Headlines about "Health plan costs - prescription drugs"
Gathered from the web by the editors at BenefitsLink.com.
A Step-by-Step Guide to the Medicare 2010 Drug Plan Finder
Excerpt: "Looking for a Medicare Part D drug plan that will cost you the least in 2010 and cover all or most of your prescription drugs? This guide provides a direct route to that information by taking you step by step through Medicare's Prescription Drug Plan Finder, a useful online tool that allows you to compare many drug plans head to head to find your best deal. The plan finder does the math for you, so that you can see your likely out-of-pocket costs -- premium, deductible and copays for the specific drugs you use -- throughout the year." (AARP)
Drug Makers Raise Prices in Face of Health Care Reform
Excerpt: "Even as drug makers promise to support Washington's health care overhaul by shaving $8 billion a year off the nation's drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years. In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts." (The New York Times; free registration required)
Medicare Part D and the Financial Protection of the Elderly
Excerpt: "We examine the impact of the expansion of public prescription prescription-drug insurance coverage from Medicare Part D has had on the elderly and find evidence of substantial crowd-out. Using detailed data from the 2002-6 waves of the Medical Expenditure Panel Survey (MEPS), we estimate that the extension of Part D benefits resulted in 75% crowd-out of prescription drug insurance coverage and 33%-50% crowd-out of prescription drug expenditures of those 65 and older. Part D is associated with relatively small reductions in out-of-pocket spending. This suggests that the welfare gain from protecting the elderly from out-of-pocket spending risk through Part D has been small." (Center for Retirement Research at Boston College)
[Guidance Overview] Remember to Distribute Annual Medicare Part D Notices by November 15, 2009
Excerpt: "Just a reminder that it's time once again to make sure that you have distributed the Notice of Creditable Coverage required under Medicare Part D, which informs participants whether the prescription drug coverage offered under your health plan constitutes creditable or noncreditable coverage. Once again, the Centers for Medicare and Medicaid Services (CMS) has issued updated forms that you may use to provide this notice. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. The only employers exempt from this notice requirement are those that establish their own Part D plan or who contract with a Part D plan." (Warner Norcross & Judd LLP)
[Guidance Overview] CMS Proposes Policy and Technical Changes to Medicare Part D Regulations, Including COB and MSP Provisions
Excerpt: "CMS has proposed policy and technical changes to the regulations for the Medicare Part D program that are intended to clarify participation requirements, strengthen beneficiary protections, improve payment rules, and implement new policy. As discussed below, some of the proposed changes affect group health plan sponsors that provide prescription drug coverage for Part D eligible individuals (including active employees, disabled employees, COBRA participants, retirees, and their covered spouses and dependents). In particular, changes have been proposed to the regulations on MSP procedures for coordination of benefits (COB) between Part D plans and other providers of prescription drug coverage (including group health plan sponsors). For example, the regulations would include a requirement for Part D plans to report credible new or changed primary payer information to the CMS Coordination of Benefits Contractor." (Employee Benefits Institute of America)
Audio and Text: How Drug Ads Changed Health Care
Excerpt: "Prescription drug spending is the third most expensive cost in our health care system. And spending seems to grow larger every year. Just last year, the average American got 12 prescriptions a year, as compared to 1992, when Americans got an average of seven prescriptions. In a decade and a half, the use of prescription medication went up 58 percent. This has added about $180 billion to our medical spending. While there are more medicines on the market today than in 1992, researchers estimate that around 20 percent of the $180 billion increase has absolutely nothing to do with the number of medications available, or increases in the cost of that medication." (Morning Edition via National Public Radio)
Senate Finance Committee Adopts New Pharmacy Benefit Management Disclosure Provision
Excerpt: "The SFC approved an amendment to its comprehensive health reform bill that would require pharmacy benefit managers (PBMs) to disclose contract provisions with payers and drug companies. But committee members rejected other controversial amendments, such as those that would have authorized the HHS secretary to negotiate drug prices or create an overall public option to compete with private insurers." (AISHealth.com)
Say Goodbye to Employer Deduction for Retiree Drug Subsidies?
