Headlines about "Health plan costs - prescription drugs"

Gathered from the web by the editors at BenefitsLink.com.
Nine Leading Trends in Rx Plan Management: Findings from a National Peer Study, 2012 Edition (PDF)
Member health decisions now the #1 cost issue; Plan sponsors look to online tools and mobile apps to lower costs; Healthcare reform raises questions about future coverage options; Employer Group Waiver Plans may soon outnumber Retiree Drug Subsidy plans; Consumer-Directed Health plans gaining momentum again; Mail strategies growing and delivering results; Comprehensive management key to mitigating specialty trend; Drug coupons raise cost concerns; and Plan sponsors embrace data-driven pharmacy care. (Express Scripts)

Arizona Now Allowing Some Religious Employers' Health Plans to Opt Out of Contraceptive Drug Coverage Mandate
"[The new law] applies only to 'religiously affiliated' employers, which are defined as non-profit groups that primarily employ and serve individuals of the same religion or religiously motivated organizations with articles of incorporation clearly stating that religious beliefs are central to the organization's operating principles." (The Arizona Republic)

Some States Mandating Better Coverage of Oral Medications Used for Cancer Treatment
"In contrast to conventional IV chemotherapy, which often kills both cancer and healthy cells alike, many of the new oral oncology drugs target specific biologic processes in cancer cells and block their growth. In addition to being highly effective, they're convenient, especially for patients who live far from a treatment facility.... Health plans, however, have been slow to adjust to the change. People who get traditional IV chemotherapy on an outpatient basis often pay a flat co-payment that covers the drug as well as the cost of administering it. Annual out-of-pocket costs are also typically capped. Oral anti-cancer medications, on the other hand, are generally considered a pharmacy benefit. Instead of a co-payment, plan members often pay a percentage of the drugs' cost -- up to 50 percent in some cases -- with no annual out-of-pocket limit." (Kaiser Health News)

Why Your Drug Co-Pay Could Change
"What if how much you paid for a drug was based on how much it might help you, instead of the sticker price? Some big employers are already taking this tack, known as value-based insurance design, by lowering copayments for medicines to manage chronic conditions like diabetes, high cholesterol and high blood pressure." (NPR)

Co-Pays Rising for Expensive Specialty Drugs
"Health plans' spending for each patient using these drugs often exceeds $1,200 per month, according to the center's report. Although they account for just 1 percent of prescriptions, specialty drugs make up 17 percent of drug spending[.]" (Kaiser Health News)

House Ways and Means Panel Mulls FSA Coverage for OTC Medicines
"The House Ways and Means Oversight Subcommittee ... considered a $5-billion provision ... in the [ACA] that prohibits using certain tax-favored spending plans to reimburse taxpayers for the cost of over-the-counter ... medicines. GOP lawmakers said requiring taxpayers to visit a doctor is tantamount to a tax increase that would clog physicians' offices, thereby reducing health care access for millions of American families." (Wolters Kluwer Law & Business / CCH)

Specialty Drug Spending Accounted for 20% of Total U.S. Drug Expenditures in 2009
"Spending for specialty drugs has grown between 15 percent and 20 percent for the last several years ... -- despite the fact that such drugs are used by only 1 percent to 5 percent of the U.S. population, according to a recent report from the Pharmacy Benefit Management Institute.... The report -- the 2011-2012 PBMI Prescription Drug Benefit Cost and Plan Design Report -- projects the growth in spending on specialty drugs will continue to outpace non-specialty drug spending." (Human Resource Executive Online)

[Guidance Overview] CMS Issues Medicare Part D Benefit Parameters for 2013
"These parameters will be used by group health plan sponsors to determine whether their plans' prescription drug coverage is creditable for 2013. The information is needed for the disclosures that must be made annually and at other specified times to Part D eligible individuals and to CMS." (Thomson Reuters/EBIA)

