Headlines about "Health plan costs - prescription drugs"
Gathered from the web by the editors at BenefitsLink.com.
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)
Employers Explore PBM Integration: Advantages Seen in Single Program for Health Insurance, Workers Comp
"Consolidated services are getting a closer look as employers strive for savings, insiders say, despite differences in the insurance programs that make pharmacy benefit integration a challenge." (Business Insurance)
Social Security Applications in Spanish Now Available on Website
"To make the process easier for Spanish speakers with limited English skills, the Social Security Administration has translated the applications for the following benefits: Retirement benefits . . . . Medicare benefits . . . . Prescription drugs benefits . . . ." (PLANSPONSOR.COM)
Prescription Drug Benefit Plans Increasingly Incorporate Multiple Tier Copayments
"Cost sharing design for prescription drug benefit plans became increasingly complex in 2011 as more plans adopted four-tier copayment structures [as found in a] recent 2011-2012 Prescription Drug Benefit Cost and Plan Design Report." (Wolters Kluwer Law & Business / CCH)
Pharmacists Form Coalition To Make Drug Prices More Transparent
"A national coalition of pharmacists and pharmacy owners announced last week a public information campaign to expose the unjustifiably high prices of prescription drugs set by pharmacy benefit managers, the unregulated, multibillion dollar industry that controls prescription health plans for more than 200 million Americans." (Employee Benefit News)
The links shown above have been gathered from the web by the editors at BenefitsLink.com. Each article's publisher is shown above in parentheses. Opinions expressed in each article are those of the article's publisher, not necessarily those of BenefitsLink.com, Inc. or any web site that displays these headlines in a "frame." You should contact the listed publisher for copyright information about any particular article or to inquire into the right to use the article in any manner.