Headlines about "Health plan costs - prescription drugs"
Gathered from the web by the editors at BenefitsLink.com.
[Guidance Overview] Claiming Damages and Evaluating New Prescription Drug Pricing Methodologies in the Wake of Two Final Settlements of a Class Action AWP Lawsuit: Action Needed by July 9, 2009 (PDF)
2 pages. Excerpt: "Effective September 26, 2009, the Average Wholesale Price (AWP) of more than 400 brand-name drugs will decrease as the result of final settlements in a class action lawsuit involving two major publishers of AWP information. Plan sponsors are eligible for damages under the settlement for one of those publishers (the McKesson Corporation) provided they meet certain requirements and file a claim by July 9, 2009." (The Segal Group, Inc.)
Study Says High-Cost Cancer Drugs Have Little Benefit, Strain Health System
Excerpt: "'Crunching data from published studies, the authors found that treating a lung-cancer patient with Erbitux, a drug that costs $80,000 for an 18-week regimen, prolongs survival by only 1.2 months,' the Wall Street Journal reports. The study, which estimates that the life of each American who dies or cancer could be extended by one year at the cost of $440 billion, was published in the Journal of the National Cancer Institute. The high cost and relatively low benefit points to 'one of the thorniest questions facing lawmakers working on the overhaul of the U.S. health-care system': reducing growing health care spending in the last months of patient's lives." (Kaiser Family Foundation)
Economy Prompts More Firms to Waive Drug Co-Payments
Excerpt: "Ultimately, the thinking goes, making it easier for employees to pay for medicine that can keep them healthy will help them -- and their employers -- avoid costly hospitalizations in the long run. While data is still being gathered to show that employers can reduce overall medical costs by cutting co-pays for chronic conditions like diabetes and asthma, other studies have shown that patients forced to pay higher co-pays are less likely to take the medicine they need to stay healthy." (Workforce Management; free registration required)
GAO Testimony: Overview of Approaches to Control Prescription Drug Spending in Federal Programs
June 24, 2009. 16 pages. Testimony given by John E. Dicken, director, health care, before the Subcommittee on Federal Workforce, Postal Service, and the District of Columbia, House Committee on Oversight and Government Reform. (U.S. Government Accountability Office)
Obama To Formally Announce Medicare Drug Costs Cuts Today
Excerpt: "The pharmaceutical industry agreed Saturday to reduce Medicare drug costs as part of health overhaul in an apparent effort to stave off potentially more-burdensome givebacks under the Democrats' health-overhaul plan. Today, President Barack Obama will make a formal announcement about the deal. The Wall Street Journal reports: 'Drug makers on Saturday outlined a proposal to forgo $80 billion in revenue over a decade, largely by covering more of the cost of brand-name prescription drugs under the federal government program for seniors. It would make up part of the $313 billion in government health-spending cuts that President Barack Obama has proposed over a decade to help pay for the overhaul plan.'" (Kaiser Family Foundation)
CMS Announces 2010 Indexed Medicare Rx Amounts
Excerpt: "Recently announced 2010 limits for Medicare Part D prescription drug benefits reflect annual adjustments that affect employers' calculations when applying for the retiree drug subsidy (RDS). Upcoming changes to the RDS application process will require actuaries to register again with additional identifying information and revise how lists of covered retirees are submitted and processed. The latest update to the RDS User's Guide includes a chapter on the appeals process." (Mercer LLC)
U.S. Prescription Drug Use Fell in 2008, Study Says
Excerpt: "Prescription drug use in the U.S. fell last year, although total spending on drugs increased as prices rose sharply on brand-name products, pharmacy benefits manager Medco Health Solutions said Wednesday." (AP via The Washington Post; free registration required)
2009 Medicare Trustees Report
Excerpt: "The Boards of Trustees for Medicare . . . report annually to the Congress on the financial operations and actuarial status of the program. Beginning in 2002, there is one combined report discussing both the Hospital Insurance program (Medicare Part A) and the Supplementary Medical Insurance program (Medicare Part B and Prescription Drug Coverage). . . . The Boards of Trustees issued their most recent report on May 12, 2009." (Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund via Centers for Medicare & Medicaid Services)
Wal-Mart Expands Discount Drug Program to Businesses
Excerpt: "Pharmacy benefit managers (PBMs) say the Wal-Mart program threatens to rob them of valuable business opportunities. Typically, a PBM representative contracts with a business or government body to establish drug coverage for the entity's employee benefits program. The PBM works with the business to determine which drugs will be covered under its benefits package and how much they will cost both employee and employer. A spokesperson for one of the nation's largest PBM companies says the Wal-Mart program is little more than a campaign to increase traffic to the store." (Synapse Medical Publishers, Inc.)
