New Congress bill - impact on ophtho?

[ophtho838]

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For those of you who understand the economics of medicine/insurance better than I do: what effect, if any, will the new climate bill (and the healthcare portion of it) have on ophthalmology? Specifically, I’m asking about the ability of medicare to negotiate drug prices. I am guessing there will be some sort of impact on intravitreal injections.

 

[Trefoil]

For those of you who understand the economics of medicine/insurance better than I do: what effect, if any, will the new climate bill (and the healthcare portion of it) have on ophthalmology? Specifically, I’m asking about the ability of medicare to negotiate drug prices. I am guessing there will be some sort of impact on intravitreal injections.

I might be somewhat naive on these matters, but the actual cost of Eylea for instance probably will not change the value of the injection to the practice. The practice is charging for the procedure, the OCT, and the exam. The cost of the medication will mostly have an impact on pharmaceutical companies. In theory, that could change the profitability of manufacturing certain medications, which may lead to companies discontinuing certain products, but I think that is more theoretical.

Edit: When people talk about cutting reimbursement for injections, they are talking about the procedure itself.

 

[Dusn]

The VA has always negotiated the cost of eylea and lucentis and pays about ~$1100 per vial vs $2000 for Medicare and private insurance. The VA pays about $10 for brand-name durezol. And the VA negotiated those prices before there was any competition - now there are more options.

So I suspect they should be able to lower the prices, which I think is a good thing for keeping Medicare and our reimbursements solvent in the long run.

We also need to store more and more drugs in our office as new drugs and bio similars are coming on the market. Lower drug prices would help with the inventory cost and mitigate the financial risk if a drug goes unused.

This is long overdue. Should have been passed decades ago.

 

[TheLesPaul]

For practices that buy and store medicines, insurers will pay a % of the cost of the medicine to cover storage and handling. If you are having $1000s of intravitreals in stock and the price is 50% of what it was, then you will take a hit on that income. But in the long run, better for Medicare and better for everyone.

 

[dantt]

Credit card points lol

 

[MstaKing10]

From a practice standpoint, it will probably be a net zero change. Especially with new agents and biosimilars coming on the market there will be more competition, and companies will have to sweeten the pot at a practice level or lobby hard at the insurance level to get their agents as first line.

For medicare will help to reduce costs but there are many other places to look for cost cutting so will see how it all pans out financialy long term.

 

[Slide]

For practices that buy and store medicines, insurers will pay a % of the cost of the medicine to cover storage and handling. If you are having $1000s of intravitreals in stock and the price is 50% of what it was, then you will take a hit on that income. But in the long run, better for Medicare and better for everyone.

In theory yes, it’s a lower %, but really we don’t ever consider that in the grand scheme of things. One nonpayment or denial wipes away whatever margin you get from it and then some. Having a lower cost I think is better for all short and long term. Especially since the alternative would be looking at our visit/surgery reimbursement.