Read today’s Kaiser Health News
Also, from The KFF: KFF’s Health Policy 101: An excellent, up-to-date, free e-book on health policy covering many areas of the field.
In other news:
UK government mulls raising NICE cost-effectiveness threshold:According to media reports on Wednesday, the formula used by the National Institute for Health and Care Excellence (NICE) to determine the cost-effectiveness of drugs is up for review. The body currently deems a medicine worthy of NHS reimbursement if it costs less than £20,000 ($26,798) to £30,000 ($40,198) per quality-adjusted life year (QALY) it delivers.
About health insurance/insurers
Medicare Proposal Would Boost Primary Care Doc Pay, Offer Surgeons Less: Through a proposed rule on physician fees for 2026, the Centers for Medicare and Medicaid Services has signaled its intent to shift resources toward primary care and away from procedures and tests.
In the first step toward transforming how physicians are paid, Medicare has proposed reducing payments for procedures, surgery, and medical tests by 2.5%, contending that physicians have become more efficient at providing these services and no longer need as much time to perform them.
Court ruling allows Medicare to negotiate prices for larger number of drugs: A federal appeals court unanimously rejected a Novo Nordisk challenge to Medicare’s drug price negotiation program, a ruling that will allow the government to lump together products with the same ingredient for the purpose of choosing drugs for negotiation.
About pharma
Biosimilar Uptake Remains Uneven Across Molecules: IQVIA data show that biosimilars launched to date account for 24% of competitive molecule volume overall. But adoption rates by molecule tell a story of stark contrasts. “Three years after launch, insulin lispro biosimilars captured just 8% of the market, [and] infliximab 13%,” Mr. Biggs reported. “At the other end of the spectrum, bevacizumab [Avastin, Genentech] and trastuzumab [Herceptin, Genentech] are at 82% and 80%, respectively. It’s the same regulatory pathway, but very different adoption curves.”
About healthcare personnel
PHYSICIAN CONSOLIDATION IS GROWING, DRIVING UP COSTS: KEY TAKEAWAYS
Nearly half of physicians were employed by or affiliated with hospitals in 2024, up from less than 30% in 2012, GAO’s research found.
Consolidation most often drives higher spending and prices, especially when hospitals acquire physician practices.
Evidence on quality and access is limited, though stakeholders warn consolidation may reduce competition and weaken independent practices.
See the full GAO report.