Competition Among Pharmacies Could Spur Change in Industry
Excerpt: "The competition among pharmacy retailers such as Walgreen and Wal-Mart 'to create more efficient business plans for pricing and selling prescription drugs has the potential to spur change across the pharmacy industry,' the Wall Street Journal reports. Wal-Mart last month announced that it would expand to other companies a generic drug purchasing pilot program it currently runs with heavy-equipment maker Caterpillar." (Kaiser Family Foundation)
Employees Taking Antidepressants and Other Psychiatric Drugs Often Don't Receive Help They Need
Excerpt: "Antidepressants were prescribed by a specialist just 36 percent of the time, while the remaining 64 percent were prescribed by primary-care offices, hospitals, outpatient programs or surgical offices, according to an August 2006 study by the Centers for Disease Control and Prevention in Atlanta, the most recent data available. What's particularly alarming is that most general practitioners are not qualified to properly diagnose and treat behavioral-health issues, argues John Kamilis, director of clinical services at Skokie, Ill.-based Curalinc Healthcare. The result is that patients often suffer from inadequate treatment, including being prescribed the wrong drugs and not being referred for counseling, he says." (Human Resource Executive Online)
Tracking Major Prescription Drugs Going Generic and Cost Savings (PDF)
Pages 4-6 of 12 pages. (Milliman)
Drug Makers/Insurers Drug Deals Tie Prices to How Well Patients Do
Excerpt: "Some experts hail such arrangements as a welcome step toward health care that rewards good outcomes for patients. 'We're going to see a growth in outcomes guarantees for pharmaceuticals, and it's very healthy,' said Robert Seidman, a consultant who was formerly the chief pharmacy officer for WellPoint, an insurance company. Traditionally, discounts and rebates that drug companies offer insurers have been based on how much drug is used, not how well patients do. But the emerging, outcomes-based contracts would -- in theory -- better align the incentives of insurers, drug companies and the employers that provide health coverage toward improving people's health." (The New York Times; free registration required)
American Medical Association to Announce Web-Based Information Service for Physicians
Excerpt: "The American Medical Association plans to announce a new online service that will offer physicians electronic prescribing, reference materials on diseases and other resources, the AP/Kansas City Star reports. The effort aims to help physicians adopt information technology and increase AMA membership. The new service, which was developed in collaboration with Compuware, will be tested as part of a pilot program before it is rolled out to members nationwide next year." (Kaiser Family Foundation)
PBMs Are Taking New Steps to Influence Consumer Behavior and Push Generics
Excerpt: "CVS Caremark provided DBN with an exclusive look at survey data that finds growing interest among employers in adopting plan designs that promote generic and over-the-counter (OTC) drug options." (AISHealth.com)
Drug Prices Up, According to AARP Study
Excerpt: "Prices of the most popular brand-name prescription drugs are on the rise even as the economy falters, the AARP says. But the group's annual study released Wednesday also found prices of generic drugs are falling and more and more seniors are making the switch to generics, a trend the powerful senior citizens' lobby hopes to encourage." (AP via The Sun News)
Firms Develop Strategies for Specialty Drugs
Excerpt: "Faced with the high cost of specialty drugs, many employers are relying more on strategies from specialty arms of their pharmacy benefit managers to control spending." (Workforce Management; free registration required)
WSJ Examines Hospital, Drug Company Price Increases, While Government, Private Insurers Attempt To Rein in Costs
Excerpt: "Many hospitals and drugmakers are raising prices on their products and services to reinforce their earnings, 'underscor[ing] the deep challenges' that the Obama administration and Congress face as they work to rein in health care costs and expand health insurance, the Wall Street Journal reports." (Kaiser Family Foundation)
