If it seems like less people around your office are taking sick days this year, it may be due to the fact that the flu bug has been hibernating. NPR’s Shots blog reports that in the 29 years since the Centers for Disease Control and Prevention began tracking influenza, this is the slowest start to a flu season ever.
“Flu season usually kicks off in a big way in late December early January,” says the CDC’s Lyn Finelli. “It peaks at the end of February or the beginning of March and we usually have influenza around until May.”
Flu specialists are uncertain why the season has been so mild, but Finelli thinks that the warm winter may be a factor. “We know that influenza virus survives best in cool and dry conditions,” Finelli said. And when it’s cold outside, people tend to stay indoors, which raises the risk of coming in contact with someone who’s got the bug.
Also playing a part may be the fact that the main flu viruses this year have been around for a couple of years already, and people have built up an immunity.
Finally, 36% of Americans have gotten a flu shot, up from 32% last season. Vaccination “remains the most effective method to prevent influenza and its complications,” according to the CDC report.
Is it possible that the Obama administration could strike the individual mandate from the Affordable Care Act even it the Supreme Court finds the provision constitutional? If they’ve been tracking the mood of the nation lately, then it could very well happen.
According to a new Gallup poll, Americans are fairly split on if they would want a GOP president to repeal the entire health care reform law – 47% say yea, while 44% say nay. But on the specific issue of the individual mandate, 72% of Americans polled believe it to be unconstitutional.
Certainly, opinions differ greatly along party lines, with over 9 out of 10 Republicans opposing the requirement that most Americans buy health insurance or pay a penlty. But even a majorty of Democrats (56%) diagree with the mandate as well.
A separate USA Today/Gallup poll also reveals opposition to the ACA in total, by voters in critical swing states. Over half of respondents consider the health care reforms “a bad thing", while 38% see it as a “good thing". The partisian divide is strong here as well – 87% of Republicans favor repeal of the health care overhaul, while 77% of Democrats oppose it.
Despite the greater availabilty of inexpensive generic alternatives, prescription drugs are still an expensive proposition for many people. To help those of us for whom medication is a mainstay of the monthly budget, WebMD offers these “Dos” and “Don’ts” for cutting drug costs, which we summarize below:
Another useful “Do": Do check out RxEOB. This online service, available to many MedBen pharmacy plan members, allows patients learn about possible lower cost generic and therapeutic alternatives. Simply log in to the MedBen Access site and click on “My Rx”.
Ezra Klein’s Wonkblog in The Washington Post posted an interesting chart recently, one which offers some insight into the reasons behind differences in health care costs from one region to another.
The chart, which is based on research from the National Institute for Health Care Reform, breaks down health care spending variations by American autoworkers employed by Chrysler, Ford and General Motors. The data represents over one million people who receive health care benefits at 19 different sites across the country.
The researchers found a wide variance in spending, from $4,500 per worker in Buffalo, N.Y. to $9,000 in Chicago. The majority of the variation (37%) was due to difference in health status: the unhealthier the worker population, the higher the spending.
Differences in how much providers charged for the same service also had a considerable impact (33%) on spending variations. “In the lowest-price communities – Syracuse and St. Louis – the autoworker prices are 30% above Medicare,” the researchers noted. “In the highest-price community – Lake County – the autoworker price is more than two-and-half times the Medicare price.”
Excess use of health care and difference in age and sex together accounted for 28% of spending, while differences in providers’ business costs made up the balance.
Not only is breakfast the most important meal of the day, it may also be the best opportunity for dieters to lose weight… and you can have ice cream if you want. At least, that’s the conclusion of a study by Tel Aviv University.
According to Medical Xpress, researchers found that by adding dessert – such as cake, cookies or chocolate – to a balanced breakfast, dieters will lose more weight, and keep it off in the long run.
For the 32-week study, 193 clinically obese, non-diabetic adults were randomly assigned to one of two groups and given diets with similar caloric intake (1,600 daily calories for men, 1,400 for women). But the first group had to stick to a diet low in carbohydrates, while the second was given a breakfast high in carbs and protein, and allowed a dessert item.
