Study finds ‘substantial’ differences between older, younger patient groups
PARSIPPANY, N.J. — Lowering health costs will require a greater understanding of differences between two distinct groups of patients, according to a new study, which also noted a growing availability of specialty drugs for complex and chronic conditions outside the hospital.
The IMS Institute for Healthcare Informatics, part of IMS Health, said Tuesday that policy-makers, payers and healthcare industry players looking to reduce the growth in healthcare costs would have to understand the "substantial" differences in spending and utilization between patients younger than 65 years old with private insurance and those ages 65 years and older with Medicare.
"As states look to define their essential health benefits packages, a deeper understanding of actual utilization patterns, especially for the small number of patients driving the lion’s share of costs, is critical," institute executive director Murray Aitken said. "Further, effective benefits packages will need to fully consider services used by the three high-cost member segments — those with cancer, chronic conditions and those with autoimmune or other specialty diseases."
The study, titled "Healthcare Spending Among Privately Insured Individuals Under Age 65," found that those in the younger group would remain the dominant part of the payment system despite expected changes in the healthcare landscape brought about by the Affordable Care Act. Meanwhile, differences in variables, such as care setting and treatment use result in a different distribution of costs across inpatient, outpatient and pharmacy services. Among those in the younger segment, outpatient and inpatient services represented 59% and 20% of total spending, respectively, compared with 39% and 43% for those older than 65 years old.
Pharmacy spending represented 21% of overall health spending, with health plan members with chronic conditions filing 78% of all prescriptions and specialty drugs accounting for 17% of retail pharmacy spending. Overall, the report found, spending on specialty drugs accounted for 6% of all spending by health plan members, while pharmacy spending represented 33% of the total for members with autoimmune and other specialty conditions. The report noted that this reflected a growing availability of drugs for specialty conditions that could be administered outside the hospital.
The report also indicated that those in the younger group who were among the top 1% in annual spending were "vastly" disproportionate users of healthcare resources, spending an average of nearly $100,000 annually per member on health services, compared with the $3,837 per member spent by the overall plan population. Among members of this group, 77% were diagnosed with at least one chronic condition, while 16% had at least one cancer. The top 20% of members with the greatest need for healthcare services were responsible for more than 80% of total healthcare spending.
Study: More people show interest in weight loss
CHICAGO — The number of working people concerned about their weight is on the rise, according to a new study.
Results of a poll released Tuesday by ComPsych, a company that calls itself the world’s largest provider of employee assistance programs, indicated that 43% of employees cited weight loss as their primary health concern, a number that was 10% higher than in 2011.
"As individuals continue to grapple with weight problems, it’s no shock that weight management is again the top issue this year," ComPsych chairman and CEO Richard Chaifetz said. "With the impact that obesity and weight issues have on corporate healthcare costs, more and more employers are providing comprehensive wellness programs."
An additional 20% cited exercise as their primary health concern; 18% said stress; 10% said diet improvement; 5% said quitting smoking; and 1% cited other issues.
Report: Court OKs agreement between GSK, Apotex over generic Paxil CR
NEW YORK — GlaxoSmithKline can sell an authorized generic of its antidepressant drug to Toronto-based drug maker Apotex, a U.S. judge ruled.
According to a Bloomberg Businessweek report, U.S. District Court judge Joe Pisano ruled the agreement was valid.
In 2008, generic drug maker Mylan entered an agreement with GSK to launch a generic version of Paxil CR. In September 2010, Mylan obtained a temporary restraining order against Apotex when the latter launched its generic version of the drug. One month later, a U.S. District Court denied a motion for a preliminary injunction filed by Mylan to prevent Apotex from making a generic version of the antidepressant drug.
“The language plainly states that GSK may commence marketing and selling of authorized generic Paxil CR after Mylan’s two-year period of exclusivity,” Pisano ruled. “GSK did exactly that. It marketed and sold authorized generic Paxil CR to Apotex.”