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Community/Retail
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Article

May 11, 2016

Trending News Today: Insurers Push for Performance-Based Drug Cost

Author(s):

Laurie Toich, Assistant Editor

Top news of the day from across the healthcare landscape.

The cost for long-term care keeps increasing annually, as a private room in a nursing home comes close to costing $100,000 per year, a new study finds. The study also found that Americans are paying for care such as home health aides and assisted living communities, but adult day care costs decreased slightly over the last year, according to The Detroit News. Since Medicare does not cover long-term care, many people are forced to pay out-of-pocket or spend down their assets to qualify for Medicaid.

Many insurers are in favor of tying drug prices to outcomes for patients. Cigna Corp will receive extra discounts from drugmakers if new cholesterol medications do not lead to outcomes in patients that match the results of clinical trials or meet patient goals. The Wall Street Journal reported that health insurance and pharmacy-benefit managers have signed more than 12 deals like this with drugmakers since 2014.

Federal prosecutors have been investigating certain drugmakers’ contracts with pharmacy-benefit managers in order to see how these companies do business. Information on at least 3 companies, including Johnson & Johnson, Merck & Co, and Endo International PLC, have been requested, according to The Wall Street Journal. Johnson & Johnson said this demand was in connection with an investigation under the False Claims Act, which stops defrauding of the government.

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