[Opinion] Text of Consumer-Directed Health Coalition's Letter Urging Repeal of Prescription Requirement for HSA-Eligible OTC Drugs (PDF)
"[The Coalition supports] ... H.R. 2529, which would repeal ... the PPACA's restriction that Health Savings Account ... or Flexible Spending Account ... dollars may only purchase over-the-counter ... medical items when a physician prescription is obtained by an individual.... [which] trigger[s] additional but unnecessary health care costs to the consumer." (Consumer Directed Health Coalition)

Present Law and Background Relating to Tax Treatment of Cost of Over-the-Counter Medicine as Medical Care Expense
Scheduled for a Public Hearing before the Subcommittee on Oversight of the House Committee on Ways and Means on April 25, 2012. "Specifically the summary discusses the law before and after the enactment of section 9003 of the Patient Protection and Affordable Care Act ... which provides that any exclusion from income for such reimbursement or use of HSA funds only applies to the cost of over-the-counter medicine if the medicine is prescribed by a physician. This document also discusses issues related to the tax treatment of the cost of over-the-counter medicine as a cost of medical care and provides selected data on over-the-counter medicine." (Joint Committee on Taxation)

[Guidance Overview] Health Plan Sponsors Assessing Effect of 2013 Medicare Part D Indexed Amounts
"[This publication provides] charts comparing the 2013 [Medicare Part D standard defined benefit and Retiree Drug Subsidy (RDS) amounts] to the 2012 numbers. It also reviews changes to the Part D benefit, which were made by the Affordable Care Act, and illustrates the impact of those changes on the 2013 benefit.... Plan sponsors should note the new benefit amounts for planning purposes for 2013 � both with respect to expected RDS income and to the design of any Medicare Part D prescription drug plan that is offered to retirees." (Segal)

[Guidance Overview] Final Medicare Part D Regulations Include Coverage Gap Discount Program
"The regulations include changes reflecting HHS' experience to date in administering Part D and will be of interest to sponsors of Part D prescription drug plans. In addition, some group health plans must coordinate with Part D prescription drug plans, among other reasons, to determine which coverage pays first and to disclose to Part D individuals whether the group health plan coverage is creditable." (Practical Law Company)

States Seek To Limit Co-Pays for Costly Drugs
"[Lawmakers in at least 20 states] have introduced bills that would limit out-of-pocket payments by consumers for expensive drugs used to treat diseases like cancer, rheumatoid arthritis, multiple sclerosis and inherited disorders. Pharmaceutical companies would also benefit from such legislation because high co-payments discourage patients from taking their medicines." (The New York Times; free registration required)

And Then There Were Two: Express Scripts Completes Medco Acquisition
"The three biggest [pharmacy benefit management companies] were reduced to two Monday when Express Scripts Inc., completed its $29.1 billion acquisition of Medco Health Solutions Inc.... The deal went through once the Federal Trade Commission said ... it would not block the move, but that decision was controversial and will not end a legal fight, if independent pharmacists have any say." (The Philadelphia Inquirer)

[Opinion] American Benefits Council Letter to House Judiciary Subcommittee Opposing H.R. 1946, Preserving Our Hometown Independent Pharmacies Act of 2011 (PDF)
"[The council opposes] H.R. 1946 because its principal impact is likely to be to increase costs to our employer members and their employees for prescription drug benefits. Indeed, permitting price fixing by pharmacies in their dealings with health plans appears to be the primary aim of H.R. 1946." (American Benefits Council)

Lower Copays Help Ensure Medication Adherence
"[In addition], the study authors suggested that insurers take such steps as referring asthmatic children to specialists, providing families with written treatment plans and better explaining the importance of regular medication use.... Insurers also should consider fully covering services and interventions that promote overall child health because it could help prevent chronic diseases from developing as the children grow up[.]" (FierceHealthPayer)

Impact of an Online Prescription Management Account on Medication Adherence
"Patients who utilized an online prescription management account had higher rates of medication adherence as compared with nonusers. Additional studies are needed to assess which specific components of the prescription management account have the biggest impact on adherence." (The American Journal of Managed Care)

First Annual Specialty Drug Benefit Report
"Total healthcare costs and specialty drug costs were the most important reported outcome across health plans and employers. More clinically-oriented outcomes, including medication adherence, disease progression, and quality-of-life, were much less frequently identified as the most important outcome for both employers and for health plans." (Pharmacy Benefit Management Institute)