Excerpt: "Tucked away in the amended version of America's Healthy Future Act of 2009 is a provision that would repeal the business deduction for federal subsidies for certain retiree prescription drug plans. In case you didn't know, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created a retiree drug subsidy program to encourage employers and unions to continue providing high quality prescription drug coverage to their retirees. Employers who continue to maintain retiree health plans that provide prescription drug coverage can receive a tax-favored subsidy." (Wolters Kluwer)
Regulation of Private Health Insurance Markets: Lessons from Enrollment, Plan Type Choice, and Adverse Selection in Medicare Part D
Excerpt: "We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets that control adverse selection and assure adequate access and coverage. We model Part D enrollment and plan choice assuming a discrete dynamic decision process that maximizes life-cycle expected utility, and perform counterfactual policy simulations of the effect of market design on participation and plan viability. Our model correctly predicts high Part D enrollment rates among the currently healthy, but also strong adverse selection in choice of level of coverage. We analyze alternative designs that preserve plan variety." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
[Guidance Overview] Data Mining Coalition Battles for Prescription Data
Excerpt: "In IMS Health Inc. v. Ayotte, 550 F.3d 42 (1st Cir. N.H. 2008), cert. den., 129 S. Ct. 2864 (2009) the First Circuit upheld a Hampshire law that among other things prohibited certain transfers of physicians' prescribing histories for use in marketing drugs to physicians. A similar battle is now underway in the Second Circuit Court of Appeals over a Vermont statute. In IMS et al v. Sorrells a coalition of data mining entities seek to overturn an decision by the district court (IMS Health Inc. v. Sorrell, 2009 U.S. Dist. LEXIS 35594 (D. Vt.) (2009)) upholding the Vermont law. The Electronic Privacy Information Center (EPIC) has filed an amicus brief urging the Second Circuit to affirm the decision." (Roy Harmon III via Health Plan Law)
As Use of Specialty Pharmaceuticals Increases, Benefit Design Can Help to Control Costs
Excerpt: "As specialty drug use and costs continue to rise, appropriate benefit design -- not just pushing a drug onto the fourth tier of a formulary -- can help manage these therapies, says a recently released report from pharmacy benefit manager (PBM) Prime Therapeutics LLC. According to its 2009 Drug Trend Insights, among Prime covered lives in 2008, specialty drugs represented 1.1% of all prescriptions filled -- but they were 15.4% of the overall drug cost. The report notes that specialty drug categories represented eight of the top-10 therapeutic categories that experienced the fastest-growing costs in 2008." (AISHealth.com)
[Guidance Overview] CMS's Proposed Changes in Disclosure to CMS Form Instructions and Revises Guidance on Disclosure to Part D Eligible Individuals
Excerpt: "EBIA Comment: The changes to the creditable coverage disclosure items . . . are merely clarifying, not substantive. But those who are responsible for providing the required disclosures to CMS and to Medicare Part D eligible individuals should pay attention to these changes. The deletion of the mail-order provision is welcome. Since plans are not required to offer mail-order prescription drug coverage to meet the safe harbor, CMS may have dropped that provision just to avoid confusion. Having clarity in the safe harbor requirements is important: Plans that do not meet those requirements must make an actuarial determination of whether their prescription drug coverage is creditable." (Employee Benefits Institute of America)
Equitable Prescription Drug Coverage in Employer-Provided Health Plans
Excerpt: "Steve Befort (Minnesota) and Elizabeth Canney Borer (former UM student) have posted on SSRN their piece in the Louisiana Law Review entitled: 'Equitable Prescription Drug Coverage: Preventing Sex Discrimination in Employer-Provided Health Plans.'" (Workplace Prof Blog)
Pfizer Settles Largest Health Care Fraud Case in History
Excerpt: "Pfizer Inc. was already under a corporate integrity agreement (CIA) stemming from an earlier Department of Justice (DOJ) settlement when it allegedly broke civil and criminal laws, triggering the largest health fraud settlement in American history. Now the pharmaceutical manufacturer will break another record, implementing what is believed to be the most extensive CIA ever imposed by the HHS Office of Inspector General (OIG)." (AISHealth.com)
