Wednesday, October 29, 2014

Mid-week update

HHS has announced that Dr. Karen DeSalvo will continue to serve as National Health Care IT Coordinator while she also acts as an assistant HHS Secretary for Ebola matters.  The American Medical Association is pleased with this news.

The Hartford Courant confirms what the FEHBlog noted earlier this month -- Aetna has announced that all 2015 health plans it offers to federal workers will provide coverage for sex-change operations, a decision that follows a shift in U.S. government policy allowing insurance to pay for gender reassignment surgery..

The New York Times has an opinion piece in which a health care economist describes consumer difficulties in selecting a health plan during the open enrollment period. The writer complains
A crucial feature of health plans is not as easily or widely accessible: the extent to which each covers services provided by one’s favorite doctors and hospitals. Except on a handful of Affordable Care Act exchanges and for federal-employee participants in the Washington area, such network information is typically available only on plans’ websites, making gathering and comparing plan networks prohibitively difficult. Moreover, which doctors are in a plan’s network can change over time.
The health care provider knows. Ask the provider. In any event, the OPM website links to plan websites. It's not that difficult. Moreover, the FEHBlog thinks that Congress missed an opportunity in the ACA when it failed to require providers to give patients information about the health plan networks in which they participate (and their pricing?).

Finally, Reuters reports that "pharmacy benefit manager Express Scripts Holding Co said it may quickly change its preferred drug formulary to favor an expected new hepatitis C drug from AbbVie if it is clinically equivalent and less costly than Gilead Science Inc's $84,000 Sovaldi and $94,500 Harvoni treatments." Hope spring eternal. According to the article, the FDA is expected to approve AbbVie's drug which is equivalent to Harvoni, later this year but AbbVie has not announced its pricing. A speaker at the ESI conference that the FEHBlog attended last week explained that the difference between big Pharma, e.g., Pfizer, and biotech companies like Gilead Sciences is that big Pharma has a lot of irons in the fire while the biotech company only has a few. So when the biotech company hits the jackpot, it has to cash in big time.


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