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Amid the sector's struggle to come up with a plausible financing structure for million-dollar gene therapies, one obvious question has yet to be answered: How much of the cost will be borne by patients?
The share of a drug's cost that must be shouldered by patients has become a barrier to the use of therapies even as old and essential as insulin, so the issue is not theoretical when it comes to bigger-ticket items. Assuming no limit on cost-sharing, a family whose child is treated with Novartis's Zolgensma could be on the hook for $520,000, and at present the main idea to defray these costs is a long-term loan.
Healthcare Finance News
Blue Cross and Blue Shield of North Carolina has entered into a shared risk contract with five of the state's major health systems and their accountable care organizations.
The program called Blue Premier, ties payment to performance. The health systems share in the cost savings if they meet industry-standard goals to improve the health of patients and reduce costs. The health systems also share in the losses if they fall short.
State of Reform
As the Utah Legislature swings into action this year, legislators have begun pre-filing bills for the Jan. 28th kickoff to the session. Of the 139 filed in the House and 72 filed in the Senate so far, there are a mere 17 filed that are health care related. However, keep a close eye in the coming weeks for new legislation to drop as the Legislature's website currently shows an additional 22 health care bill requests, which means they are in the process of being researched and drafted by the Office of Legislative Research and General Counsel. Here is a run-down of some bills and bill requests that we'll be watching.
The average outpatient visit in the United States costs nearly $500, and the average inpatient stay cost more than $22,000.
That's according to a global study from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington that included outpatient data from 130 countries and inpatient data from 128 countries.
"Before our research, there were global estimates of health spending, health resources like hospital beds per 1,000 population, and burden of disease, but not health services," Marcia Ruth Weaver, PhD, research professor at IHME and one of the study's co-authors, told HealthLeaders.
Gov. Charlie Baker is proposing to expand the eligibility for Medicare Savings Programs to allow more low-income seniors to qualify.
In his annual budget submissions, Baker is including the proposal to spend $7 million every year to leverage more than $100 million in federal funds for Medicare prescription drug subsidies for eligible seniors over 65.
Expanding the program would bring the number of eligible low-income seniors from 18,000 to around 43,000. Most of the current folks in the program would receive better benefits, and approximately 25,000 people who aren't now eligible would become so.
In crime novelist Agatha Christie's biggest hit, And Then There Were None, guests at an island mansion die suspicious deaths one after another.
So you can forgive Jeff Lyle, a big fan of Christie's, for comparing the 36-bed community hospital he runs in Marlin, Texas, to one of those unfortunate guests. In December, two nearby hospitals, one almost 40 miles away, the other 60 miles away, closed their doors for good. The closings were the latest in a trend that has seen 21 rural hospitals across Texas shuttered in the past six years, leaving 160 still operating.
Watertown Daily Times
Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.
The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.
Health plans have annual limits on consumers' out-of-pocket costs. Under the proposal, insurers would not have to cover the full amount of a consumer's copayment for a brand-name drug — only the lower price for a generic version.
Becker's Hospital Review
Texans are increasingly taking advantage of the state's billing mediation program as they face unexpected out-of-pocket medical costs, according to KUT FM 90.5, a public radio station in Austin.
The Texas Department of Insurance mediation program aims to help patients with surprise medical bills by working with the health insurance company and the healthcare provider to reach an agreement on the amount charged by the provider, the amount paid by the insurer to the provider, and the amount paid by the patient.
Apple is reportedly in talks with multiple insurers, discussing possible ways to subsidize the cost of the Apple Watch for seniors on Medicare Advantage plans. If the discussions come to fruition, it could prove to be a win-win, allowing Apple to bolster Watch sales while potentially helping insurers lower their healthcare costs. In this note, we try to size up the potential market for the Watch among seniors on Medicare Advantage plans.
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NAHU Newswire is a daily brief featuring the latest news of interest to healthcare agents and brokers, selected from thousands of sources by the editors of MultiView. NAHU personnel, in accordance with internal policies, do not approve all stories selected. Any comments regarding content of this publication should be emailed to NAHU. It should not be understood or inferred from the presence of advertisements that NAHU endorses any products or services advertised. Similarly, NAHU is not responsible for the quality of journalism reflected in the articles: it should not be understood or inferred that NAHU supports the information provided. MultiView and NAHU are not liable, for any delays or inaccuracies in the information contained in this brief, nor for any actions taken or outcomes resulting from relying on the information provided herein.
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