Headlines about "Health plan costs - prescription drugs"
Gathered from the web by the editors at BenefitsLink.com.
Patients Suffer As Care, Coverage Limits Collide; Physicians Say Insurers Intrude on Treatment
Excerpt: "Increasing healthcare costs and an influx of expensive drugs and tests, combined with an aging population, set off a healthcare crisis in the United States. Contending with soaring costs, insurers changed the business of health care by requiring preauthorizations, mandating cheaper drugs, and tightening controls on treatment decisions. But among the first casualties of these changes, many physicians said, was the doctor-patient relationship." (Toledo Blade)
The Medicare Part D Coverage Gap: Costs and Consequences in 2007
Excerpt: "This study quantifies, for the first time, the number of Medicare Part D plan enrollees in 2007 who reached a gap in their prescription drug coverage known as the 'doughnut hole,' as well as the changes in beneficiaries' use of medications and out-of-pocket spending after they reached that gap. The analysis excludes beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan." (Kaiser Family Foundation)
[Opinion] Maximum Coverage As Defined by Anthem Blue Cross
Excerpt: "Letter From: Anthem Blue Cross, Oxnard, California . . . Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. . . . What's this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system." (Physicians for a National Health Program)
Medicare Drug Plan Monthly Premiums Up About 12% for 2009
Excerpt: "The typical Medicare beneficiary can expect to see about a $3 increase in their monthly premiums for prescription drug coverage in 2009, federal officials said Thursday. Officials made the projection based on bids from private insurers that get the premiums along with a federal subsidy to administer the benefit. The increase of 12% will up the monthly premium to $28 for standard drug coverage." (USA TODAY)
Drug Therapy Often Trumps Angioplasty, Study Finds
Excerpt: "The slim early advantage for angioplasty at relieving pain in these nonemergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study. That is sooner than the five years doctors estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. Results are in today's New England Journal of Medicine." (San Francisco Chronicle)
Employers Count on Workers to Help Control Pharmacy Benefit Costs
Excerpt: "The success of pharmacy benefit cost management strategies cited by respondents to a survey from Buck Consultants will depend largely in part on employee involvement." (PLANSPONSOR.com; free registration required)
Prices for Some Drugs Skyrocket
Excerpt: "Drug companies are quietly pushing through price hikes of 100% -- or even more than 1,000% -- for a very small but growing number of prescription drugs, helping to drive up costs for insurers, patients and government programs." (USA TODAY)
GM Benefits to Cost Salaried Employees More
Excerpt: "General Motors Corp. salaried employees learned Friday morning that dental and vision coverage will be more expensive next year and that prescription drug co-pays also will increase. The benefit cost increases are part of GM's plan, announced July 16, to conserve and raise $15 billion as the world's largest automaker deals with plunging sales due to a weak U.S. economy and dramatically changing vehicle preferences." (Detroit Free Press)
Kucinich Introduces Legislation That Seeks To Lower Prescription Drug Costs by Replacing Medicare Part D
Excerpt: "Rep. Dennis Kucinich (D-Ohio) recently introduced a bill (HR 6800) that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries." (Kaiser Family Foundation)
[Guidance Overview] Medicare Part D Creditable Coverage Notices Are Updated
Excerpt: "[The Centers for Medicare & Medicaid Services' three Model Notices are revised primarily to reflect formatting and organization changes. Substantive changes appear minor but include: Re-Enrollment: Definitive disclosure of whether the individual can re-enroll in the plan after dropping coverage. Medicare Special Enrollment Period: Clarification that the special enrollment period for enrollment in Medicare Part D is 2 months (rather than 60 days) after loss of Creditable Coverage." (Deloitte via BenefitsLink.com)
Prescription Data Used To Assess Consumers, Aid Insurers