Caterpillar's Pharmacy-Benefit Arrangement Seeks to Cut Out the Middleman to Gain Transparent Pricing
Excerpt: "Hal Rosenbluth, who, as president of Walgreens's health and wellness unit, may have an interest in buttering up finance chiefs, observes that CFOs have an 'innate' ability to find out the true cost of goods or services their companies are spending money on. Rosenbluth, whose company launched a direct pharmacy-benefit purchasing arrangement with Caterpillar last week, suggests that the current national focus on cutting health-care costs and the structural shift in workplace-based drug buying that the Caterpillar model features will push CFOs to start asking tough questions about waste in the current pharmaceutical supply chain." (CFO.com)
Document Released by Senate Committee Details Plan to Promote Costly Drug
Excerpt: "No drug better demonstrates the [pharmaceutical] industry's salesmanship than Lexapro, an antidepressant sold by Forest Laboratories. And a document quietly made public recently by the Senate's Special Committee on Aging demonstrates just how Forest managed to turn a medicinal afterthought into a best seller. The document, 'Lexapro Fiscal 2004 Marketing Plan,' is an outline of the many steps Forest used to make Lexapro a success. Because of concerns from Forest, the Senate committee released only 88 pages of the document, which may have originally run longer than 270 pages. 'Confidential' is stamped on every page." (The New York Times; free registration required)
Fact Sheet on Health Insurance Plans' Coverage of H1N1 and Seasonal Flu Shots (PDF)
1 page. Excerpt: "The approach of the seasonal flu season and warnings about an H1N1 (swine) flu pandemic have raised the questions: Does employment-based health coverage typically include flu shots? Will insurerscover H1N1 shots when they become available?" (Employee Benefit Research Institute)
Wal-Mart Adds More Employers to Its Retail Pharmacy Fulfillment Program
Excerpt: "Mike Struhs, director of business development at Wal-Mart Health and Wellness, tells DBN that the new employer clients are a 'variety of sizes in different parts of the company,' although he declines to name specific companies. The Wal-Mart Health Solutions Affordable Prescription Program is aimed at 'providing [pharmacy] pricing directly to the payers, whether that be self-insured employers or health plans.' He declines to say whether any of the new clients are health plans." (AISHealth.com)
2010 Medicare Part D Retiree Drug Subsidy Application Deadline Is Coming Soon
Excerpt: "Sponsors of calendar-year retiree medical plans must submit applications by Oct. 2 to obtain the Medicare Part D retiree drug subsidy (RDS) during 2010. RDS applications with valid initial retiree lists are due 90 days before a plan year begins, although sponsors can request an automatic 30-day extension. Even sponsors that previously received the subsidy must reapply each year. This year, attesting actuaries also must register anew, supplying birth dates and Social Security numbers as well as their American Academy of Actuaries membership numbers." (Mercer LLC)
With LA Rx, City of Los Angeles Puts Prescription Drug Bulk Purchasing Card in the Hands of Every Resident
Excerpt: "Consumers who use the free prescription drug discount card, available at www.forlaxrx.com can save up to 40% on their prescription drugs. It's a Costco card without the Costco membership. And the savings are bigger than Costco on the top 20 most used drugs. Five years ago the idea of giving Angelenos a bulk buy on their prescription drugs took shape on the floor of the City Council when Villaraigosa hatched the plan with my colleaugues and I. He had been hearing about the high price of prescription drugs from seniors in his district and we told him if Costco could do it why not the City of Los Angeles. A reporter today asked why it had taken so long. The Mayor said City Bureaucracy. The fact is that public programs like LA Rx are not only hard to get off the ground. They also are hard to get people to use. It will take marketing on the part of the Mayor, the City and low income groups to let people know how a simple LA Rx card can give them big discounts on their prescription drugs. Insured and uninsured can benefit." (Consumer Watchdog)
Walgreens and Caterpillar Make Pharmacy Benefit Deal