After 16 weeks, both groups had lost an average of 33 lbs. per person. But in the second half of the study, the low-carb group regained an average of 22 lbs. per person, while the dessert group lost another 15 lbs. each.
The authors of the study say that because the body’s metabolism is at its most active in the morning, it’s better to indulge during breakfast. That gives the body extra time to work off calories throughout the day. Further, by allowing yourself a daily treat, you remove the craving that often accompanies diet deprivation, which means you’re more likely to stay the course.
The perpetrators of health care wrongdoing have undoubtedly been sleeping a lot less easy of late. In fiscal 2011 alone, the federal government recovered $4.1 billion in fraudulent health care payments – the largest amount ever collected in a single year, according to federal officials.
MedPage Today reports that between 2009 and 2011, enhanced efforts to combat fraud resulted in a 50% increase in judgments and settlements of payments fraudulently obtained from Medicare and Medicaid. Last year, criminal charges were filed against 1,430 defendants for fraud-related crimes, 743 of whom were convicted.
The Affordable Care Act has earmarked $350 million to fight health care fraud. Common cases include durable medical equipment fraud; illegal marketing of medical devices or drugs for uses not approved by the FDA, including unlawful pricing by drugmakers; and violations of self-referral and anti-kickback laws.
At MedBen, we share a similar dedication to protecting clients against fraud (with a slightly smaller budget, of course). Our Anti-Fraud Unit reviews questionable claims, and other related information, to help conserve plan assets. We also belong to associations formed to share information regarding possible fraudulent activities, and the data we obtain from them is compared against our claims detail daily.
For additional information on how MedBen’s anti-fraud efforts, contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
Direct on the heels of yesterday’s mammogram news comes a report that says colonoscopies can reduce the risk of dying from colon cancer by half. It marks the first time a major study has offered clear evidence of the usefulness of such screenings, according to the Associated Press.
Researchers at Sloan-Kettering Cancer Center in New York tracked 2,602 patients who had precancerous growths removed during colonoscopies for an average of 15 years. They found that 12 patients in the study group died from colon cancer – 53% less than the 25 estimated deaths that would be expected among a similar group in the general population.
A second study in Europe revealed that colonoscopies are more effective at finding polyps than tests that look for blood in stool, another popular (and far less expensive) screening technique.
The American Cancer Society says that deaths for colorectal cancer have decreased for more than two decades, primarily due to colonoscopies and other screening tests. But only about half of Americans who should get screened actually do – likely in part because of the somewhat unpleasant preparation required. The organization is hopeful that the studies will help more people realize that the benefits outweigh any discomfort.
MedBen follows ACS guidelines, which recommend that people with an average risk of developing colon cancer get screened starting at age 50.
Cincinnati, Dayton and Cleveland, Ohio are among the top ten cities for emergency medicine quality, according a new report.
Based on an analysis of 7 million Medicare patient records from 2008 to 2010, researchers determined that patients admitted to the top U.S. hospitals for emergency care have a nearly 42% lower death rate than those admitted to other hospitals in the nation. That represents about 170,000 more people who would have survived had their care been equivalent to the top-ranked hospitals, says HealthGrades, an independent provider of consumer information about doctors and hospitals.
According to Medical Xpress, the report found that emergency-room admissions for heart attacks fell 1.7% between 2008 and 2010, while admissions for stroke rose 2.2%. It also noted that 61% of senior hospital admissions begin in the emergency room, the highest of all age groups.
Other cities with the lowest risk-adjusted death rates for patients admitted through the ER were: Detroit; Milwaukee; Phoenix-Prescott, Ariz.; West Palm Beach, Fla.; Baltimore; Traverse City, Mich.; and Fargo, N.D.
The overwhelming support for Qnexa came as something of a surprise, as concerns about potential risks of heart problems and birth defects had lead an earlier FDA advisory panel to reject it. But some of the same members who opposed it perviously said they were reassured this time that the drugmaker Vivus would take measures to minimize the risks, such as recommending that pregnant women not get the medication.