Excerpt: "Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health 'credit report' drawn from databases containing prescription drug records on more than 200 million Americans." (The Washington Post; free registration required)
Incentives to Switch from Prescription to Over-the-Counter Drugs Can Produce Large Savings for Members and Plans Alike
Excerpt: "WellPoint NextRx and Blue Cross & Blue Shield of Rhode Island (BCBSRI) recently ended a year-long pilot program that offered OTC allergy drugs at no charge to members. Other health plans and PBMs say they too are eyeing programs that can move members to lower-cost OTC drugs when appropriate." (AISHealth.com)
2009 Retiree Drug Subsidy Application Deadline Is Near
Excerpt: "Retiree medical plan sponsors that want to receive the Medicare Part D retiree drug subsidy (RDS) for the 2009 calendar year should begin the application process now. Calendar-year plans must apply for the 2009 RDS by Oct. 2, 2008 -- 90 days before the start of the plan year for which the subsidy is sought. The RDS requires a new application for each plan year, even if a sponsor previously received the subsidy. Applications that fail to include a new actuarial attestation, signed plan sponsor agreement and list of qualifying covered retirees will be denied." (Mercer LLC)
[Guidance Overview] CMS Posts Spanish-Language Versions of Model Disclosure Notices for Medicare Part D Eligible Individuals
Excerpt: "CMS officials have informally indicated that the Medicare Part D rules do not require group health plan sponsors to provide the disclosure notices in languages other than English. Nevertheless, sponsors of plans with participants who speak Spanish may find the Spanish-language versions of the notices to be useful in educating portions of their workforce about Medicare Part D." (Employee Benefits Institute of America)
Medicare Part D a Boon for Drug Companies, House Report Says
Excerpt: "U.S. drug manufacturers are reaping a windfall from taxpayers because Medicare's privately administered prescription drug benefit program pays more than other government programs for the same medicines, a House committee charged in a report Thursday." (Los Angeles Times)
Health Officials Back the Move Away from Handwritten Doctors' Prescriptions
Excerpt: "The widespread adoption of electronic prescribing is expected to save taxpayers as much as $156 million over the next five years and save lives, Health and Human Services Secretary Michael Leavitt said Monday." (AP via Chicago Tribune)
Demand Grows for Value-Based Rx Plans; As Insurers Expand Offerings, ROI Is Elusive
Excerpt: "Pharmaceutical payers are expressing increased interest in adopting value-based insurance designs, according to health plans and other stakeholders involved in the VBID concept. As insurers roll out new VBID offerings to meet the growing demand, some pharmacy executives acknowledge that hard data demonstrating a return on investment (ROI) remain elusive." (AISHealth.com)
Health Plans Urged to Demand More from Specialty Pharmacies in Therapy Management
Excerpt: "[Medication therapy management] programs, also referred to as specialty therapy management (STM) programs when applied to specialty drugs, focus on meeting primary objectives and producing superior outcomes for patients." (AISHealth.com)
Total U.S. Prescriptions Drop as Consumers' Health Care Costs Rise
Excerpt: "The Wall Street Journal on Wednesday examined how U.S. prescription drug volume has 'fallen steadily' since early 2007 and in recent months have 'slipped in and out of negative territory' because of a 'troubled economy and the growing burden of out-of-pocket health care costs.'" (Kaiser Family Foundation)
Building a Value-Based Health Benefit Culture - Manatee County, FL As an Example
Excerpt: "Manatee County's Your Choice medical and drug benefit plan designs offer strong financial incentives for healthy behaviors and cost-effective decision making. The medical benefit offers three levels of cost sharing linked to health management activities. Employees and insured family members qualify for the Basic, Better or Best cost-sharing options based on their participation in health screenings, wellness programs and condition management programs." (Pharmacy Benefit Management Institute, LP)
[Guidance Overview] Updated Medicare Part D Notices (PDF)
