When patients go to the pharmacy to fill a prescription, they are often told that their insurance company won’t pay for the medication unless a physician obtains approval. Patients may even wait days, weeks, or months for a necessary test or medical procedure to be scheduled because physicians must obtain similar authorization from an insurer. This tactic, used by insurance companies to control costs, is called prior authorization.
Category Archive: Bad practices
Patient advocates on Tuesday blasted the Biden administration’s refusal to compel the manufacturer of a lifesaving prostate cancer drug developed entirely with public funds to lower its nearly $190,000 annual price tag. The drug’s development was 100% taxpayer-funded. Yet a one-year supply of Xtandi currently costs $189,800 in the United States.
Since the 1930s, the National Institutes of Health has invested nearly $900 billion in the basic and applied research that formed the pharma and biotech sectors. 75% of so-called new molecular entities with priority ratings (the most innovative drugs) trace their existence to NIH funding, while companies spend more on “me too” drugs.
Fewer than half of Americans rate the quality of U.S. health care as excellent or good. Only 12% say it is handled extremely or very well. Americans have similar views about health care for older adults. The public gives even lower marks for how prescription drug costs, the quality of care at nursing homes, and mental health care are handled, with just 6% or less saying those health services are done very well in the country. Can it ever be improved?
Big Insurance revenues and profits have increased by 300% and 287%, respectively, since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans they call Medicare Advantage. The for-profits now control over 80% of the national PBM market and over 70% of the Medicare Advantage market.
U.S. senators called for Medicare to offer broad coverage of Alzheimer’s treatments approved by the Food and Drug Administration, warning that current restrictions cost patients precious time as their disease progresses. They are asking the FDA to approve a drug based on hope, not science.
A disturbing new study conducted by Health Action Council shows millennials exceed older generations in chronic health conditions like diabetes and obesity. We need to focus on emphasizing lifestyle as medicine and stop making excuses for lack of common sense when it comes to obesity.
When JAMA points out the greed in health care, you know we have a problem. “The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit.”