Excerpt: "A program by drugstore chain Walgreens offered to employers featuring prescription drug benefits in their health care program includes a price list reflecting the cost Walgreens pays the drug supplier. A Walgreens news release said Caterpillar Inc. had signed up for the drug pricing program." (PLANSPONSOR.com; free registration required)
Video: The Co-Pay Connection
Excerpt: "Our Co-Editor-in-Chief, A. Mark Fendrick, MD, explains the concept of 'value-based insurance design' and discusses the implications of reducing co-pays for employers and insurers." (The American Journal of Managed Care)
Centers for Medicare & Medicaid Services Announcement of Medicare Part D Premium Amounts for 2010
Excerpt: "The national average Part D premium for Medicare prescription drug coverage will reach $31.94 in 2010, up from $30.36 per month in 2009, CMS estimates. Employers applying for the retiree drug subsidy use this figure when determining the actuarial equivalence of their benefits. Part D beneficiaries will pay an average monthly premium of $30 in 2010, up from $28 in 2009. Other 2009 Part D figures released by CMS supply national average monthly bid amounts for stand-alone and Medicare Advantage (MA) plans offering prescription drug benefits, low-income subsidy amounts and MA benchmarks." (Mercer LLC)
PBMs Say Plan Sponsors Can Achieve 70%+ Generic Rates Without Aggressive Tactics
Excerpt: "Pharmacy benefit managers (PBMs) that have achieved generic drug fill rates of 70% or more say aggressive management tactics are not as important as a focus on educational and communication tools and an overall formulary design aimed at obtaining the lowest unit price rather than the highest rebate revenue." (AISHealth.com)
[Guidance Overview] New Audit Guide for Medicare Advantage and Part D Programs Released for Comment
Excerpt: "In its proposed collection and comment request published in the Federal Register on Friday, July 31, 2009, CMS announced the merger of the existing Part C and Part D audit guides into a single Medicare Part C and Part D Universal Audit Guide. Currently available in draft form, the universal audit guide reflects streamlined data elements, uniform language, and omits duplicative data elements as well as previously deleted items. The information collection and comment request also includes a draft audit confirmation letter; minimum documentation requirements for sample case files; and the accompanying 'universe request' for data for Medicare Advantage and Part D Plan audits." (McDermott Will & Emery)
Wal-Mart Expands Rx Benefit to Employers, Targets Waste in Drug Supply Chain
Excerpt: "Wal-Mart Stores, Inc. is rolling out a pharmacy benefit program to employers and health plans that it says will greatly simplify the drug-pricing system and eliminate up to 20% of the waste in the current pharmaceutical supply chain. Some industry observers say the new program could pressure pharmacy benefit managers (PBMs) on pricing, but others tell DBN that the jury is still out on whether the program will shake up the pharmacy benefits industry. And at least one large PBM appears to be shrugging off the competitive threat." (AISHealth.com)
Tracking Prescriptions: Big Business
Excerpt: "[I]n fact, prescriptions, and all the information on them -- including not only the name and dosage of the drug and the name and address of the doctor, but also the patient's address and Social Security number -- are a commodity bought and sold in a murky marketplace, often without the patients' knowledge or permission." (The New York Times; free registration required)
Democrats Say No to Cost Cap for Drug Makers
Excerpt: "Congressional Democrats said Thursday that they intended to push the Obama administration to back away from its deal with the drug industry to cap its share of the costs in a health care overhaul. A spokesman for Speaker Nancy Pelosi said she stood by her position that the House was not bound by any such agreement. Ms. Pelosi supports House efforts 'to squeeze more money out of the system, including from the pharmaceutical industry,' her spokesman, Nadeam Elshami, said in a statement." (The New York Times; free registration required)
Dynamic Cost-offsets of Prescription Drug Expenditures: Panel Data Analysis Using a Copula-based Hurdle Model
