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What We're Reading: Tufts Health Plan Removes Hepatitis C Drug Restrictions
What we're reading, April 20, 2016: Tufts Health Plan will pay for hepatitis C drugs for all patients with the disease; drug advertisements don't sway consumers; and Express Scripts countersues Anthem.
Tufts Health Plan, based in Massachusetts, will now pay for expensive hepatitis C drugs regardless of the patient’s disease stage. The change in policy comes amidst public outrage over insurers limiting the drugs to people with severe liver damage despite medical guidelines recommending treating nearly every infected person, according to The Boston Globe. Blue Cross Blue Shield of Massachusetts also pays for the hepatitis C drugs regardless of how much liver damage a patient has, but most insurers in Massachusetts require evidence of advanced liver disease.
Few consumers say drug advertisements prompt them to speak with a doctor about the medicine being promoted. With only 7% of people surveyed saying they spoke with a doctor about a drug after seeing the advertisement for it, people may not be swayed by direct-to-consumer advertising, reported STAT. However, spending on drug ads on TV was up 31% from 2014 to 2015 and the pharmaceutical industry spent $5.4 billion total on advertising last year.
Express Scripts is countersuing Anthem, which first sued the pharmacy benefit manager in March for allegedly violating its contract by refusing to renegotiate pricing terms. According to The Wall Street Journal, Express Scripts denied Anthem’s allegations and filed a lawsuit demanding unspecific damages from Anthem and a judgment that Anthem cannot end the contract. Express Scripts is now alleging that Anthem has refused to negotiate in good faith.
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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