Insurance Payment Lags As Cancer Care Comes in a Pill
Excerpt: "Pills and capsules are the new wave in cancer treatment, expected to account for 25 percent of all cancer medicines in a few years, up from less than 10 percent now. The oral drugs can free patients from frequent trips to a clinic to be hooked to an intravenous line for hours. Fewer visits might save the health system money as well as time. And the pills are a step toward making cancer a manageable chronic condition, like diabetes. But for many patients, exchanging an I.V. bag for a pill is a lopsided trade because the economics and practice of cancer medicine have not caught up with the convenience of oral drugs." (The New York Times; free registration required)
[Guidance Overview] CMS's Medicare Part D Benefit Parameters for 2010
Excerpt: "EBIA Comment: The new parameters will help group health plan sponsors determine whether their plans' prescription drug coverage is creditable for 2010. 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 [Centers for Medicare & Medicaid Services]." (Employee Benefits Institute of America)
[Guidance Overview] 2010 Medicare Part D Benefit Parameters (PDF)
2 pages. 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 2010." (Buck Consultants)
[Guidance Overview] CMS Revision of Indexed Medicare Part D Amounts for 2010, Updated April 8, 2009
Excerpt: "In an April 6, 2009 announcement, the Centers for Medicare & Medicaid Services (CMS) revised and made final the indexed Medicare Part D standard benefit and Retiree Drug Subsidy (RDS) amounts for 2010, previously announced in an advance notice. This Capital Checkup features charts comparing the final 2010 numbers and the 2009 numbers." (The Segal Group, Inc.)
CMS Issues Retiree Drug Subsidy User Guide and New FAQs
Excerpt: "Employers applying for the Medicare Part D retiree drug subsidy (RDS) now have additional resources on the RDS application and reconciliation process. CMS has issued a new RDS User Guide, which includes information from many how-to documents on its website. The agency also has released eight frequently asked questions addressing how to correct submitted drug costs, payment requests or retiree lists after an application has completed reconciliation." (Mercer LLC)
[Guidance Overview] AWP Settlement and the Implications for the Healthcare Industry
Excerpt: "On March 30, the U.S. District Court for the District of Massachusetts entered a Final Order and Judgment approving a long-awaited class action settlement that involved two major publishers of drug pricing information. Alleged to have inflated the Average Wholesale Prices (AWP) for hundreds of brand-name drugs, the publishers agreed to roll-back the AWP on all drugs to a uniform 120 percent of the Wholesale Acquisition Cost. The settlement will affect all organizations (e.g., insurers, employers and health plans) that contract with a third party for pharmacy benefit services." (Deloitte via BenefitsLink.com)
[Guidance Overview] CMS Update of Creditable Coverage Disclosure to CMS Form
Excerpt: "EBIA Comment: Happily, there are few changes to the Disclosure to CMS Form, and none of them are rocket science. Most seem aimed at fixing practical problems raised by how individuals were filling out the previous version of the Form." (Employee Benefits Institute of America)
[Guidance Overview] Federal Court Holds D.C.'s Access Rx Act Preempted by ERISA
Excerpt: "In a decision handed down on March 19, 2009, the Pharmaceutical Care Management Association (PCMA) won a multi-year battle in federal court when the United States District Court for the District of Columbia held that the Access Rx Act (the 'Act') 'impermissibly intrudes upon a field exclusively reserved for federal regulation.' This court's holding that the Act is preempted by the Employee Retirement Income Security Act (ERISA) marks a departure from a First Circuit opinion upholding a nearly identical Maine statute in the face of a preemption challenge." (Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C.)