The committee was also swayed by the contention of Vivus and some obesity specialists that excessive weight carries its own set of risks.
The FDA is expected to decide whether to approve Qnexa by April 17. If approved, it would be the first new prescription drug to treat obesity in 13 years.
A new study suggests that when women in their 40s get breast cancer, their tumors require less intense treatment and recur less if they were first detected through a regular mammogram screening. Nearly 2,000 women diagnosed with first-time breast cancer at age 40 to 49 participated in the research, which took place between 1990 and 2008.
As WebMD reports, the finding bolsters the recommendation by the American Cancer Society (ACS) that women start breast cancer screening in their 40s. The U.S. Preventive Services Task Force (USPSTF) had previously concluded that women should wait until their 50s to begin screening, but does accept the fact that starting earlier does cut the death rate.
“If you have mammography-detected breast cancer in your 40s, it is less likely to need radical surgery or chemotherapy,” says study co-leader Judith A. Malmgren, PhD. “All the USPSTF looks at is mortality. But should we not also consider as benefits the reduced need for treatment and less relapse?”
MedBen follows ACS mammogram screening guidelines for women 40 and over, with the caveat that women should be made aware of both risks and benefits. And a reminder for our female Worksite Wellness members: you can monitor your compliance with mammograms and other critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
In order to head off critical cancer drug shortages, The Food and Drug Administration is loosening up its rules regarding the importation of unapproved foreign drugs, Bloomberg reports.
Detroit-based drugmaker Caraco will temporarily import the drug Lipodox from its Mumbai, India-based parent, Sun Pharmaceutical Industries. Lipodox contains the same active ingredient as Doxil, used for treating ovarian cancer and multiple myeloma.
In a statement announcing the action, the FDA said the supply of Lipodox “is expected to end the shortage and fully meet patient needs in the coming weeks.”
The agency has also given expedited approval to APP Pharmaceuticals for a generic form of methotreaxate, used for leukemia and tumors of the breast and lung. The product is expected to become available in March.
Methotreaxate and Doxil are among 220 types of drugs deemed to be in short supply in the U.S. by the American Society of Health-System Pharmacists.
The Supreme Court will hear challenges to the Affordable Care Act beginning on March 26, and as we approach the date, most of the talk has centered on the constitutionality of the individual mandate. But as reported in USA Today, the justices first have a decision to make that may put the constitutionality question on the back burner for several years.
People who refuse to buy health insurance by 2014 will face a financial penality, which is considered a “tax". When the legality of a tax is challenged, a federal policy requires that a person must first pay the disputed tax and seek a refund before bringing a lawsuit. And should the Supreme Court find that the policy pertains in this case, the legal fight over the individual mandate could be delayed, possibly until 2015.
None of the main parties to the litigation is arguing for that option, but it is conceivable that the legal interpretation of the policy leaves the justices with no choice but to delay. Further, if the ideological divide between the justices is too wide to brook, the option could become an useful way to settle the dispute – for the time being, anyway.
Most lower court judges who considered the tax policy “out” didn’t adopt it, and the individual mandate debate would be best served by a resolution before it takes effect – but at this point, nothing is certain. Stay tuned.
Choosing generic drugs over costlier brand-name alternatives has benefited U.S. families in the wallet, The New York Times recently reported.
A study by the RAND Corporation revealed that the number of Americans living in a family that spent more than 10% of its out-of-pocket income on prescription drugs decreased from 2003 to 2008. This represents a reversal of the preceding five-year period (1999-2003), when drug costs rose annually.
The study also noted that the declines were due, in large part, to financial incentives from employers and health plans to encourage the use of generic drugs over brands. Through the use of Rx formularies – tiered lists that offer lower patient copayments for less expensive medications – prescription plan members can realize greater savings while still getting the same health benefits as with pricier pills.
At MedBen, we offers a standard (more open) formulary, as well as a high-performance formulary designed to drive drug use to lower cost drugs in class while still providing a wide range of prescribed drug therapies. And that’s in addition to superior Rx discount rates for plan members.
