Clash of the Titans: Big Pharma vs. Big Insurance Print E-mail
Written by Luis Collar, MD | Sapphire Equinox   
Thursday, 17 July 2014 11:34

Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly effective in the treatment of chronic HCV infection. In fact, with an overall SVR (sustained virologic response) of 90% for the genotypes studied, Sovaldi may represent a cure for many of the 3.2 million Americans afflicted with the disease.
Sovaldi's price, however, has raised more eyebrows than its efficacy. At around $1,000 per pill, or $84,000 for a twelve-week course of treatment, there's no denying it's expensive.

And given its hefty price tag, it's no surprise that most insurance companies now require prior authorization before patients can obtain the drug. So is Sovaldi too expensive? Maybe it is, maybe it isn't; we'll address that shortly. But should insurers ever be allowed to require prior authorization for a drug, regardless of its price?

The two industries most relevant to this discussion possess diametrically opposed...

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Federation's Model Telemedicine Policy is Well Timed Print E-mail
Written by Jeffrey L. Cohen | Florida Healthcare Law Firm Blog   
Wednesday, 16 July 2014 12:03

Many health policy experts are betting on the expanded role of telemedicine as an essential cost-saving, quality (and access) enhancing tool. Yet legal and policy issues have dogged the development of useful telemedicine guidelines, making it difficult to know what's ok and what's not. What sort of licensure is required for physicians practicing telemedicine? When is the physician "practicing medicine" vs. "merely consulting?" When is a physician patient relationship established? Is one even necessary? The newly developed model policy developed by the Federation of State Medical Boards should help guide states in developing specific telemedicine standards.

Federation Guidance

The model policy adopted by the Federation provides the following core guidance...

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The Expanding Range of Strategic Alternatives Available in Hospital System Mergers and Acquisitions Print E-mail
Written by Advisory LLC   
Thursday, 10 July 2014 11:25

The business of governing acute care health systems has become increasingly complex in recent years as board governance and industry structure have worked to keep up with the pace of reform and consolidation. The sector has evolved from a largely charitable function to a major industry that comprises 5 percent of the gross domestic product. The acute care health system business is capital intensive, highly regulated and technology driven.

Some industry observers point to the level of ownership fragmentation as a challenge to managing and improving acute care services in the United States. The hospital industry is composed of very small companies compared to similarly sized sectors of the economy. In other industries like managed care, airline, auto and food, beverage and tobacco companies, for example, the 50 largest companies hold market shares in excess of 75 percent. The 50 largest hospital companies together command less than 25 percent market share. The hospital industry has no "large" companies and none have full access to capital like major manufacturing companies have-e.g., commercial paper markets, equity markets, debt markets, synthetic markets, foreign listings, etc.

The passage of the Affordable Care Act and other macroeconomic initiatives are designed, in part, to stimulate the creation of larger health care companies that can deliver higher quality, more cost-effective care. Meaningful consolidation will be challenging and take time. Of the roughly 4,500 total acute care hospitals in the United States, there are more than 2,000 "companies" delivering care. With such fractured ownership, population health as well as standardized, efficient, consistent and coordinated care has been an elusive goal.

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Last Updated on Thursday, 10 July 2014 11:47
Sponsor Showcase Print E-mail
Written by Sponsor   
Thursday, 17 July 2014 00:00
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Last Updated on Thursday, 17 July 2014 12:10

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