[Guidance Overview] Medicare Part D: Optimizing the Opportunities for Employer Plans (PDF)
5 pages. The article discusses the pluses and minuses of options. (International Foundation of Employee Benefit Plans via Milliman)
[Guidance Overview] New Medicare Reporting Requirements (PDF)
5 pages. Excerpt: "In general, effective January 1, 2009, insurers, third party administrators, and administrators of self-insured and self-administered group health plans must collect specified information from plan participants and report this information to CMS. If your group health plan's third party administrator does not already have a voluntary data sharing arrangement with CMS, implementation begins April 1, 2009." (Bryan Cave LLP)
Wal-Mart/Caterpillar Prescription Drug Price Program May Drive Down Employer Health-Care Costs
Excerpt: "Wal-Mart Stores Inc., the world's largest retailer, is aiming its economic might at the health-care industry with a program that lowers prescription drug prices for employers. A pilot program with Caterpillar Inc. to streamline the way drugs are purchased has shown enough promise that Wal-Mart is in talks with several other firms to do the same, the companies said Friday." (Chicago Tribune)
[Guidance Overview] Indexed Medicare Part D Amounts for 2010
Excerpt: "The Centers for Medicare & Medicaid Services (CMS) has announced the indexed Medicare Part D standard benefit and Retiree Drug Subsidy (RDS) amounts for 2010. This Capital Checkup features charts comparing the 2010 numbers and the 2009 numbers." (The Segal Group, Inc.)
Actuaries Can Determine E-Prescribing's Potential for Savings and Improved Outcomes
Excerpt: "In the article, An Electronic Prescription for Health Care Efficiency, [Susan] Pantely asserts that e-prescribing makes a doctor's prescribing practice more efficient by helping the doctor make an 'appropriate determination of the best drug for the patient' in a real-time fashion. To determine e-prescribing's potential, an actuary can review doctors' drug prescribing patterns and their generic proportions; that is, lower order rates for generic drugs shows greater potential for savings, she wrote." (Wolters Kluwer)
[Guidance Overview] PBMs Prevail in Controversy over ERISA Preemption of Disclosure Legislation
Excerpt: "The PBM industry won a significant victory in [Pharm. Care Mgmt. Ass'n v. D.C.] which, if sustained on appeal, may serve as a vehicle for Supreme Court review of ERISA's preemptive limits on PBM disclosure legislation." (Health Plan Law)
Requiring Generics for Rx's May Be Leading to Higher Health Care Costs
Excerpt: "A new study indicates that a common cost-containment tool that substitutes less expensive generic medications for costlier brand name drugs, referred to as step therapy, may actually lead to higher overall health care costs. The study focused on anti-hypertensive drugs, but found that benefit plan members subject to step therapy incurred $99 more in quarterly health care expenditures than a comparable group, Business Insurance reports. Additionally, the study found plan members in step therapy programs also had more inpatient admissions and emergency room visits." (PLANSPONSOR.com; free registration required)
[Opinion] Medicare Part D Is an Example of Bad Policy
Excerpt: "GENERATING efficiency in the health-care market will be one of President Obama's greatest challenges. To do this, he will have to create meaningful competition between drug companies, and between public and private plans. Congress's attempt at market-driven health care offers good instruction in what not to do. Medicare Part D, the prescription benefit that went into effect three years ago, was supposed to let the elderly get their medicines more cheaply by creating competition between private insurers. Yes, the program has undeniably improved access to prescriptions. But the cost to taxpayers has been 3.5 times the market value of those prescriptions, according to a study in the journal Health Affairs." (The New York Times; free registration required)
[Guidance Overview] Part D Plans Have Only One Month to Comply With E-Prescribing Rules
Excerpt: "With just a month to go before the April 1, 2009, compliance deadline, some Part D plans still are not ready to support some e-prescribing technologies outlined by CMS in an April 2008 final rule. And plan sponsors can expect more e-prescribing rules from CMS -- possibly every 12 to 24 months, one industry insider predicts -- as more providers adopt e-prescribing technology, spurred by incentives created by the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and funding provided by the economic stimulus law signed Feb. 17 by President Obama." (AISHealth.com)
Healthcare Stimulus Provisions
Excerpt: "The stimulus bill, expected to be signed today by President Obama, includes provisions for a new federal bureaucracy to research prescription drugs and treatments, funding for healthcare information technology and expanded COBRA benefits." (Human Resource Executive Online)
