Tag: 2019 News

A team of Internet entrepreneurs in downtown Manhattan wants to revolutionize how Americans get prescription drugs. Their company, Blink Health, has a crazy idea: let customers shop for the best deal. The founders of Blink Health seek to eliminate the middlemen and comparison-shop at their website to see if you can get a better deal than what’s being offered by and insurance plan or the drugstore.

Blink Health claims that the pharmacy business remains largely untouched because customers haven’t easily been able to shop online for a better price. They’re buying drugs the way they bought them in the predigital age – at the drugstore. The middlemen still flourish, at the expense of everyone else..

The dominant middlemen are the pharmacy benefit managers, or PBMs, which are hired by private and government health-insurance plans to administer drug benefits. Dozens of small PBMs once competed for business, but today three large firms – Express Scripts, CVS Caremark, and OptumRx – together control more than 75 percent of the market.

While other twentysomethings were launching Internet startups, Geoffrey Chaiken was wondering why there was no Uber or Airbnb in the pharmacy industry. After dropping out of Yale to start a company developing epilepsy drugs, he began studying the industry’s supply chain.

Together with his younger brother, Matthew, he started Blink Health in his downtown apartment four years ago. Today, it has 600,000 customers and an office in SoHo with 220 employees. To help them run the company, the Chaikens brought in veterans of online companies like Kayak as well as the drug industry, including Bill Doyle, who’d spent decades working for Johnson & Johnson.

Blink negotiates with drug manufacturers, using its purchasing power to extract discounts off the list price. Then, instead of collecting secret rebates or steering patients to a preferred drug, it posts all the discounted prices on its website (and makes money by charging the patient slightly more than it reimburses the pharmacy). Instead of forcing patients to turn over their prescription to a pharmacist to find out what it will cost, Blink lets doctors and patients shop on the web before making a commitment.

For example, a month’s supply for the generic version of Lipitor (atorvastatin) would typically cost more than $100 at CVS and more than $200 at Walgreens. The generic version of Crestor (rosuvastatin) would cost more than $175 at either chain. If your plan covered the Lipitor but not the Crestor generic, you might spend between $5 and $40 for the Lipitor, but you’d have to pay the full $175 for the Crestor – so you might not buy it, even though it would be the better option for you.

At Blink’s website, you can typically find the Lipitor generic priced under $9 and the Crestor under $12. If you buy it from Blink, you can get it delivered to your home or pick it up at a local drugstore. Independent pharmacies have been eager to work with Blink because it’s simpler and more profitable than dealing with insurance plans.

Blink makes straightforward payments for the drugs and doesn’t impose complicated contracts (or gag clauses). The PBMs often pay less, and they impose various fees, like charging pharmacists $5 if they call their help desk to deal with a prescription. The PBMs can decide months after a transaction that the pharmacy must give back part of the reimbursement—a retroactive penalty called a “clawback”—which can cause the pharmacy to lose money on the prescription.

Blink Health has shown that the same market forces that liberated airlines and their passengers can liberate drugmakers and patients. These forces could transform the rest of the health-care industry. The prices of most medical procedures and hospital stays are as complex and opaque as they are for prescription drugs. The prices are known, again, only to the middlemen, so it’s not surprising that costs keep rising.

Researchers led by a team from The University of Texas Medical Branch at Galveston were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance.

This discovery could dramatically alter the way that some forms of chronic pain can be identified and managed. Dr. Miguel Pappolla, UTMB professor of neurology, said that although the discovery is very preliminary, it may lead to a revolutionary shift on how fibromyalgia and related forms of chronic pain are treated. The new approach has the potential to save billions of dollars to the health care system and decrease many peoples’ dependence on opiates for pain management.

The UTMB team of researchers, along with collaborators from across the U.S., including the National Institutes of Health, were able for the first time, to separate patients with fibromyalgia from normal individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance, which dramatically reduced their pain levels. The study was recently published in PlosOne.

Fibromyalgia is one of the most common conditions causing chronic pain and disability. The global economic impact of fibromyalgia is enormous – in the U.S. alone and related health care costs are about $100 billion each year. Despite extensive research the cause of fibromyalgia is unknown, so there’s no specific diagnostics or therapies for this condition other than pain-reducing drugs.

“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder,” Pappolla said. “We showed that most – if not all – patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past two to three months.”

Pre-diabetics with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders.

The researchers identified patients who were referred to a subspecialty pain medicine clinic to be treated for widespread muscular/connective tissue pain. All patients who met the criteria for fibromyalgia were separated into smaller groups by age. When compared with age-matched controls, the A1c levels of the fibromyalgia patients were significantly higher.

“Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” said Pappolla. “The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life. Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects.”

For the fibromyalgia patients, metformin, a drug developed to combat insulin resistance was added to their current medications. They showed dramatic reductions in their pain levels.

