Managed Care - March 2008 - (Page B45) CONTINUING EDUCATION POST-TEST Biologic Therapy Management: The Need for Value-Based Health Benefits Models Please tear out the assessment/evaluation form on page 44. On the answer sheet, place an X through the box of the letter corresponding to the correct response for each question. There is only one correct answer to each question. 1. What is the fundamental purpose of health insurance? a. Protect the insured against a catastrophic health event. b. Maintain an acceptable health care level for the insured. c. Keep risk low for the insurer. d. Subsidize the health care of noninsured people. 2. According to The Zitter Group, the average cost share for biologics ($ copayment, % co-insurance) in late 2007 was: a. $44, 10%. b. $44, 22%. c. $88, 10%. d. $88, 22%. 3. Among payers and purchasers, a primary objection to randomized controlled clinical trials is that they: a. Have no real-world relevance. b. Lack methodological rigor. c. Are expensive to conduct. d. Answers a and c. 4. What did the Rand Health Insurance Experiment demonstrate? a. Patients will seek medical care regardless of cost. b. Demand for care is elastic: The less a family pays, the more services it uses. c. Cost sharing promotes the use of effective health services. d. Growth of health care expenditures stems from consumption of excess marginal care. 5. Studies document that high cost sharing reduces health care utilization. Which of the following is/are true? a. Reduced utilization has little effect on healthy people, but outcomes are poorer for those at higher medical risk. b. Cost-cutting techniques are counterintuitive when applied to drugs for which patients perceive a strong need. c. Drug copayments and coinsurance generally count toward out-of-pocket annual maximums, reducing concerns about access to biologics. d. All of the above. e. Answers a and b only. 6. True or false: A rigid focus on a single type of health care efficiency decribed by Aaron (2005) should have no measurable consequences on the overall efficiency of a biologics management strategy. a. True. b. False. 7. By 2013, the share of drug spending attributable to biologics will be: a. 1 percent. b. 25 percent. c. 37 percent. d. More than 50 percent. 8. Moral hazard refers to the insurance principle that says: a. People without health insurance endanger the lives of those who have it. b. People who have health insurance will use more health care services. c. People with health insurance will demand coverage of lifestyle drugs. d. The cost of employee health insurance is offset by lower wages. 9. Value-based benefit design holds that: a. Patients with chronic conditions should receive rebates for filling prescriptions. b. Patients with chronic conditions might be able to avoid expensive downstream care if medications are made available to them at little or no cost. c. Life-saving drugs should be placed on the lowest pharmacy tier and lifestyle drugs on the highest. d. Benefit plan design should mirror National Committee for Quality Assurance HEDIS recommendations. 10.Economic analyses are used to determine the value of a health care intervention: a. To assess which intervention would be the least costly to the insurer. b. To assess which intervention will be most clinically effective for the patient. c. To reconcile subjective or disparate determinations of an intervention’s value. d. So that an economic value can be applied to clinical trial results. 11.Molecular tests, also known as genetic tests: a. Have the potential to predetermine the clinical value of a biologic therapy. b. Could eventually reduce biologics’ research and development costs, and ultimately, cost to employers. c. Are widely supported by payers and employers. d. All of the above. e. Answers a and b. 12.In the first year it tried a value-based benefit design, Pitney Bowes saved in cost offsets: a. $500,000. b. $1 million. c. $5 million. d. Nothing; ER visits decreased but drug expenditures increased. 13.Nyman (2003) argues that an optimally designed insurance policy would: a. Use cost sharing to control inefficient moral hazard. b. Use cost sharing to control all moral hazard. c. Be based on moral hazard profiles for specific illnesses d. Answers a and c. e. Answers b and c. 14.Characteristics of a patient’s insurance coverage can influence distributional and medical efficiencies. Which of the following is true in that regard? a. Benefit design and financial incentives can promote prescribing of one biologic over another. b. Designating a preferred biologic promotes distributional efficiency. c. Benefit design and cost sharing are more important to distributional efficiency than to medical efficiency. d. Designating a preferred biologic promotes medical efficiency. 15.True or False: The top seven chronic conditions in the United States costs employers $100 billion annually. a. True. b. False. 16. Why is rheumatoid arthritis important to employers? a. It emerges during middle age. b. It leads to high rates of absenteeism and disability. c. It is associated with serious concomitant health conditions. d. All of the above. 17.On average, what share of a health plan’s members use specialty drugs? a. 1 to 3 percent. b. 1 to 5 percent. c. 5 to 10 percent. 18.An economic perspective of corporate health benefits holds that employers offer health insurance primarily to: a. Improve productivity. b. Keep wages low. c. Meet employee demand for health care. d. Compete in the marketplace. 19.By 2011, per-member, per-month (PMPM) spending for biologics is expected to be: a. $9.80. b. $3.00. c. $5.00. d. More than $9.80. 20.Why is adherence to a biologic treatment regimen important to efficiency? a. Plan designs that directly and indirectly promote adherence can yield medical and insurance efficiencies. b. A patient’s inability to follow a dosing regimen, administer a self-injectable, or take time from work for regular infusions can lead to medical inefficiency. c. Mode of administration is strongly linked to distributional efficiency, but the designation of preferred biologics based on their mode of administration may introduce barriers to adherence. d. All of the above. BIOLOGIC THERAPY MANAGEMENT 45
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