Assessing the Future Basis of Drug Pricing (PDF)
2 pages. (Milliman)
Success of $4 Generic Programs Highlights Potential Consumerism (PDF)
1 page. (Milliman)
An Electronic Prescription for Health Care Efficiency
Pages 12-15 of 32 pages. Excerpt: "Making appropriate determinations of the best drug fit for an individual patient is clearly more efficient right in the doctor's office when the physician is most focused on the patient. E-prescribing is uniquely poised to offer exactly that capability. . . . By most measures, e-prescribing is still in its infancy. But proponents see a bright future, arguing that e-prescribing offers a significantly effective strategy for both cost savings and improved health outcomes, particularly in combination with the use of an electronichealth record (EHR)." (Society of Actuaries)
Employer Brings Simplicity to Specialty Pharmacy Benefits
Excerpt: "There are really two main strategies with managing specialty pharmacy, said [Keith Bruhnsen, assistant director of benefits at the University of Michigan]. 'You want to get the best pricing out there in the market, and you want to manage for appropriate use. That means getting the right drug in the right amount at the right time for the patient.'Employers also need to decide which drugs will go on the medical side and which ones will go on the pharmacy side, he said. Organizations will most likely have specialty medications in both the medical benefit and pharmacy benefits." (Employee Benefit News; free registration required)
Pharmacy Benefit Management Transparency Could Be Inevitable
Excerpt: "The pharmacy benefit management (PBM) industry has come under intense scrutiny to become more transparent in its contracts with health plans and employers. Some PBMs have embraced transparency and see it as an inevitable shift in how pharmacy benefits are delivered. Others have stuck to their guns, maintaining that historical contracting practices enable better pricing deals than could be achieved in fully transparent contracting environments. So which is it: a passing fad or an inevitable change?" (Managed Healthcare Executive)
[Guidance Overview] CMS Requests Comments on Proposed Changes to RDS Subsidy Calculation
Excerpt: "The Centers for Medicare & Medicaid Services (CMS) is concerned that certain new requirements it has established for Medicare Part D plans (i.e., reporting the pass-through prices instead of lock-in prices, and treating amounts retained by the pharmacy benefit manager or other intermediary contracting organization as administrative costs) will, if applied to the retiree drug subsidy program, induce employers to terminate their programs or place their retirees in a Part D plan because of the reduced subsidy. As a result, CMS has postponed applying these changes to the retiree drug subsidy program and is requesting further comments. 74 Federal Register 1494 & 1550 (January 26, 2009)." (Deloitte LLP via BenefitsLink.com)
[Guidance Overview] Your Medicare Part D Disclosure to CMS May Be Due Soon
Excerpt: "This filing requirement applies to health plans that cover any individuals who are eligible for the Medicare Part D prescription drug program, whether as active employees, spouses, dependents, or retirees. There are a few limited exemptions for plans that contract with a Medicare Part D plan or that contract directly with Medicare to become a Part D plan, and for retiree plans where an employer has successfully applied for the retiree drug subsidy. No disclosures are required for health flexible spending accounts (FSAs) or health savings accounts (HSAs); but disclosures are required for Health Reimbursement Arrangements (HRAs) either on a stand-alone basis or, more likely, in connection with a high deductible health plan, if the HRA reimburses prescription drug expenses." (Warner Norcross & Judd LLP)
Take-Up of Medicare Part D: Results from the Health and Retirement Study
Excerpt: "We analyze data from the Health and Retirement Study on senior citizens' take-up of Medicare Part D. Take-up among those without drug coverage in 2004 was high; about fifty to sixty percent of this group have Part D coverage in 2006. Only seven percent of senior citizens lack drug coverage in 2006 compared with 24 percent in 2004. We find little circumstantial evidence that Part D crowded out private coverage in the short run, since the persistence of employer coverage was only slightly lower in 2004 -- 2006 than it was in 2002 -- 2004." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
The Effects of the Medicare Part D Coverage Gap on Drug Spending