Generic Medication Program Targets Pharmacy Benefits Costs
"A maintenance medication wrap-around program gaining ground among some self-funded middle-market employers demonstrates that when it comes to health benefits, sometimes it costs less to pay a bigger share." (Business Insurance; free registration required)

How to Manage Pharmacy Benefits Plans in a Rapidly Changing Pharmaceutical Landscape (PDF)
"[One consideration is the o]ngoing consolidation of the pharmacy benefits manager (PBM) marketplace, which has created a "buyer's market" of PBM services for employers." (Buck Consultants)

Health Insurance Plans Sue Drug Companies over Coupons
"Coupons for drug co-payments are illegal and drive up long-term health-care costs for all, a consumer group and four trade-union health-insurance plans said ... in announcing lawsuits against eight pharmaceutical companies. Drug companies use co-pay coupons to entice patients to stay with higher-cost brand-name drugs and not switch to lower-cost generics." (philly.com)

Trends in Retail Prices of Prescription Drugs Widely Used by Medicare Beneficiaries, 2005 to 2009 (PDF)
"AARP Public Policy Institute's first look at retail prices for a combined set of widely used prescription drugs finds that the cumulative change in retail prices was almost double the rate of inflation between 2005 through 2009." (AARP Public Policy Institute)

Senate Defeats Amendment to Overturn Prescription Contraceptive Rule
"Proposed by Sen. Roy Blunt, R-Mo., the amendment to a broader highway bill -- S. 1813 -- would have allowed employers and insurers to deny coverage of items or services if the coverage would be contrary 'to the religious beliefs or moral convictions' of the sponsor or issuer." (Business Insurance)

Low Premiums, Zero-Dollar Deductibles and Preferred Pharmacy Networks Winning Strategies for Medicare Part D Sponsors Last Open-Enrollment Period
"Both the Humana Walmart-Preferred Rx Plan and Coventry Health Care, Inc.'s First Health Part D Value Plus succeeded at netting new enrollees. And UnitedHealth Group's AARP MedicareRx Preferred plan lost 12% of its members, although it still remained the market leader." (AISHealth)

GAO Report on Drug Pricing: Research on Savings from Generic Drug Use
"[GAO was asked] to identify research completed on estimates of cost savings from the use of generic drugs in the United States. This report summarizes the findings of peer-reviewed articles, government reports, and studies by national organizations, including trade and nonprofit organizations, on this topic. [Podcast of audio interview by GAO staff with John Dicken, Director, Health Care is at http://www.gao.gov/multimedia/podcasts/588917.]" (U.S. Government Accountability Office)

[Guidance Overview] Creditable Drug Coverage Disclosure Due to CMS, but Website Problems May Hamper Filing
"By Feb. 29, employers with calendar-year plans providing prescription drug benefits to Medicare-covered people must disclose whether their plans' coverage is 'creditable' to [CMS]. Plan sponsors must make this disclosure even if a plan covers only active employees or is fully insured. Sponsors must use CMS' web-based disclosure form and provide information about themselves and the coverage options they offer. Because the CMS website is frequently unavailable, sponsors may submit their information later; no penalties apply for late filing." (Mercer)

How to Manage Pharmacy Benefits Plans Part 5, Conclusion: Opportunity in the Marketplace
"Marketplace forces at play create challenges for plan sponsors to manage their pharmacy benefits plans effectively. These forces also present savings opportunities for employers, provided realistic strategies are developed and implemented effectively." (Buck Consultants)

How to Manage Pharmacy Benefits Plans Part 4: Specialty Drugs, the New Major Cost Driver
"Pharmacy benefits plans are increasingly under cost pressures from biotechnological drugs ? new specialty drugs for the treatment of chronic diseases ? that in the next 3 years could account for almost half of an employer's annual health care plan costs." (Buck Consultants)