Other authors include UTMB’s Clark Andersen and Xiang Fang as well as Laxmaiah Manchikanti from Louisiana State University School of Medicine Health Sciences Center; Nigel Greig from the National Institutes of Health; Fawad Ahmed from St. Michael’s Pain & Spine Clinics; Michael Seffinger from the College of Osteopathic Medicine of the Pacific and Andrea Trescot from the Pain and Headache Center in Eagle River, Alaska.  

Insurance agent Francis Okyere, 67, self-surrendered yesterday at the Los Angeles County Superior Court after being charged with four felony counts of grand theft.

The charges arose from an investigation by the Department of Insurance’s Investigation Division, Valencia Regional Office, into multiple complaints filed by clients of Okyere alleging that their insurance policies were canceled despite paying Okyere for the coverage.

The investigation revealed that, between July 2015 and September 2016, Okyere misappropriated at least $65,456 in insurance premiums payments from four small business owners and used those funds for his personal benefit.

Okyere’s actions left the business owners uninsured against potential liability and workers compensation claims.

Okyere will be arraigned on July 11, 2019 and bail was set at $30,000. The case is being prosecuted by the Healthcare Fraud Division of the Los Angeles County District Attorney’s Office.

The Department of Insurance Legal Division filed an Accusation against Okyere on December 18, 2018 and is seeking to revoke his insurance license. If anyone has information on this investigation, we urge them to call the department at 661-253-7500.

The Organisation for European Economic Cooperation (OEEC) was established in 1948. Other countries joined in, starting with Japan in 1964. Today, 36 OECD member countries worldwide identify problems, discuss and analyse them, and promote policies to solve them.

The OECD has just reported that opioid use has reached crisis proportions not only in the United States but also in Canada and some European countries, as prescription opioid painkillers have become much more common.

“The United States is by no means alone in facing this crisis,” the Organization for Economic Cooperation and Development said in its report. The Paris-based policy forum said deaths linked to opioid use were also rising sharply in Sweden, Norway, Ireland, and England and Wales.

Ilicit opioids constitute a significant product of international illicit trade. Heroin is a semi-synthetic opiate synthesised from morphine and is the most prevalent illicit opioid worldwide. Approximately twice as potent as morphine, heroin has a high potential for problematic use. In recent years, fentanyl and fentanyl analogues have become much more prominent in the illicit drugs scene in many countries.

The majority of those who die in Europe are men, accounting for 3 out of 4 deaths. However, in the United States, opioid use has been rising among pregnant women, particularly among those on low incomes. Having a mental health disorder was also associated with a two-fold greater use of prescription opioids in the US.

An increase in prescription and over-prescription of opioids for pain management is among the factors driving the crisis. Governments should review industry regulations to ensure they protect people from harm as, since the late 1990s, manufacturers have consistently downplayed the problematic effect of opioids.

Doctors should improve their prescribing practices, for instance through evidence-based clinical guidelines and increased surveillance of opioid prescriptions. Governments can also regulate marketing and financial relationships with opioid manufacturers. Coverage for long-term medication-assisted therapy, such as methadone and buprenorphine, should be expanded.

Strengthening the integration of health and social services, such as unemployment and housing support, and criminal justice systems would help improve treatment for people with Opioid Use Disorder.

NCCI’s Chief Actuary Kathy Antonello, FCAS, FSA, MAAA, delivered the company’s highly anticipated State of the Line Report, which provided the audience with a detailed description of 2018 industry results, market indicators, and trends.

The workers compensation Calendar Year 2018 combined ratio for private carriers was 83%. This is the fifth consecutive year that the workers compensation line of business has posted an underwriting gain. Total market net written premium volume increased to $48.6 billion in 2018.

The Calendar Year 2018 workers compensation combined ratio of 83 is the lowest on record since the 1930s. The industry’s favorable combined ratio results over the last several years has been primarily driven by notable improvement in the underlying loss ratios. Underwriting discipline appears to have contributed to these results in what seems to be a perpetual low interest rate environment, with low investment returns.

The combined ratio is typically expressed as a percentage. A ratio below 100 percent indicates that the company is making an underwriting profit, while a ratio above 100 percent means that it is paying out more money in claims that it is receiving from premiums.

On an accident-year basis, the industry-reported 2018 workers compensation combined ratio was 97%. NCCI expects this accident year’s combined ratio to develop favorably over time.

Other market indicators and trends highlighted in NCCI’s 2019 State of the Line Report included:

— NCCI estimates that as of Year-End 2018, the overall reserve position for private carriers is a $5 billion redundancy. A redundant workers compensation reserve position has not been observed in at least 25 years.
— On a preliminary basis, average lost-time claim frequency across NCCI states declined by 1% in 2018.
— In NCCI states, the preliminary 2018 average indemnity accident year claim severity increased by 3% relative to the corresponding 2017 value. Medical lost-time claim severity increased by 1%.
— The workers compensation Residual Market Pool premium volume was approximately $1 billion during 2018, representing a residual market share of about 7%.