Excerpt: "We calculated prescription drug usage in two groups of Medicare beneficiaries: employer group with no coverage gap, and individual Part D group with no coverage or some generic drug coverage in the coverage gap. Among those with employer coverage, 40 percent reached the doughnut hole, compared with 25 percent of those without such coverage. Overall, 5 percent went through the doughnut hole to reach the catastrophic coverage level. Those lacking coverage in the doughnut hole reduced their drug use by 14 percent; those with generic coverage reduced their use by 3 percent. Coverage of generic drugs with a $0-$10 copayment in the doughnut hole could be financed by, at most, a six-to-nine-percentage-point increase in initial coinsurance." (Health Affairs)
The Effect of Medicare Part D Coverage on Drug Use and Cost Sharing Among Seniors Without Prior Drug Benefits
Excerpt: "This study evaluates the effect of Medicare Part D among seniors who previously lacked drug coverage, using time-trend analyses of patient-level dispensing data from three pharmacy chains. Of 114,766 seniors without drug benefits, 55 percent initiated drug insurance under Part D. After the penalty-free Part D enrollment period, use of statins, clopidogrel, and proton pump inhibitors stabilized at levels ranging from 11 percent to 37 percent above the trend that would have been expected if Part D had not been implemented." (Health Affairs)
Insurers Overcharged Medicare for Prescriptions, Report Finds
Excerpt: "If you buy medicine through Medicare's prescription drug program, you could be paying too much. The taxpayers who finance Medicare aren't doing too well, either. Insurance companies involved in the Medicare prescription drug benefit have overcharged subscribers and taxpayers by several billion dollars, according to the inspector general for the Department of Health and Human Services. Eighty percent of the participating insurance companies owe the program an estimated $4.4 billion for 2006 alone." (The Miami Herald)
House Democrats Introduce Legislation That Would Allow Medicare To Offer Prescription Drug Plans That Compete With Private Plans
Excerpt: "Congressional Democrats on Tuesday introduced legislation (HR 684, S 330) that would allow traditional Medicare to establish one or more plans to compete with private plans under the prescription drug benefit, CQ HealthBeat reports. In addition, the legislation, sponsored by Senate Majority Whip Richard Durbin (D-Ill.) and Reps. Marion Berry (D-Ark.) and Jan Schakowsky (D-Ill.), would strengthen the ability of Medicare beneficiaries to appeal denials of coverage for medically necessary medications under all Medicare Part D plans. The legislation also would require the HHS secretary to negotiate directly with pharmaceutical companies for the prices of medications under Part D." (Kaiser Family Foundation)
Retiree Drug Subsidy (RDS) Program Guidance: Rebates and Other Price Concessions (PDF)
5 pages. Excerpt: "This document provides guidance for plan sponsors (sponsors) in the Retiree Drug Subsidy (RDS) program on how to submit cost data for purposes of receiving the RDS, including how to: Take into account manufacturer rebates and similar price concessions that are retained by a pharmacy benefit manager (PBM) . . . ." (Centers for Medicare & Medicaid Services)
More Nonelderly Americans Face Problems Affording Prescription Drugs
Excerpt: "More children and working-age Americans are going without prescription drugs because of cost concerns, according to a new national study by the Center for Studying Health System Change (HSC). In 2007, one in seven Americans under age 65 reported not filling a prescription in the previous year because they couldn't afford the medication, up from one in 10 in 2003. . . . The number of Americans who cannot afford prescription medications is likely to grow as the economy continues to decline and the ranks of the uninsured grow." (Center for Studying Health System Change)
PBMs Tout Transparency, but Model Doesn't Always Lower Drug Costs for Clients
Excerpt: "The pharmacy benefit management (PBM) industry claims to embrace the concept of 'transparency.' In today's business environment, few, if any, PBMs would dare prohibit clients from examining at least a good measure of their contract arrangements. But as more and more PBMs tout their commitment to financial disclosure, some acknowledge that transparency alone doesn't always lower Rx payers' costs. And at least one consultant claims the industry still has a long way to go on demonstrating 'real' transparency." (AISHealth.com)
[Guidance Overview] CMS's Revised Guidance and Model Disclosure Notices for Part D Eligible Individuals for Use After January 1, 2009
Excerpt: "EBIA Comment: CMS had previously requested public comment on a proposal to drop the model personalized notice, so its elimination is not surprising . . . . Employers using the model disclosure notices will need to replace them with the revised versions, while those using customized versions of the notices should review their practices for providing personalized information for consistency with the revised guidance. In any event, employers will likely welcome having one less notice to track for Medicare Part D." (Employee Benefits Institute of America)
