Weekend update

Congress is in session this coming week. However, according to the Hill's Floor Action blog, it's unlikely that Congress will resolve the debt ceiling this week due to scheduling issues. The Politico notes that Congress recesses this week on Wednesday, then takes a week off and comes back Feb. 25 — just two days ahead of the [the Treasury Secretary's debt ceiling increase] deadline.

The FEHBlog ran across (via twitter of all things) this interesting Businessweek chart suggesting that the reported demise on independent medical practices is in error. "The share of self-employed doctors has leveled off at around 60%." That's down from 75% from thirty years ago but much higher than Accenture's prediction that the self-employed doctor percentage would be at 36% in 2013.

The FEHBlog also found this Drugchannels.net article about the "explosive" growth of specialty drug pharmacies.  Specialty drug pharmacies dispense expensive "large molecule" biotech drugs which often are injectable or infused and require special handling. According to the article,

In 2008, only two companies—CuraScript (4 locations) and Optum Rx (2 locations)—had achieved [URAC] “Full Accreditation.”  As of December 2013, 59 companies with 114 specialty pharmacy locations had achieved “Full Accreditation” from URAC. An additional 51 companies are “In Process” and will likely be accredited shortly. 

Despite the accreditation boom, market share for dispensing specialty drugs remains highly concentrated—for now. (See New Drug Channels Institute Study Finds Three Companies Dominate Specialty Pharmacy, Identifies Key Trends Affecting Profitability.) The specialty industry is becoming much more competitive, which will compress margins for undifferentiated pharmacies.

Cost curve up.