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Rx can help rein in nation’s health costs

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Rx can help rein in nation’s health costs

Health insurance companies are in the midst of negotiating with regulators about the size of premium increases for 2017, and early indications are that consumers and other payers won’t be happy with the results. A new analysis by the Kaiser Family Foundation examines rates for the first and second lowest-cost Silver options, the most commonly purchased plans under the Affordable Care Act, in urban centers in 13 states and the District of Columbia. While the proposed premiums vary widely from city to city — in some instances, they would actually fall — and are subject to change, the study concludes that rates for the second lowest-cost Silver coverage will rise 10% next year, twice the increase in 2016.

MMR OpinionButtressed by reports from other sources, the Kaiser study points to the ACA’s failure to achieve one of its primary objectives — reduce the annual growth in health care spending to a tolerable level. If health care premiums do indeed rise by 10% next year, that rate would be five times higher than the annual economic growth expected by the Federal Reserve over the next three years. Already accounting for nearly 18% of GDP, health care spending can’t be allowed to continue to advance significantly faster than the economy as a whole without serious consequences.

In fairness, the growth rate in health care spending has, at least until now, moderated under the reform measures advocated by President Obama. But whether the ACA or a weak economy in the wake of the financial crisis of 2008 is the primary reason for the slowdown remains an open question.

There’s clearly a lot of work to do to put the health care system on a sustainable course. Provisions included in Obamacare are designed to get the ball rolling, but in the end private sector initiatives may prove more decisive. CVS Health is one of the companies embracing the challenge. Speaking at the American Health Insurance Plans Institute and Expo earlier this month, CVS president and chief executive officer Larry Merlo talked about the challenge.

“Between now and 2030, the cumulative cost of chronic illness is projected to grow to $42 trillion and, despite all efforts to encourage Americans to live healthier lifestyles, we don’t seem to be gaining ground,” he noted. “I believe the way to find solutions is to look at the problems through the eyes of your customers, and at CVS Health we are working to do just that by collaborating with stakeholders across the health care continuum to provide better, more cost-effective care.”

As the most accessible health care providers in the U.S., community pharmacies are well suited for the task. Like CVS, the other top pharmacy operators — Walgreens Boots Alliance, Walmart, Rite Aid and Kroger — are enhancing their capabilities with immunization programs, in-store clinics and diagnostic testing, as well as teaming up with other health care professionals. Even independent pharmacies, with the pivotal support of the big pharmaceutical distributors, are raising the level of their game to help patients get and stay well.

Cost pressures, the shortage of primary care physicians and the consistently high level of trust that pharmacists maintain among patients could make this a golden age for the profession. The arrival of that era is contingent on industry advocates securing the support of policy makers and payers who can ensure that the reimbursement model evolves to reflect pharmacy’s expanding horizons. Only then will the profession be able to realize its full potential to help patients and rein in health care costs.


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