[Opinion] A Very Open Letter from an Oncologist
Excerpt: "During the holidays, I received the letter [included in this blog] from Dr. Peter Eisenberg, Medical Director at California Cancer Care, an oncology practice in Northern California. . . . One of the things I admire about Eisenberg is that he pulls no punches. In the extraordinarily candid letter . . . he criticizes a health care system that pays physicians fee-for-service for 'doing more' in the form of ever more aggressive treatments." (Maggie Mahar via The Century Foundation)
[Guidance Overview] Deadline for Submission of Creditable Coverage Disclosures to CMS (PDF)
2 pages. Excerpt: "Group health plan sponsors that provide prescription drug coverage to Medicare Part D eligible individuals must annually disclose to the Centers for Medicare & Medicaid Services (CMS) whether such coverage qualifies as creditable or non-creditable prescription drug coverage. All plan sponsors that provide prescription drug coverage are required to make this disclosure, even if they do not make coverage available to retirees. Calendar year plans must submit the disclosure to CMS by March 1, 2009." (Buck Consultants)
Payers Integrate Medical and Pharmacy Data to Get a Complete Picture of Care
Excerpt: "Specialty drugs have long posed a problem when it comes to adjudicating claims. While some of them fall under the pharmacy benefit, many more fall under the medical benefit. Health plans have struggled to determine how best to structure their benefits in order to manage these products and get a complete picture of their members and those members' utilization." (AISHealth.com)
Health Insurers See Value of Covering Members in Rx Clinical Trials
Excerpt: "With a flood of specialty pharmaceutical drugs moving through the research pipeline, more and more health plans are covering medical expenses of members participating in clinical trials, as well as the experimental drugs. Some insurers urge all plans to develop clear policies around clinical trials as a way to benefit both members and themselves." (AISHealth.com)
CMS Finalizes Medicare Rule That Aims To Stop Pharmacy Benefit Manager Practice That Inflates Drug Costs for Some Beneficiaries
Excerpt: "PBMs negotiate prescription drug prices with pharmacies and reimburse them for medication purchased by patients, after which health insurers pay PBMs for administration of claims. Under the so-called lock-in approach, health insurers pay PBMs a set amount for claims regardless of the amount that they reimburse pharmacies for prescription drugs. The amount that health insurers pay PBMs for claims often exceeds the amount that they reimburse pharmacies for prescription drugs. PBMs in most cases do not disclose the amount of the difference, which the companies retain. The approach can cause Medicare beneficiaries to reach the so-called 'doughnut hole' coverage gap earlier." (Kaiser Family Foundation)
Giant Food To Offer Generic Antibiotics at No Cost for Three Months
Excerpt: "Giant Food stores and stores of its sister chain Stop & Shop will provide no-cost generic antibiotics to customers with prescriptions for three months beginning Jan. 2, the Washington Post reports. Numerous popular antibiotics, such as amoxicillin, penicillin and ciprofloxacin, will be included. Medications that treat common viral illnesses, such as the flu and the common cold, will not be included. According to the Post, such medications often are not available in generic form and are more costly." (Kaiser Family Foundation)
Health Insurers Roll Out Value-Based Prescription Drug Plans, Tap a Growing Demand
Excerpt: "More and more health plans, including WellPoint, Inc. and a subsidiary of UnitedHealthcare, are rolling out value-based insurance design (VBID) programs in response to growing demand for the concept that aims to boost pharmaceutical adherence by lowering barriers to access. Interest in value-based benefits, pharmacy executives say, will continue to expand alongside emerging evidence that the programs improve overall member health and avoid more costly medical expenses later on." (AISHealth.com)
One Health Plan's Experience With a Part D Audit
Excerpt: "When CMS came to audit CIGNA HealthCare of Arizona's Medicare Advantage prescription drug (MA-PD) plan in May, the company was prepared, said Jody Miller, operations manager in the Medicare administration and compliance department. And the best piece of advice she could give other plans is to do the same. Put everything that CMS wants to look at together, and have it ready for the auditors when they get there, she advised attendees at the recent Medicare Enrollment and PDE Data Summit sponsored by CBI in Alexandria, Va." (AISHealth.com)
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