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What We're Reading: Gottlieb Criticizes Pharmacy Rebates; High-Deductible Health Plans and Cancer; California Audit Faults Health Regulator
FDA Commissioner Scott Gottlieb, MD, took aim at the federal antikickback law that protects the legal status of rebates paid by drug companies to insurers and pharmacy benefit managers; high-deductible health plans are deterring women from getting care for breast cancer; a California state audit found that health regulators have allowed substandard care to spread at nursing homes.
Gottlieb Talks About Taking Action Against Pharmacy Rebates
High-Deductible Health Plans Delay Breast Cancer Care
California Audit Slams Care at Nursing Homes
FDA Commissioner Scott Gottlieb, MD, took aim Thursday at the federal antikickback law that protects the legal status of rebates paid by drug companies to insurers and pharmacy benefit managers, The Hill reported. Making changes could help increase competition and make drugs more affordable, he told food and drug industry attorneys. “One of the dynamics I’ve talked about before that’s driving higher and higher list prices is the system of rebates between payers and manufacturers,” Gottlieb said. “And so, what if we took on this system directly, by having the federal government reexamine the current safe harbor for drug rebates?”High-deductible health plans are deterring women from getting care for breast cancer, The New York Times reported. The paper interviewed patients, physicians, and health policy analysts detailing the effect that the plans have had on getting diagnostic imaging and biopsies, delaying treatment. Some foundations offer financial assistance to patients but not enough to prevent medical debt.A California state audit released this week found that health regulators have allowed substandard care to spread at nursing homes, and the number of incidents that could cause serious injury or death has jumped, California Healthline reported. The report singled out the Department of Public Health, saying it had not performed inspections or issued timely citations. The audit also found that the department’s nursing home licensing decisions were inconsistent and lacking in transparency.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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