Health insurance plans in the U.S. have committed to simplifying and streamlining the prior authorization process to improve patient access, reduce administrative burdens, and enhance transparency, with specific actions including standardizing electronic submissions, reducing scope, ensuring continuity of care, and expanding real-time responses, aiming for significant improvements by 2026-2027.
A study found that most cancer drugs granted accelerated approval by the FDA do not demonstrate clinical benefits within five years, raising concerns about patient access to unproven medications. Despite the program's intention to speed access to promising drugs, only 43% of the drugs demonstrated a clinical benefit in confirmatory trials, yet 63% were converted to regular approval. The study highlights the need for better communication of uncertainty to patients and the importance of careful explanation by doctors. Recent updates to the program give the FDA more authority to withdraw drugs when companies don't meet their commitments, aiming to streamline the process for verifying drug efficacy.
A study found that most cancer drugs granted accelerated approval by the FDA do not demonstrate clinical benefits within five years, despite the program being intended to give patients early access to promising drugs. Between 2013 and 2017, 63% of cancer drugs granted accelerated approval were converted to regular approval, even though only 43% demonstrated a clinical benefit in confirmatory trials. The study raises concerns about whether patients understand the uncertainty surrounding drugs with accelerated approval and emphasizes the importance of doctors carefully explaining the evidence to patients. Congress recently updated the program, giving the FDA more authority and streamlining the process for withdrawing drugs when companies don’t meet their commitments.
Health care providers, including hospitals and doctors, are increasingly refusing to accept Medicare Advantage plans, despite the growing popularity of these plans among Medicare beneficiaries. The friction between insurers and providers arises from payment rates imposed by Medicare Advantage plans and the perceived burdensome requirements for preapproval and claims denials. Patients may be forced to switch plans or revert to traditional Medicare, which can be challenging. The conflicts between insurers and providers may be the beginning of a trend as the Medicare market becomes more concentrated among a few insurers. Studies show that Medicare Advantage costs taxpayers more per beneficiary than the traditional program, but the plans enjoy political support due to their popularity.
Gene therapy makers are concerned about the profitability of their treatments in Europe, while patients fear being left behind. Bluebird Bio's gene therapy, Zynteglo, was approved in Europe in 2019 for the treatment of beta thalassemia. The therapy has shown promising results in clinical trials, offering the potential for a life free of blood transfusions. However, the high cost of gene therapies and uncertainties surrounding reimbursement have raised concerns about patient access and the financial viability of these treatments in Europe.
Thousands of Mainers face potential loss of healthcare access as the contract between Catholic health care system Covenant Health and insurer Anthem Blue Cross and Blue Shield expires. If the dispute is not resolved, about 14,000 patients may have to find new providers or switch insurance companies, leading to increased costs and potential disruptions in care. Anthem has encouraged its members to schedule appointments with alternative providers, while Covenant Health claims it has asked for modest rate increases to account for rising costs. Emergency care will not be affected.
BJC HealthCare and Saint Luke’s Health System have announced plans to merge assets to create an integrated Missouri-based healthcare system, aiming to improve access, affordability, and quality of care across the state. The merger is expected to expand patient access to healthcare services, increase access to tools and technology for healthcare teams, and address healthcare disparities in local communities. The hospitals hope to come to a definitive agreement by the end of 2023, with dual headquarters in St. Louis and Kansas City and keeping their current names.
