Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
A recent study published in JAMA Surgery found that prices for initiating care at trauma centers vary across hospitals, according to Modern Healthcare. To analyze cash and negotiated prices associated with emergency care, the researchers used hospital price transparency data released in relation to a law that went into effect in 2021. They found that across 761 hospitals, prices associated with preparing doctors and other personnel for trauma cases varied 16-fold in 2023. More specifically, the median cash price for trauma activation fees among level 1 trauma centers was 25% lower than the median rate hospitals negotiated with insurers in 2023, meaning that patients with insurance at times paid more than patients without coverage. Consequently, the researchers advocated for the government to pass legislation that gives patients the option to pay the cash price if the negotiated price is higher; this is already the case in states like Tennessee and Texas.
Drug shortages reached a record high during the first quarter of 2024, according to USA Today. Data provided by the American Society of Health-System Pharmacists and the University of Utah Drug Information Service reported that supplies of 323 drugs were running low during the first quarter of 2024, surpassing the 2014 high of 320. The drug shortage has affected both basic and life-saving drugs, from chemotherapy medications to attention-deficit/hyperactivity disorder (ADHD) medications. Other drugs affected include the injectable drug semaglutide (Wegovy and Ozempic) for treating obesity and diabetes. In response, the Federal Trade Commission and HHS announced in February that they will investigate whether drug wholesalers and companies that buy medicines for health care providers are partly to blame for the shortages.
Although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by younger kids with asthma, according to CNN, putting them in danger of flare-ups and emergency visits. The 3 inhaler options for children are ciclesonide (Alvesco), mometasone furoate (Asmanex), and fluticasone, the authorized generic version of GSK’s Flovent that was taken off the market earlier this year. These inhalers are made by Covis Pharma, Organon, and Prasco Laboratories, respectively, all of which are not among the companies that made the $35 pledges on asthma drugs. Consequently, these inhalers have become increasingly expensive and hard to find. To help, some insurers have provided coverage options. For example, CVS Caremark allows patients 6 years and under to receive generic Flovent without submitting a formulary exception. However, it is not always clear at the point of prescribing which pharmacy benefit manager a patient has, resulting in hurdles like filling out paperwork to obtain coverage. Also, even with coverage, out-of-pocket costs can still be high.
Industry Experts Tackle Specialty Drug Access Challenges for Employer Benefit Plans
May 2nd 2024Representatives from ICON plc and Symphony Health joined forces as AXS24 to discuss the challenges of managing high-cost specialty drugs and how they influence self-funded employer benefit plan design and employee access to specialty medications.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
BRCA-Like Classification May Be a Useful Biomarker for Olaparib Response in Ovarian Cancer
May 1st 2024Adding olaparib to maintenance therapy with bevacizumab was associated with significantly longer survival for patients with ovarian cancer whose tumors have a BRCA-like genomic profile, but not among those with non-BRCA-like tumors, a study found.
Read More