Top news of the day from across the health care landscape.
A new federal pilot program will require individuals who sign up for an insurance policy on healthcare.gov after the annual open enrollment period closes on January 31, 2017, to submit documentation verifying eligibility for special enrollment periods before coverage begins. Health insurance stakeholders have been in agreement regarding the necessity of special enrollment periods for people who have major life changes, such as loss of employment or having children, according to Kaiser Health News. However, many insurers argue that customers abuse these programs, waiting to sign up once they are sick and need pricey care, according to the report. A study commissioned by America’s Health Insurance Plans and the Blue Cross Blue Shield Association revealed that monthly health insurance claims for those who enrolled in coverage under a special enrollment period in 2015 was 41% higher during the first 3 months of coverage compared with individuals who signed up during regular open enrollment. Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities told Kaiser, “we reject the idea of widespread abuse [of special enrollment periods], and that the evidence of costs is evidence of abuse.”
Tens of millions Americans who are unable to afford high-priced drugs are buying medications outside of the United States, Kaiser Health News reported. In a poll conducted in November by the Kaiser Family Foundation, 8% of respondents said they, or someone in their household, had imported a drug at some point. This figure translates to about 19 million adults in the United States, based on current Census population estimates, according to Kaiser. In the poll, individuals who had imported medications ranged from college-aged students in their 20s to retirees in their 80s. Although 8% seems low, it is still far higher than surveys conducted by government interviews, which suggested the figure was about 2% in 2011. The internet has given Americans easy access to buy prescriptions abroad, often times from disreputable sources. The FDA has cautioned that many online pharmacies are not what they seem, and that some medications could be inferior, expired, or counterfeit. Still, a large proportion of prescription drugs purchased outside the country cost half or less than the price of the product in the United States.
GlaxoSmithKline PLC’s ViiV Healthcare reported positive phase 3 trial results for a dual HIV drug regimen, according to The Wall Street Journal. The results further support the company’s audacious bet that it could shift AIDS treatment orthodoxy away from 3-drug combinations, the Journal reported. The HIV pill, dolutegravir plus rilpivirine, suppressed the virus as well as traditional 3- or 4-drug combinations in a pair of identical, yearlong clinical trials, which each involved about 500 patients, according to the study.