Biosimilars Will Change Market
The manufacturers of tumor necrosis factor–alpha inhibitors could lose billions of dollars in revenue with the introduction of biosimilars in the United States and Europe, according to the research firm Decision Resources. By 2018, biosimilars of TNF-alpha drugs could cut $9.6 billion from brand sales in the United States, France, Germany, Italy, Spain, and the United Kingdom. But the development could also be a boon for payers in those countries, which could save $4 billion during that period. Decision Resources said it expects the movement to TNF-alpha biosimilars to be driven largely by payers, not physicians. “For the second year in a row, surveyed U.S. payers rank TNF-alpha inhibitors as their top priority” for reducing biologics spending, MaryEllen Klusacek, Ph.D., an analyst at the research firm, said in a statement. “Based on this finding, we anticipate that payer pressure on physicians to prescribe biosimilar TNF-alpha inhibitors will be high.”
Arthritis Kit Seller Busted for Fraud
The owner of a Houston-based durable medical equipment company has pleaded guilty to selling medically unnecessary orthotic devices as parts of “arthritis kits” to Medicare beneficiaries. The kits included braces for both sides of the body and related accessories, such as heating pads. Noel Wayne Jhagroo, owner of Trucare Medical Equipment Services, is alleged to have billed Medicare about $4,000 per kit, according to U.S. Health and Human Services Inspector General Daniel R. Levinson. The case was investigated by the FBI and Inspector General Levinson's office as part of a larger HHS effort to crack down on Medicare fraud.
Pipeline Is Full of Treatments
Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. They include medications for breast and cervical cancers, arthritis and musculoskeletal disorders, diabetes, autoimmune diseases, eye conditions, gastrointestinal problems, kidney and urologic diseases, respiratory diseases, neurologic conditions, psychiatric disorders, sepsis, obstetric and gynecologic diseases, and more, according to the trade group. For example, there are 114 medicines under development for autoimmune diseases, which affect women at a rate three times that for men.
Electronic Tools Effective: AHRQ
Consumer health informatics (electronic tools and applications designed to provide tailored health advice to patients) could save money by eliminating the need for some health education activities now performed by clinicians, said a report from the Agency for Healthcare Research and Quality. The agency reviewed more than 100 studies of consumers' getting health information via the Web, computer programs, and other electronic avenues such as texting and chat groups. The analysis found that the most effective health informatics applications tailor messages using a patient's own health information and give feedback about that person's progress as the intervention progresses. The AHRQ report also found that feedback from a clinician doesn't seem to be any more effective than that provided by computer. The key is timeliness, not the human touch, the study concluded.
Provider Fraud Most Common
By far, most health care fraud (80%) involves providers' systematically overcharging public or private insurers, according to a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. The study found that these schemes disproportionately target demographic groups who are likely to be enrolled in Medicare and Medicaid. However, the study found that fraud information on the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.
DEA Effort Delays Pain Relief
Heightened efforts by the Drug Enforcement Administration to prevent the theft of prescription narcotics are denying pain relief to many nursing home, hospice, and other long-term care patients, said two senators in a letter to Attorney General Eric Holder. Sen. Herb Kohl (D-Wis.), chairman of the Senate Special Committee on Aging, and Sen. Sheldon Whitehouse (D-R.I.) called on Attorney General Holder to issue new directives to the DEA. To deter theft and diversion of prescription drugs, the agency recently stepped up the enforcement of laws that require pharmacies to obtain hard copies of prescriptions with signatures from physicians—instead of routine medication orders—for controlled substances that are prescribed in residential care settings. This has disrupted “well-established medication coordination protocols” and has led to delays in providing those medications to sick patients, the two lawmakers said.