AHIP: Rx, physician services consume most premium dollars | Shifting drugs to Part D could raise out-of-pocket costs for some patients | AAP: Flu shot preferred over spray for upcoming season
May 23, 2018
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AHIP: Rx, physician services consume most premium dollars
An analysis of commercial and individual market plans from 2014 to 2016 showed that 23.3% of every premium dollar goes to prescriptions drugs, 22.2% to physician services, 20.2% to office visits and 16.1% for hospital stays, according to a Milliman study commissioned by AHIP. "As prescription drug prices and medical costs continue to rise, it forces premiums higher for hardworking American families," said incoming President and CEO Matt Eyles.
Healthcare Finance (5/22) 
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Shifting drugs to Part D could raise out-of-pocket costs for some patients
Shifting drugs to Part D could raise out-of-pocket costs for some patients
(Joe Raedle/Getty Images)
A proposal to move some or all prescription drugs offered under Medicare Part B to Part D as part of a plan to lower drug prices could raise out-of-pocket costs for patients who buy supplemental coverage for Part B and are ineligible for cost-sharing subsidies in Part D, according to an Avalere Health analysis, but other patients might benefit. There is significant difference in average out-of-pocket costs between Part D and Part B, and proposals to move drugs to Part D should take this into account, according to the report's authors.
HealthLeaders Media (5/22),  BioCentury (5/21) 
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Providers & Suppliers
AAP: Flu shot preferred over spray for upcoming season
The American Academy of Pediatrics recommended that children be immunized with the inactivated influenza vaccine for the upcoming flu season and only receive the quadrivalent live-inactivated influenza vaccine as a last resort, noting the shot has provided consistently better protection than the nasal spray. The AAP will release a policy statement on flu prevention and treatment in September.
Healio (free registration)/Infectious Diseases in Children (5/22) 
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Physicians say hospitals not prepared for major disasters, tragedies
A poll of 1,328 emergency room doctors conducted by the American College of Emergency Physicians found that 9 in 10 respondents indicated their hospitals are insufficiently prepared for mass tragedies or major disasters. The findings underscore the need for an increased focus on medical aspects of preparedness as Congress works on major disaster preparedness legislation called the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018, said ACEP President Dr. Paul Kivela.
United Press International/HealthDay News (5/22) 
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HSA Bank Health & Wealth IndexSM
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Medical Update
Report: US cancer incidence, mortality rates decreasing
The Annual Report to the Nation on the Status of Cancer found cancer diagnoses and deaths in the US overall have been decreasing for men and women, mainly due to better treatments, prevention and screening in colorectal, lung and breast cancers. Prostate cancer death rates stabilized, however, after years of decline, and cases of oral and liver cancers are rising.
HealthDay News (5/22) 
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USPSTF finds little evidence on child maltreatment prevention in primary care
A US Preventive Services Task Force statement said there is insufficient evidence on the efficacy of primary care interventions to prevent abuse and neglect among youths who are not showing signs of maltreatment. However, clinicians should remain vigilant in monitoring young patients for signs of maltreatment; learn federal, state and local laws mandating suspected child abuse reporting; and employ their best medical judgment when providing care to children who may be experiencing mistreatment, said task force member Dr. Alex Kemper.
Healio (free registration) (5/22),  Physician's Briefing/HealthDay News (5/22) 
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Best practices for MA onboarding
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Emerging Trends
Researchers watch as Ebola vaccine is put to the test
Researchers watch as Ebola vaccine is put to the test
(Junior D. Kannah/AFP/Getty Images)
One of the Ebola virus vaccines that has worked well in studies involving nonhuman primates is being used under a compassionate use exemption in the Democratic Republic of Congo, where the virus recently reemerged. The vaccine was also effective in a ring-vaccination trial in Guinea, where people exposed to someone who had an Ebola infection were vaccinated to build a ring of immunity that blocks transmission.
STAT (tiered subscription model) (5/22) 
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Geisinger to offer primary care-based DNA testing for patients
Geisinger Health System plans to offer DNA sequencing to 1,000 patients, with primary care physicians discussing the option with patients and getting results of the testing. Patients will be invited to meet with their primary care clinician and a genetic counselor to discuss the results and potential treatment and prevention options that could reduce their health risks.
Kaiser Health News (5/22) 
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Building a next-generation platform for care at home
Home-centered care drives significant savings, promotes recovery, and increases patient satisfaction. Surprisingly, home care remains underused due to barriers that are structurally embedded into the healthcare system. What will it take for the home to become a center of patient care? LLearn more by downloading this study now.
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Health Insurance Provider Company News
Solutions Provider News
Institute/Expo sponsorships still available
Health insurance providers look for solutions at Institute & Expo. Will they see yours? Let's discuss a package to deliver decision makers, and ROI. Contact BusinessDevelopment@ahip.org.
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Pharma News
FDA developing guidance on gene therapy manufacturing, development
FDA Commissioner Scott Gottlieb is paving the way for drug developers to advance more gene therapies for various diseases by creating a framework that will guide gene therapy manufacturers. "The first therapeutic area we'll focus on is hemophilia, where factor production may be sufficient in some cases as a surrogate measure of benefit where a gene therapy product can potentially normalize factor production," Gottlieb said.
BioCentury (5/22),  Endpoints News (5/22) 
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Policy Watch
House approves "right-to-try" legislation
House approves "right-to-try" legislation
(Stefan Zaklin)
House lawmakers approved legislation Tuesday that would allow terminally ill patients to request access to experimental drugs that have undergone early-stage clinical trials but have yet to receive approval from the FDA. The bill, which would not require pharmaceutical companies to provide the drugs, was passed by the Senate last year and now goes to President Donald Trump for his expected signature.
National Public Radio (5/22),  The Examiner (Washington, D.C.) (5/22) 
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AHIP News
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If you are an agent or broker, educator, or a student, AHIP Individual Membership is ideal for you. Throughout the year, you'll receive access to the latest news and information affecting the industry, as well as discounts on dozens of AHIP education programs, such as, "Health Insurance 101," "Long-Term Care Professional Combined Course," and many more. Learn more and join.
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