An Evaluation of the Impact of Patient Cost Sharing for Antihypertensive Medications on Adherence, Medication and Health Care Utilization, and Expenditures
"The trend has been for managed care organizations and employers to require patients to bear a greater out-of-pocket burden for health care resources consumed. This study illustrates the potential adverse effects of higher patient cost sharing among patients with hypertension stratified by different risk levels. A decrease in the proportion of days covered was predictive of higher resource utilization and health care costs, which should be of interest to payers and employers alike." (Dovepress)

How to Manage Pharmacy Benefits Plans Part 3: As Pharma Consolidates, Even Smaller Employers Can Negotiate
"Just 3 years ago, there were few opportunities for employers with 10,000 or fewer covered lives to negotiate with the PBMs. Today, the intense competition among the PBMs for employer business has opened up the possibilities to these employers to strike better arrangements. Competitive bidding by, and follow-on negotiations with, PBMs have enabled larger [employers] to achieve even greater savings that before. As a result, virtually all financial and non-financial terms are negotiable." (The Benefit of Benefits - A Buck Blog)

How to Manage Pharmacy Benefits Plans Part 2: Poor Drug Adherence Can Play Havoc with Pharmacy Benefit Plans
"A key element in any pharmacy benefit plan involves providing up-front guidance to plan members through a clinical management program, built into the plan terms. Sound clinical programs are critical in managing pharmacy benefit costs by minimizing unnecessary drug use and waste. The overriding objective of clinical programs is to ensure that members receive the right drug for the right condition at the right dose at the right time." (Buck Blog)

Americans Weigh in on Contraception Rule
The target page provides links to [1] The Public Religion Research Institute's survey of public opinion on whether certain categories of religiously affiliated employers, such as Catholic hospitals or universities, should be required to include birth control in their health insurance coverage; and [2] Gallup's polls asking Americans their views on how President Barack Obama is handling health care policy. (Kaiser Health Reform)

Bishops Reject White House's New Plan on Contraception Coverage
"The United States Conference of Catholic Bishops -- which has led the opposition to the [Obama administration's contraception coverage mandate] -- said in a statement late Friday that the solution offered by the White House to quell a political furor was 'unacceptable and must be corrected' because it still infringed on the religious liberty and conscience of Catholics." (The New York Times; free registration required)

White House Compromise Still Guarantees Contraceptive Coverage for Women
"The compromise goes beyond similar accommodations in Hawaii and several other states, because in those states, insurers can charge an extra premium for the contraceptive coverage. Administration officials did not explain why the compromise was not incorporated earlier, despite the fact that it had been widely discussed as early as last fall." (The Washington Post; free registration required)

Obama Compromises Amid Catholic Contraception Coverage Anger
"Under the new plan put forward by the White House health insurance companies, rather than the employer, will be required to offer contraception directly to employees of religious-linked institutions if requested. The institutions -- such as universities or hospitals -- would not be required to subsidize the cost of offering birth control to their employees, nor would they be asked to refer them to organizations that provide it." (BBC News)

Bishops Stand Strong Against Birth Control Coverage Mandate
"Polls show most people, including Catholics, want access to birth control and favor the administration's mandate. But [Rev. Tom Reese of Georgetown University's Woodstock Theological Center] says they also bristle at government pushing a religious entity to violate its beliefs." (National Public Radio)

Financial Burden from Prescription Drugs Has Declined Recently for the Nonelderly
"For example, one in four nonelderly people devote more than half of their total out-of-pocket health care spending to prescription drugs." (Health Affairs)

How to Manage Pharmacy Benefits Plans: Part 1: Getting the Plan Design Right
"As pharmacy plan costs have risen and the economy has deteriorated, many employers have made significant changes in their pharmacy benefits plan designs. Two key plan design trends have emerged during the past 5 years, which were validated in the findings of our 2011 Prescription Drug Benefit Survey Report: 1. A shift from 2-tier to 3-tier cost sharing to encourage plan members to switch to lower-cost generic drugs and formulary brand drugs. 2. A shift from flat-dollar co-pays to co-insurance to minimize cost-shifting to the employer as drug costs rise." (Buck Blog)

Effects of Pharmacy Benefit Carve-in on Utilization and Medical Costs (PDF)
"A study finds that plan sponsors offering health care benefits that include a carved-in pharmacy benefit are likely to experience significant medical cost savings over carving out the pharmacy benefit." (Benefits Magazine)