Excerpt: "This paper presents a new multivariate copula-based modeling approach for analyzing cost-offsets between drug and nondrug expenditures. Estimates are based on panel data from the Medical Expenditure Panel Survey (MEPS) with quarterly measures of medical expenditures. The approach allows for nonlinear dynamic dependence between drug and nondrug expenditures as well as asymmetric contemporaneous dependence. The specification uses the standard hurdle model with two significant extensions. First, it is adapted to the bivariate case. Second, because the cost-offset hypothesis is inherently dynamic, the bivariate hurdle framework is extended to accommodate dynamic relationships between drug and nondrug spending. The econometric analysis is implemented for six different groups defined by specific health conditions. There is evidence of modest cost-offsets of expenditures on prescribed drugs." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
Marijuana Reimbursement Claims Highlight How Pot Could Pay for Employers
Excerpt: "In mid-June, Rhode Island became the third state to legalize the sale of marijuana for medical use, giving momentum to advocates who believe the legalization of the drug offers a dose of sanity for the nation's costly health care system. Now that more states are legalizing the sale of the marijuana used solely as a medicine, the next hurdle for reformers who say the drug is more cost-effective than pharmaceuticals is getting those who pay for health care -- insurers and employers -- to reimburse patients for its use." (Workforce Management; free registration required)
More Employers Embrace Cost-Sharing As Utilization Management Tool in Prescription Drug Programs, According to New Survey
Excerpt: "Buck's 'Prescription Drug Benefit Survey', completed in July 2009, found that more than three-quarters (76%) of 140 respondent firms use employee cost sharing as a utilization management tool, up substantially from 51% a year ago. According to the survey, the most common target cost-sharing range is 11% to 20% of claim costs (used by 39%of respondents)." (PLANSPONSOR.com; free registration required)
Medicare Part D Update : Lessons Learned and Unfinished Business
Excerpt: "Enacted in 2003, Medicare's Part D prescription drug benefit reflected an unprecedented and controversial new approach for Medicare, relying exclusively on private plans to provide health coverage and including an unusual gap in coverage. This analysis by Kaiser researchers examines in detail how the new model has worked since its launch almost four years ago. Published as an article in today's New England Journal of Medicine, the analysis by Kaiser vice president Patricia Neuman and principal policy analyst Juliette Cubanski assesses the evidence related to key policy questions arising from the Part D benefit. It also briefly discusses a number of potential policy changes to the Part D benefit that could arise as Congress and the Obama Administration weigh the program's future." (Kaiser Family Foundation)
Express Scripts Using Behavioral Economic Theories to Get Customers to Adopt Money-Saving Practices Such As Mail-Order Prescriptions
Excerpt: "Express and rivals such as Medco (MHS) typically try to persuade patients to switch by making mail-order drugs cheaper than store-bought ones. (Some employers require mail order for certain medications.) But incentives don't always work. The reason, says Express Chief Scientist Bob Nease, is a phenomenon known as 'present bias,' one of the principles of behavioral economics, which stresses that humans often act irrationally. People are more inclined to focus on the immediate hassle of changing a habit than the future benefit. So faced with the paperwork to initiate home delivery, most will keep driving to a pharmacy. Express attacked such inertia by forcing Lowe's employees to make a conscious choice. The company contacted employees with letters and phone calls, asking them to choose between mail and retail. If employees didn't make a decision by their third refill, their drug costs would not be covered until they decided. That forced customers to weigh their options." (BusinessWeek)
PhRMAs $80 Billion in Part D Concessions May Drive Up Health Plan Drug Costs
Excerpt: "Some analysts predict that Medicare Part D plans will see higher drug costs and possibly higher brand-name utilization as a result of the $80 billion pledge made by trade group Pharmaceutical Research and Manufacturers of America (PhRMA) to defray seniors' drug expenses in the Medicare Part D 'doughnut hole' coverage gap. But others say the impact will be negligible, since Part D plans bear a low share of catastrophic drug costs." (Drug Benefit News via AISHealth.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.)
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