Employers also see significant savings through MedBen pharmacy plans. All network discounts and rebates received for both retail and mail order prescription drug claims are passed through to the group.
For additional information about MedBen pharmacy plans, please call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
“Social Security’s disability program is a political quagmire – and a metaphor for why federal spending and budget deficits are so difficult to control,” writes Robert J. Samuelson in a recent Washington Post opinion piece. According to facts he credits to economist David Autor, disability spending has increased at a 5.6% annual rate during the past two decades, compared with 2.2% for the rest of Social Security.
“The disability program, Autor writes, is a ‘central component of the U.S. social safety net’ but doesn’t help “workers with less severe disabilities’ to stay in the labor force (By law, recipients can’t be employed because disability is defined as the inability to work.) This means Social Security collides with the 1990 Americans with Disabilities Act, which aimed to keep the disabled in jobs.
“Guess which prevails. One program, Social Security, pays the disabled not to work; the other, the ADA, simply encourages their work. Money wins. In 1988, 4% of men and 2% of women aged 40 to 59 received disability benefits. By 2008, the men’s rate was almost 6% and the women’s, 5%.
“Autor attributes disability’s expansion mainly to liberalized, more subjective eligibility rules and to a deteriorating job market for less-educated workers. Through the 1970s, strokes, heart attacks and cancer were major causes. Now, mental problems (depression, personality disorder) and musculoskeletal ailments (back pain, joint stress) dominate (54% of awards in 2009, nearly double 1981’s 28%). The paradox is plain. As physically grueling construction and factory jobs have shrunk, disability awards have gone up.”
You can read the rest at The Washington Post website.
Based on some recent dietary research, one might speculate that there’s a “calories count” movement afoot. Last month, we saw evidence that fats, carbs and protein matter less in losing weight than calories. And now comes a fructose study that suggests that the number of daily calories is more important than their source.
According to HealthDay, Canadian researchers reviewed 41 studies, most in which participants consumed a similar number of calories, but one group ate pure fructose and the other ate no fructose. They found that the pure fructose had no effect on weight compared to diets that provided the same calories using other sugars.
High-fructose corn syrup, which contains about half fructose and half glucose, is commonly used in sodas and snacks, and has developed a reputation as a major contributor to obesity in America. But weight gain isn’t simply a matter of what one eats and drinks, said Connie Diekman, director of university nutrition at Washington University in St, Louis.
“The issue of weight is complex, it is not just ‘avoid this, eat that’ as some would like it to be,” Diekman said. She did note, however, that “there’s no one-size-fits-all explanation for weight gain” and that people do need to be mindful of the calories they consume and burn.
With the second anniversary of the passage of the Affordable Care Act fast approaching, it’s an appropriate time to look forward to what health plans have to do to comply with reform law in 2012. Fortunately, it’s a pretty quiet year from a compliance perspective – or at least it was, until the Department of Labor released the final SBC regulations a few weeks back.
The most intriguing aspect of reform in 2012 is, arguably, the “unknown". In March, the Supreme Court hears the cases brought by 26 states and others regarding the ACA’s constitutionality. Then in November, the Presidential election takes center stage. Both events carry the potential to alter portions of the law, or even strike it down altogether.
So while we wait for this drama to unfold, here are a few things plan administrators need to make sure to do:
Transitional Annual Plan Maximums – Effective for plan years on or after January 1, 2012, all plans that are taking advantage of the transitional annual plan maximum must make sure to increase the overall plan maximum to no less than $1,250,000.00.
Explanation of Benefits – Effective for plan years on or after January 1, 2012, all non-grandfathered plans need to make sure that they are including required language on EOBs, including references to foreign language EOB availability and additional remark and denial codes. MedBen has made the required changes to our EOBs for groups affected by this requirement.
External Review Procedures – Effective January 1, 2012, all health plans must have contracted with at least two Independent Review Organizations (IROs). By July 1, 2012, all health plans must have contracted with at least three IROs. On behalf of our clients, MedBen has contracted with two IROs for external review purposes and is in the process of reviewing a third.