[Opinion] Over-the-Counter (OTC) Medicine Saves Healthcare System Billions
"[T]he study findings underscore the importance of reversing a provision in the 2010 Affordable Care Act (ACA) that prohibits consumers from using their flexible spending arrangements (FSAs) to purchase OTC medicines without first getting a prescription. At the time this provision was enacted, an estimated 19 million working American families purchased OTC medicines, relying on these accessible and affordable medicines to keep their families healthy." (Consumer Healthcare Products Association)

[Opinion] PBM Merger Would Mean More Bad News for Consumers
"Small and independent pharmacies may not fit into the [pharmacy benefit manager] industry's vision for the future. But community pharmacies and pharmacists are the most affordable and accessible health care provider in many communities -- and underserved communities in particular. Certainly their loss will have an adverse affect on patient care and outcomes." (Eva M. Clayton in the Huffington Post)

[Guidance Overview] Deadline for Calendar Year Health Plans to Submit Creditable Coverage Disclosures to CMS is February 29 (PDF)
"Group health plan sponsors that provide prescription drug coverage to those eligible for Medicare Part D must disclose to CMS on an annual basis whether the coverage qualifies as creditable or non-creditable." (Buck Consultants)

[Opinion] Pharmacy Benefit Managers Have Emerged as Vocal Critics of Drug Industry's Reliance on Copay Cards, Coupons, and Other Tools
"The PBMs' leading trade group -- the Pharmaceutical Care Management Association -- has taken the position that the practice represents an additional driver of costs to the health care system." (The Institute for HealthCare Consumerism)

A Four-Part Prescription for Managing the Cost of Pharmacy Benefits
"This NewsLetter discusses four emerging strategies for managing the cost of prescription drug coverage, one of which also aims to enhance the value of the coverage to participants: Review retail pharmacy networks, Maximize the utilization and cost effectiveness of generic drugs, Combat direct-to-consumer 'couponing' by brand-name drug manufacturers, and Improve drug-therapy adherence through plan design and the promotion of personal contact between participants and their pharmacists." (The Segal Group, Inc.)

Health Plans Seeking the Cost Savings of Generic Drugs Must Still Remain Vigilant for Overcharges
"Employer plans appear vulnerable to at least two forms of pharmacy fraud, according to the U.S. Health and Human Services Department's Office of Inspector General: collecting brand name prices for dispensing generics; and 'dispensing fees.'" (SmartHR)

Psychiatric Group Pushes to Redefine Mental Illness Sparks Revolt
"The draft is sparking a backlash among practitioners concerned the expanding mandate will increase the number of patients treated with drugs. The guide would loosen diagnostic criteria on some existing ailments and brand as mental disorders some common behaviors . . . ." (Bloomberg)

U.S. Consumers Tell Insurers to Cover Experimental Drugs
"62% of Americans 'oppose decisions by the government or health insurance plans' to deny care if those entities determine that the benefits of that care do not justify its costs." (Reuters via Employee Benefit News)

New Cancer Drugs Affordable By The 1 Percent?
"[A]n economic drama . . . is playing itself out in cancer wards and oncologists' offices across the country. Unaffordable new drugs, even when they're covered by insurance, are being rationed by price as patients, doctors and hospital officials struggle with what is likely to be the most pressing problem for the nation's health care system over the next decade: how to pay for the spectacular rise in the cost of cancer care, especially drugs and diagnostic tests." (The Fiscal Times)

What to Make of The 'That's What PBMs Do' PR Campaign
"On the whole the campaign is accurate. On the whole the campaign is accurate. . . . But there are certain omissions and misleading statements. . . . Rebates -- which represent revenue from the pharmaceutical industry to PBMs -- are not discussed." (Health Care Solutions And Benefits Management)

Walgreen-Express Scripts Pricing War Could Cut Drug Costs
"Starting this month, plan participants at most companies that contract with Express Scripts for PBM services can no longer get prescriptions filled at any of Walgreen's approximately 8,000 locations. The two companies were unable to reach an agreement to renew the contract under which Express Scripts paid Walgreen to fill its clients' prescriptions." (CFO Publishing LLC)

