Archive for September, 2012

Aetna Health Insurance Covers Prostate Cancer Drug

Saturday, September 29th, 2012

More prostate cancer patients will be receiving treatment with a newer cancer drug.  Previously, metastatic prostate cancer patients whose disease had spread to the brain or lungs were not able to receive Provenge.  Aetna health insurance did not pay for this course of treatment for patients whose cancer had spread to the brain, lungs, or liver.  They still don’t cover Provenge when patients’ cancer has spread to the liver, but have removed the exclusion for brain and lungs.  Toni Clarke’s Reuters story, “Aetna expands coverage of Dendreon drug; stock jumps,” says that the company who makes the drug has seen increasing stock prices because of this announcement.  Dendreon Corp.’s shares have increased ten percent.

Provenge was the first vaccine of its kind on the market when it was approved in April of 2010.  It is a personalized, therapeutic vaccine for cancer patients who have not responded to hormone therapy.  Unfortunately, the price tag of $93,000 per treatment coupled with physicians having trouble and confusion with reimbursement, hasn’t made it as popular as Dendreon thought it would be.  The company projected sales to be around $440 million in 2011, but they only saw around half of that.  Despite the controversy that Provenge has illicited, prostate cancer patients are hopeful that it will extend their life and improve the quality.  Initial clinical trials showed an increase of life expectancy of 4.1 months.  That increased survival time from 21.7 to 25.8 months.  With Aetna health insurance increasing the number of patients allowed to use Provenge, other insurers may follow suit to help cancer patients.

Compare Health Insurance if BREVAGen Risk is High

Monday, September 24th, 2012

BREVAGen is a new predictive risk test that could not only make a huge difference for health insurance, but also for the lives of women all over the world.  Primary Care Associates’ Dr. Lisa Steffensen is using this test to help her patients determine their risk of developing breast cancer that is not related to a familial tie.  This type of cancer is sometimes referred to as sporadic breast cancer.  The press release, “Primary Care Associates of Bellevue Pioneers Breast Cancer Risk Assessment,” is in Yahoo!’s Finance section today.  Dr. Steffensen says that by using this test, it allows her practice to treat patients in a way that will minimize their risk and hopefully save many more lives than without the use of BREVAGen.

This predictive risk test has been clinically validated to help predict sporadic, estrogen-positive breast cancer risk.  Some of the factors used in determining patients’ risk are their lifetime exposure to estrogen along with scientific markers to predict both a five-year and lifetime risk of developing this type of breast cancer.  BREVAGen uses an oral swab, which is sent to a CLIA-certified laboratory.  They study seven genetic markers and determine your risk factor based on those markers and other medical history.  Some of the medical history studied includes race, ethnicity, the age you first gave birth, your current age, your reproductive history and more.

Health insurance companies could garner some valuable information if BREVAGen becomes a widely used risk assessment measure.  They could lower health insurance rates for those with lower risk factors and offer additional health screenings and preventative care for those with higher risk factors.  The law ensures that Americans will not be denied health insurance coverage for pre-existing conditions, but a high risk factor may force people to compare health insurance rates if some companies use BREVAGen results to charge higher rates.  Primary Care Associates says that BREVAGen has been proven better at determining breast cancer risk than only using the Gail score.  They also say that it follows the guidelines for prevention and early detection given by the American Cancer Society and other non-profit cancer groups.

Republican States Hide Health Insurance Exchange Work

Monday, September 17th, 2012

It’s a tough time to be a Republican insurance commissioner right now, especially in a conservative state like Mississippi.  On one hand, the law is mandating that individual states show they will be able to run their own health insurance exchanges by November 16.  But with the Presidential election coming on November 6, some Republican party leaders are hopeful that the mandatory health insurance exchanges will go away if Mitt Romney defeats President Obama in the election.  By waiting to prepare a state health insurance exchange, insurance commissioners run the risk of Republicans losing the Presidential election and them running out of time to set up their exchanges.  If that happens, the federal government will run their exchange for them, which Mississippi’s commissioner does not think is in the best interest of his state.

Reuters’ Anna Yukhananov talked about the tough spot some commissioners are in in the article “U.S. state officials in stealth mode on health exchanges.”  Insurance commissioners in Republican run states have almost been forced to hide the work they are doing to prepare state health insurance exchanges because of pressure from Republican governors and other officials.  Some say that doing any work to follow the law of the Affordable Care Act somehow makes it more legitimate and they urge commissioners to force the federal government to run the exchanges themselves in hopes that they won’t be able to maintain the stipulations of the Act.  Mississippi’s Insurance Commissioner is under pressure from many organizations and political leaders not to organize an exchange, but he thinks it is better run by him than by the federal government in the case that the mandate is not repealed.

January of 2014 is the deadline for states to start running their health insurance exchanges, a mandate which hopes to help insure 16 million Americans that previously had no health insurance policies.  Thirteen states have committed to running their own exchange and seven states have said no way.  The remaining thirty states range from a loose commitment to establishing an exchange to the majority of Republican run states who have people working behind the scenes on their programs just in case they need them.  Insurance companies like Wellpoint, UnitedHealth, and Aetna health insurance would much rather see states run the program than the federal government because they know more of what is important locally.  While those in Republican states are under immense pressure not to conform to rules from the Affordable Care Act, many people don’t actually think Mitt Romney would get rid of the health insurance exchanges if elected.  It seems like it’s in the best interest of every state to at least have a plan, just in case.

Maine Allows Insurers to Increase Health Insurance Rates

Tuesday, September 4th, 2012

There’s an ongoing debate over whether more or less regulation of the health insurance industry will help to lower customers’ premiums.  The Boston Globe published Julie Appleby of Kaiser Health News’ article, “Loosening health insurance rules in Maine has produced mixed results after 6 months.”  Last year, health insurance regulations in Maine changed in an attempt to reverse the fact that they have some of the highest health insurance premiums in the United States.  The promises given to Maine residents with this legislation were that everyone’s premiums would decrease and that more health insurance companies would enter the market to increase competition.  After six months, a little bit has changed, but not much.

No new health insurance companies have entered into Maine’s marketplace, hopefully some will with more time, but they haven’t yet.  And while people under the age of 40 did see lower health insurance rates across the board, older people mostly saw rate increases.  About half of individuals saw health insurance increases averaging 1.7%, but as high as 18%.  An insurance consultant said that regulations are not about lowering overall premiums, but making insurance premiums more fair.  This tends to lower rates for the young and increase rates for the old, since health insurance costs tend to increase the older people get.

Maine’s regulators made three large changes six months ago.  They allowed insurers more freedom to vary premiums, gave them the ability to issue rate increases of less than 10% without state approval, and made a “reinsurance” fund that is meant to protect insurers from the costliest medical bills.  Anthem Blue Cross and Blue Shield, the top insurer in Maine, increased the rates of 54% of their policyholders.  They do have 3.5 times more clients over the age of 55 than they do under the age of 40.  Around 10% of small businesses saw their rates go down compared to 3% before the changes, but that means that 90% did not.  Some experts do believe that even those who saw rate increases had lower increases than they would have before Maine’s new regulations.

Many of the new regulations in Maine mimic changes that are likely to occur soon from the Affordable Care Act.  There is a good chance that we will see some similar results nationally, but there will be help in the form of subsidies to help some people pay for their health insurance costs.  Six months is too soon to make a declaration of success or failure with this program, but we’ll continue to watch it closely.