The Daily Rise: Wednesday, March 30

Assembly Bill 533: Better Billing in California

This week’s “State Spotlight” shines on legislation in California that would put an end to insurance companies’ bait-and-switch billing practices.

Assembly Bill 533 would ban insurance companies from adding additional fees to patients’ bills as long as they stay within their network. Right now, some patients are hit with additional fees when, unbeknownst to them, out-of-network doctors are brought in for a treatment.

“The new law would allow the health plan to pay these doctors based on rates approved for the federal Medicare program. An independent appeals board would settle any disputes,” Daniel Weintraub, editor of the California Health Report, writes in an opinion piece featured at the Sacramento Bee. “Insurers try to drive down costs so they can offer consumers cheaper premiums, but the plans have to offer doctors high enough fees to entice them to join their networks.”

Whose Value?

Robert Rubin of Health Affairs Blog asks the right questions about value pricing: Whose Value? What Price?

“If we decide that value pricing is the right way to encourage pharmaceutical innovation while ensuring access to innovative drugs for our patients, then there are many policies we can employ,” Rubin argues. “Even a small difference in the subjective analysis can make a large difference in the estimated “value” of a drug”.

All value pricing tools are inherently subjective and make assumptions about the value provided. That’s because we value things differently.

“The methodology should be transparent and replicable,” Rubin points out. “We should not be arguing about numbers but we should be discussing the implication of various numbers in developing a cost effectiveness analysis.”

National Doctors’ Day 2016

Today is National Doctors’ Day and in honor of all the great doctors out there, our Executive Director, Terry Wilcox highlights her doctor and why he was so special to her.

She says a great doctor is one who often suffers in silence with you, holding you up and helping you navigate when things are not going as well. When the pregnancy does not take again, when the cancer comes back, when the infection gets worse … when you might not walk again, or run again, or see again. A great doctor is one who looks at you and says this is where we are, let’s work together to get through this. A great doctor gives you all the options and follows your lead, often carrying you through the rough patches and cheering you on through the smooth ones. They commit to being with you to the end — whatever the end of your journey happens to be.

Happy National Doctors’ Day to all the great ones.  We thank you.

One Step Closer Drug

Matthew Perrone of the Associated Press shares good news for patients with Parkinson’s disease. An experimental drug to treat psychotic delusions and behaviors moved one step closer to approval.

“The panel of Food and Drug Administration advisers voted 12-2 Tuesday that the benefits of the drug from Acadia Pharmaceuticals outweigh the risks,” Perrone reports. “That vote — considered a recommendation for approval — is non-binding, though the FDA often follows the advice of its panelists.”

As many as half of Parkinson’s patients suffer from the psychotic problems, but “there are no FDA-approved drugs currently available for the condition.” Let’s hope Acadia Pharmaceuticals Inc. gains FDA approval for pimavanserin and that the treatment works to treat hallucinations experienced by patients with Parkinson’s disease.

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