[Official Guidance] HHS Final Rule: Payments to Sponsors of Retiree Prescription Drug Plans (PDF)
"This final rule implements and finalizes provisions regarding thereporting of gross covered retiree plan-related prescription drug costs (gross retiree costs) and retained rebates by Retiree Drug Subsidy (RDS) sponsors; and the scope of our waiver authority under the Social Security Act . . . . DATES: Effective Date: These regulationsare effective on March 12, 2012." (U.S. Department of Health & Human Services)

[Opinion] AARP Asks U.S. Supreme Court to Uphold Competition in Prescription Drug Market
"AARP's brief in Caraco v. Novo Nordisk, filed by attorneys with AARP Foundation Litigation . . . . parses the language of the [Hatch-Waxman Act and its 2003 amendment], reviews the debates leading up to its enactment, details the skyrocketing escalation of pharmaceutical drug costs and the devastating effect these costs have on public health, and reviews the 'gamesmanship' brand name manufacturers use to protect their exclusivity." (AARP)

No Co-Pay Pays Off for Pharmaceutical Firms
"Several large pharmaceutical companies . . . go beyond discounts and provide their prescription products with no co-payment to employees who have a script, and the reason is simple: profit. . . . [A]s employers, pharmaceutical companies are [no different from other companies] in wanting to keep employee health-care costs low. The drug industry - like many doctors - is a proponent of patients taking medication prescribed by a physician." (The Philadelphia Inquirer)

Americans' Access to Prescription Drugs Stabilizes, 2007-2010
"While remaining stable overall, access to prescription drugs improved for working-age, uninsured people, likely reflecting a decline in visits to health care providers, as well as changes in the composition of the uninsured population." (Center for Studying Health System Change)

New Law Bans Mail-Order Drug Mandates in New York
"The bill barred insurers or employers from forcing patients to use mail-order plans for prescription drugs, except for plans negotiated by unions." (The New York Times; free registration required)

Obese People Use More Medications, According to Study
"Medications to treat high blood pressure and high cholesterol topped the list. Roughly a third of obese adults over the age of 20 used at least one drug to lower blood pressure and one in five used a cholesterol-lowering drug. That compares to about 17% of normal-weight adults on blood pressure meds and one-in-10 on cholesterol drugs." (Reuters via Employee Benefit News)

Catholic Groups Fight Contraceptive Mandate, but Many Already Offer Coverage
"[W]hile some insist that the rules, which spring from last year's health law, break new ground, many states as well as federal civil rights law already require most religious employers to cover prescription contraceptives if they provide coverage of other prescription drugs." (NPR)

Chronic Disease May Increase Out-of-Pocket Costs for Insured
"Among families with employer-sponsored health care plans, those coping with chronic illness pay more out of their pockets than those without chronic illness, primarily because of higher prescription drug copayments, a new study finds." (HealthDay via U.S. News & World Report LP)

Managing Pharmacy Benefits
"Complex pharmaceutical issues require HR leaders to take a multi-faceted approach to strategic plan designs that balance employee needs with financial prudence. Education and communication to ensure employees understand the impact of their pharmacy choices are also crucial." (Human Resource Executive Online)

Cost-Effectiveness of Potential FEHBP Reforms Questioned
"The Office of Personnel Management has attributed the smaller [premium] increase in part to its ability to leverage the program's nearly 8 million participants and is seeking to take that a step further with changes to FEHBP's prescription drug options. But some observers question whether that buying power brings federal workers the best value -- or even the best benefits." (Government Executive)

Probe Continues Into Reform Law Dealings Between White House and Pharmaceutical Manufacturers
"The inquiry [by the House Energy and Commerce Subcommittee on Oversight and Investigations] aims to answer the following: Did the Obama administration and outside stakeholders make deals that exchanged policy outcomes for public support of the law; if so, who made such deals; was Congress left out of the discussions; what issues were negotiated; and what, if anything, did the White House gain in the arrangement." (Modern Healthcare)

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