1 page. Excerpt: "The Center for Medicare and Medicaid Services ('CMS') recently updated the model notices required under Medicare Part D, including the model notices of creditable and non-creditable coverage. For any notice of creditable or non-creditable coverage provided after June 15, 2008, plan sponsors should utilize these updated notices." (Haynes and Boone, LLP)
Creative Pairing of HSAs with Other Benefits Can Result in Synergies That Deliver Better Benefits and Coverages
Excerpt: "In the early days of HSAs, employers were trying to get their bearings in order to understand – and then utilize – this new savings vehicle. Now, a solid group of HSA devotees has begun pairing other products and programs with HSAs so employees can better maximize the advantages inherent in these plans. These pairings must take into account that HSA-eligible individuals must be covered by a high deductible health plan that meets IRS criteria and can have no other coverage that pays benefits before the IRS-established minimum deductible has been met." (Warner Norcross & Judd LLP)
[Guidance Overview] CMS Issues Updated Disclosure Notices to Medicare Part D Eligible Individuals for Use After June 15, 2008
Excerpt: "The changes should make the model notices more accessible and easier for individuals to understand. Employers using the model disclosure notices will need to replace them with the updated versions. Those using customized versions of the notices should look at the updated model notices to see if any of the changes should be incorporated." (Employee Benefits Institute of America)
Segal Medicare Part D Survey of Multiemployer Health Funds (PDF)
2 pages. Excerpt: "The survey found that most multiemployer health funds continue to take the Retiree Drug Subsidy (RDS). We expect that will change in the coming years as RDS administration becomes increasingly challenging for plan sponsors." (The Segal Group, Inc.)
[Opinion] Bad Medicine, Under Guise of Helpfulness, Big Pharma Wants Your Confidential Medical Records
Excerpt: "[A California] bill, SB 1096, was sponsored by Sen. Ron Calderon (D-Montebello) and would have allowed pharmacies to sell patients' prescription and medical information to third-party entities -- including Adheris, Inc., the bill's main business backer. The ostensible goal behind the bill was to allow Adheris and other similar marketing companies to mail 'reminder' notices to patients so they wouldn't forget to take their medication." (San Francisco Bay Guardian via Consumer Watchdog)
More Than 500 Backlogged Whistle-Blower Cases Allege Health Care, Drug Company Fraud
Excerpt: "Whistle-blower lawsuits alleging that pharmaceutical companies and government contractors defrauded the federal government have created a backlog of more than 900 cases at the Department of Justice, the Washington Post reports. According to the Post, more than 500 of the cases involve the health care and pharmaceutical industries, as well as Medicare and Medicaid." (Kaiser Family Foundation)
Medication Managers and Drug Stores Merge Networks
Excerpt: "The drug store and pharmacy benefit management industries on Tuesday will announce a combination of their information systems in order to boost electronic prescribing by physicians." (AP via The New York Times; free registration required)
Study Will Provide Cash Payments To Encourage People With Chronic Diseases To Take Medications
Excerpt: "The Hartford Courant on Sunday examined a new lottery-like program that offers patients a chance at winning daily cash prizes of $10 or $100 if they promptly take their prescription medications." (Kaiser Family Foundation)
[Guidance Overview] Centers for Medicare & Medicaid Services Issues Additional Guidance on Rebate Adjustments for the Retiree Drug Subsidy Program (PDF)
2 pages. Excerpt: "Recent CMS guidance clarifies that the requirement that plan sponsors report rebates retained by a Pharmacy Benefit Manager applies only to RDS applications with plan years starting on or after January 1, 2007." (Buck Consultants)
Aetna Fights Drug Duplication
Excerpt: "Aetna announced it has expanded its therapeutic duplication program after it achieved a 70% reduction in members who receive multiple prescriptions for the same ailment." (PLANSPONSOR.com; free registration required)
Safeway Launches Generic Prescription Drug Discount Program in Eastern U.S.
