek and Anna Chmiel started by looking at the prevalence of 1,055 diseases in the overall population. They ran statistical analyses to uncover the risk of having two diseases together, identifying pairs of diseases for which the percentage of people who had both was higher than would be expected if the diseases were uncorrelated — in other words, a patient who had one disease was more likely than the average person to have the other. They applied statistical corrections to reduce the risk of drawing false connections between very rare and very common diseases, as any errors in diagnosis will get magnified in such an analysis. Finally, the team displayed their results as a network in which the diseases are nodes that connect to one another when they tend to occur together.

A human disease network maps out connections between diseases — if patients who have one disease tend to also have another, the two disease nodes are connected.

One disease module they’ve studied is for pulmonary hypertension (elevated BP in the pulmonary artery. The researchers published their findings in the journal Pulmonary Circulation.

Another module looks at Type 2 diabetes.   Researchers have linked diabetes to about 200 spots on the genome through genome-wide association studies.  We know genes have multi-factorial effects, but have less evidence for association in different diseases. Empirical clinical cases reveal a co-incidence of Type II  diabetes, and hypertension.  Mapping disease networks may explain more objectively the association between these two diseases.

The real promise is to reveal previously unknown associations of diseases.

This article was reprinted on ScientificAmerican.com.