On Wednesday, a weight-loss drug gets a second chance to impress the Food and Drug Administration. The New York Times reports that a committee of outside advisers to the agency will weight the benefits of the drug, called Qnexa, against concerns that it may cause birth defects and heart problems.
Qnexa is a combination of two existing drugs: the stimulant phentermine and the epilepsy and migraine drug topiramate, also known by the brand name Topamax. Some doctors already prescribe (legally) the pair to obese patients.
The FDA rejected Qnexa in 2010 following reports that the drug increases the risk of a heart attack, and that use of topiramate during pregnancy may be linked to oral clefts, such as cleft lip, in newborns. Drugmaker Vivus had then proposed that Qnexa be allowed on the market with a warning against its use by women of childbearing potential – a suggestion rejected by the FDA as overly broad.
Clinical trials of Qnexa have shown that in addition to losing weight, users had improvements in blood sugar, blood pressure and cholesterol compared to those given placebos. Even so, the advisory committee may request the Vivus conduct an additional trial to further assess the risk of heart attack – a process that could delay approval by years.
In a Wall Street Journal opinion piece, J.D. Kleinke of the American Enterprise Institute argues that better medical care and consumer choice have contributed to slowing the growth rate of national health expenditures over the past decade:
“As the graph nearby shows, the growth rate of national health expenditures, according to data compiled by the Centers for Medicare and Medicaid Services, has been moderating since 2002.
“The moderation has been driven by cumulative improvements in medical care and by insurers, and by marketplace disciplines on the demand for medical care. Consumers are finally getting more involved in managing and paying for their own care.
“Contrary to the perennial doomsaying, the health-care system is – almost in spite of itself – getting better. A generation of breakthrough drugs for chronic disease, mental illness, HIV and cancer were developed in the 1980s and ’90s at great cost. Dozens of these drugs – like Zocor for heart disease or Zyprexa for schizophrenia – are now widely available, many in generic form. There are now countless electronic ways of telling patients about them. And health insurers are driven by their own evolving market disciplines to make sure patients start taking them and keep taking them in the cheapest available versions.
“Combine all these new medicines, information channels and business compulsions with the slow, steady transfer of economic responsibility for health care – from corporate and government bureaucrats to consumers and their families – and suddenly health-care starts to look almost like an actual market.”
Here’s a eye-opener for anyone who has thought about bypassing their doctor and buying medications online without a prescription: Most websites that sell Lipitor and other cholesterol pills fail to provide vital information about contraindications (factors which may increase the drug’s risk), key warnings and side effects.
The Pharmalot blog reports that a recent British study found that the 92% of the websites were lacking general contraindications, while information about contraindicated medicines was absent on 47.3%. Warnings were missing about symptoms associated with myopathy (37% absent), liver disease (48%), hypersensitivity (9%) and pancreatitis (96%). Only 7% listed side effects compatible with current prescribing infomation.
“This has potentially serious implications for the safety of purchasers who may not be aware of the problems associated with ordering medicines online or the actual medication, which they receive. Direct to consumer advertising websites need tighter controls,” wrote the authors in the latest issue of Pharmacoepidemiology & Drug Safety.
The study also noted that 95% of the websites didn’t bother to mention that the drugs were precription-only, and 92% didn’t state that they should only be taken by adults. And just 46% of the sites noted that the buyer should speak with a physician if they’re aleady using other medicines.
As part of an effort to encourage more small businesses to provide health care coverage, the Obama administration has expanded the Affordable Care Act’s healthcare tax credit to $14 billion in its proposed fiscal 2013 budget.
According to Modern Healthcare, the proposal would raise the size of small businesses allowed to claim tax credits from the existing 25 or fewer workers to 50. Additionally, the tax credits themselves will cover up to 50% of employee premiums beginning in 2014, a 15% increase from the current standard.
“We need to make it easier for small-business owners to provide insurance to their employees right now,” said Karen Mills, the administrator of the Small Business Administration, in a conference call with reporters Thursday.
The administration also said it would promote greater interest in the healthcare tax credit plan by better publicizing the incentives and simplifying the application process.