Excerpt: "Safeway on Wednesday launched a generic prescription drug discount program at stores in the eastern U.S. and the Chicago area, according to company spokesperson Greg TenEyck, the Washington Post reports." (Kaiser Family Foundation)
Increasing Transparency in the Pricing of Health Care Services and Pharmaceuticals (PDF)
8 pages. Excerpt: "This brief explores whether increased transparency about prices for specific health care services and pharmaceuticals would help to temper the rapid growth in costs. The answer is unclear because evidence can be marshaled on both sides of the issue." (U.S. Congressional Budget Office)
Increasing Transparency in the Pricing of Health Care Services and Pharmaceuticals (PDF)
8 pages. Excerpt: "Questions about transparency in health care costs extend beyond the prices for specific services and pharmaceuticals. Workers pay for employment-based health insurance through reduced take-home pay, but those costs may not be evident to many of them. A greater awareness of the total costs of health care and who ultimately bears them might generate increased demand for efficiency in that sector." (U.S. Congressional Budget Office)
ERIC Writes to Congress about Benefits of e-Prescribing
Excerpt: "ERIC was one of 20 organizations that signed an educational letter to key House and Senate committee leaders about the benefits of e-prescribing in terms of safety and efficiency for physicians, pharmacists, and patients. The letter sought to dispel the notion that the U.S. healthcare system lacks uniform or complete e-prescribing standards, or that those standards have yet to be adopted broadly by physician technology vendors." (The ERISA Industry Committee)
PBMs Allegedly Manipulate Definition of 'Brand' and 'Generic' Rx at Payers' Expense
Excerpt: "By miscategorizing drugs . . . PBMs achieve a number of financial aims. These include charging brand prices for generic products, retaining rebates for brand drugs by calling them generics, and misstating a health plan's generic drug utilization rate." (AISHealth.com)
Health Plans, PBMs Consider Strategies for Increasing Health Literacy of Their Members
Excerpt: "Nearly half all U.S. adults lack the 'health literacy' skills necessary to understand and act on basic health information - a problem that costs pharmaceutical payers billions of dollars annually on misused medications and contributes to roughly 1.5 million adverse drug events every year, experts say." (AISHealth.com)
Member Education Vital for Managing Costs and Compliance for Specialty Pharmaceuticals
Excerpt: "With a wave of new biologic drugs expected soon to hit the market, some health plans and pharmaceutical payers are seeking ways to ensure that members know exactly how to take these expensive therapies -- and not waste millions of dollars on unused product or avoidable emergency-room visits." (AISHealth.com)
New York Governor Proposes Legislation Aimed at Rx Drug Makers and PBMs
Excerpt: "Gov. David A. Paterson (D) this month proposed a bill limiting the value of gifts that drug makers could give to providers, and requiring PBMs to disclose specific information to health plans, physicians and patients." (AISHealth.com)
U.S. FTC Reports 14 Deals to Delay Sales of Generics in '07
Excerpt: "The FTC considers the controversial deals a violation of antitrust law but the courts have split on whether they are legal." (Reuters)
Report Cites 15 New York State HMOs for Setting Consumer Restrictions on Prescription Drugs To Boost Profits
Excerpt: "Some HMOs in New York state are restricting patients' access to so-called single-source drugs, brand-name medications for specific ailments that do not have lower-cost generic versions, according to a report released on Sunday, the New York Daily News reports." (Kaiser Family Foundation)
Biologic Therapy Management: The Need For Value-Based Health Benefits Models (PDF)
48 pages. Excerpt: "The emergence of biologic therapies [also known as biopharmaceuticals and specialty drugs] is straining traditional models of health insurance and health care financing . . . . For payers and purchasers, the cost of biologics is provoking benefit design changes that include significant cost shifting to patients and attempts to control or limit the cost of these therapeutics to the plan or plan sponsor." (Managed Care)
Most Americans Are Taking Prescription Medications for Chronic Health Problems
Excerpt: "For the first time, it appears that more than half of all insured Americans are taking prescription medicines regularly for chronic health problems, a study shows. The most widely used drugs are those to lower high blood pressure and cholesterol -- problems often linked to heart disease, obesity and diabetes." (AP via Washington Post; free registration required)
[Opinion] Kaiser Family Foundation's Testimony -- Public Views on Direct-to-Consumer Prescription Drug Advertising
Excerpt: "Mollyann Brodie, Kaiser vice president and director of Public Opinion and Media Research, testified before the House Energy and Commerce Subcommittee on Oversight and Investigations about the public's views of prescription drugs, the pharmaceutical industry, and direct-to-consumer drug advertising. Brodie's testimony was a part of the hearing titled, 'Direct-to-Consumer Advertising: Marketing, Education, or Deception?'" (Kaiser Family Foundation)
Incentives for Patients to Switch From Prescription to Over-the-Counter Drugs Can Produce Large Savings for Members and Plans Alike
Excerpt: "A program that incentivized patients to switch from prescription drugs to over-the-counter (OTC) alternatives saved members thousands of dollars and provided the insurer with a solid return on investment (ROI), according to the PBM and health plan responsible for the initiative." (Drug Benefit News via AISHealth.com)
Health Plan Participants: Think Generic and Save
Excerpt: "Switching to generic drugs could save you up to 80 percent per prescription. Thanks to a tidal wave of brand-name drugs losing patent protection, more generics are available than ever before. . . . Switching to a generic on some company health plans could save you $30 in a snap on the co-payment." (Kiplinger via Washington Post; free registration required)
[Opinion] Congress Should Impose a 3-Year Moratorium on Ads for New Drugs
Excerpt: "Congress should require drug companies to wait three years after approval to advertise new prescription drugs to consumers, says Consumers Union, the non-profit publisher of Consumer Reports magazine. In a letter sent to the House Energy and Commerce Subcommittee on Oversight and Investigations, the group also calls on Congress to provide adequate funding for FDA review and enforcement of false or misleading ads, and to require that all drug ads on TV list a toll free 1-800 number and website so consumers can report serious adverse events to the Food and Drug Administration." (Consumers Union)
Drug Company Executives Respond to Concerns About Ads at House Panel Hearing
Excerpt: "During a hearing of the House Energy and Commerce Committee Oversight Subcommittee on Thursday, executives from Johnson & Johnson, Pfizer and a joint-venture between Merck and Schering-Plough defended TV prescription drug advertisements that lawmakers have claimed potentially misled consumers, the AP/Houston Chronicle reports." (KaiserNetwork.org)
[Guidance Overview] CMS Final Medicare Part D Regulations Affect Retiree Drug Subsidy (PDF)
3 pages. Excerpt: "CMS recently issued final regulations that make policy clarifications and technical corrections to its earlier final regulations on Medicare Part D. The regulations contain provisions affecting the retiree drug subsidy program, including clarification of rules regarding the timing of applications for the subsidy, submission of actuarial attestations upon a material change and changes to the rules for determining actuarial equivalence." (Buck Consultants)
Testimony: Trends in FDA's Oversight of Direct-to-Consumer Advertising of Prescription Drugs (PDF)
19 pages. Excerpt: "GAO was asked to discuss trends in FDA's oversight of DTC advertising and the actions FDA has taken when it identifies violations. This statement is based on GAO's 2006 report, Prescription Drugs: Improvements Needed in FDA's Oversight of Direct-to-Consumer Advertising, GAO-07-54 (November 16, 2006). In this statement, GAO discusses the (1) DTC advertising materials FDA reviews, (2) FDA's process for issuing regulatory letters citing DTC advertising materials and the number of letters issued, and (3) the effectiveness of FDA's regulatory letters at limiting the dissemination of false or misleading DTC advertising." (U.S. Government Accountability Office)
Incentives to Switch from Prescription to Over-the-Counter Drugs Can Produce Large Savings
Excerpt: "A program that incentivized patients to switch from prescription drugs to over-the-counter (OTC) alternatives saved members thousands of dollars and provided the insurer with a solid return on investment (ROI), according to the PBM and health plan responsible for the initiative." (AISHealth.com)
Ten Prescription Drugs Accounted For More Than $1 Billion In Spending Across Upstate New York In 2007
Excerpt: "Out of more than 3,000 prescribed drugs in upstate New York last year, 10 brand-name drugs accounted for more than $1 billion in spending, or nearly 20 percent of the total amount spent on prescription medications, according to a new report issued by Excellus BlueCross BlueShield." (Blue Cross and Blue Shield Association)
Health Plans, PBMs Consider New Ways to Boost the Health Literacy of Their Members
Excerpt: "[S]ome health plans and pharmacy benefit managers (PBMs) contacted by AIS are taking steps to address the health literacy issues of their members in an attempt to improve therapeutic outcomes and the bottom line." (AISHealth.com)
Wal-Mart Expands Discount Drug Plan
Excerpt: "Wal-Mart . . . said that it would expand the program under which it charges $4 for a month's supply of more than 350 generic prescription drugs by offering a 90-day supply for $10. The company also added several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone deficiency. And it said it would lower the price of more than 1,000 over-the-counter drugs." (The Tennessean)
[Guidance Overview] CMS Issues Medicare Part D Benefit Parameters for 2009
Excerpt: "EBIA Comment: The new parameters will help group health plan sponsors determine whether their plans' prescription drug coverage is creditable for 2009. This information is needed for the disclosures that must be made annually and at other specified times to Part D eligible individuals and to CMS." (Employee Benefits Institute of America)
Colorado House Approves Legislation That Would Bar Insurers from Providing Incentives for Prescribing Generic Drugs
Excerpt: " The Colorado House on Monday voted 62-3 to approve a bill (HB 1411) that would ban insurance companies from offering physicians cash incentives to switch patients to less-costly generic versions of prescription drugs, the Denver Post reports." (Kaiser Family Foundation)
A Serious Look at Expensive Drugs Used by Federal Employees and Retirees
Excerpt: "The Office of Personnel Management is undertaking a review of how much federal employees and retirees pay for certain types of expensive, specialized prescription drugs that help treat such diseases as cancer, multiple sclerosis and hepatitis." (The Washington Post; free registration required)
[Opinion] Providing Health Care for All Shouldn't Make Insurers Rich
Excerpt: "Government subsidies and outsourcing may be good for business without always being good for the public. Medicare outsources the administration of its prescription drug program, Medicare D, to private insurers. Medicare Advantage -- Medicare C -- subsidizes managed care insurance plans for seniors choosing them. Several current presidential aspirants -- Clinton and Obama -- would subsidize the purchase of insurance for the low-income uninsured. Each of these plans offers private insurers protection against a less wasteful plan, one that does without private insurers." (Herald Times via Physicians for a National Health Program)
Newark Star-Ledger Examines Effect of Wal-Mart Generic Drug Discount Program on Pharmaceutical Industry
Excerpt: "The Newark Star-Ledger on Tuesday examined how analysts say the 'overall impact' of Wal-Mart Stores' generic prescription drug program on the pharmaceutical industry 'has been relatively small' . . . ." (Kaiser Family Foundation)
[Opinion] A Better Way to Pay for Prescriptions
Excerpt: "The pricing plans most people choose for their cell phones are simple: Pay one price and talk as much as you want. What if paying for your prescription drugs were as easy and appealing? It's not as outlandish as it may appear. Paying for drugs the same way we pay for cell phones would encourage people to use as much as they need, not just what they can afford. That could result in better medical care, help avoid hospitalizations and cut medical expenses." (Providence Journal via RAND)
[Guidance Overview] CMS Releases 2009 Medicare Part D Benefit Parameters (PDF)
Excerpt: "The Centers for Medicare and Medicaid Services (CMS) has updated the Medicare Part D standard benefit parameters and the cost thresholds and limits for qualified retiree prescription drug plans for 2009." (Buck Consultants)
The links shown above have been gathered from the web by the editors at BenefitsLink.com. Each article's publisher is shown above in parentheses. Opinions expressed in each article are those of the article's publisher, not necessarily those of BenefitsLink.com, Inc. or any web site that displays these headlines in a "frame." You should contact the listed publisher for copyright information about any particular article or to inquire into the right to use the article in any manner.