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.
It’s Friday, and therefore, the perfect time to talk sweat.
It’s one of life’s little injustices that some people just tend to perspire more than others. Occasionally, heavy sweating may be caused by a medical condition or medication, in which case your doctor may be able to help.
Most of the time, however, it’s the simple combination of genes and environment that determine our level of perspiration. Fortunately, there are ways to keep sweat to a minimum, regardless of circumstances. WebMD has put together a list of helpful hints on its website – we’ll highlight a few here.
Most older members of the U.S. workforce have vision care coverage, but not all of them take full advantage of their benefits, Employee Benefit News reports.
A recent Transitions Optical survey found that 79% of baby boomers have enrolled in a group vision plan. However, one-third of them say that don’t bother to schedule regular eye exams – leaving them at a higher risk for age-related vision problems and chronic conditions that affect eye health and compromise productivity.
“A quality vision benefit is important for everyone, but especially for employees ages 45 and older, who are more likely to experience vision problems that hurt job performance. This age group also has a higher risk for developing costly eye diseases and whole body conditions such as diabetes and hypertension, all of which can be detected through comprehensive eye care,” says Pat Huot, director of managed vision care at Transitions Optical.
MedBen encourages its customers to get their eyes checked regularly. Our VisionPlus plan promotes early detection and treatment of vision abnormalities by covering exams, basic lenses and selected extras in full when using a network provider. In addition, the program also provides the highest quality ophthalmic materials at extremely affordable prices.
To learn more about MedBen VisionPlus, contact MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
The birth control compromise offered by the Obama administration quelled – momentarily, at least – a growing political headache. But, as the New York Times notes, it ignored one conspicuous point.
To appease religiously-affiliated employers that oppose contraceptive usage, the administration announced last week that insurers, rather than the organizations, would be required to cover women’s birth control costs in full. Trouble is, many of these organizations self-fund their employee health care benefits – which means that they serve as their own insurers, and therefore, are still responsible for covering the costs.
So far, the administration has only said that the details will be worked out with religious leaders in the coming weeks. But some aren’t confident that a suitable solution can be reached.
“Putting the obligation on the insurer and not the employer doesn’t help much if they are the same person,” said Richard M. Doerflinger of the United States Conference of Catholic Bishops. Ironically, several Catholic organizations went the self-insurance route in order to avoid similar birth control mandates already present in certain states.
Often, making just a small change to your diet can make a big difference if you’re trying to shed a few pounds. Case in point: A new clinical trial found that participants who replaced sugar-sweetened soda with water (or a diet beverage) nearly doubled their likelihood of meaningful weight loss.
According to Reuters, researchers divided 300 overweight adults into three groups. The first and second groups substituted sugary soda for, respectively, water and diet drinks, while the third was given weight-loss advice but could make their own beverage choices.
After six months, all three groups lost an average of four or five pounds. But 20% of the first two groups dropped at least 5% of their starting weight, compared to only 11% of the third group. And while that may not seem like much, it’s enough for the body to realize such healthful benefits as a reduction in blood pressure.
Lead researcher Deborah F. Tate, of the University of North Carolina at Chapel Hill, advised that people who have a hard time with a major diet overhaul can start with sugar-free drinks before making changes to eating habits. “This is a simple thing you can do consistently each day,” she said.
In an effort to reduce excessive medical testing, the American College of Physicians (ACP) is releasing guidelines to aid physicians in determining whether or not patients should screen for specific disesases.
“Excessive testing costs $200 billion to $250 billion (per year),” Dr. Steven Weinberger, CEO of ACP said in an interview to Reuters. “There’s an overuse of imaging studies, CT scans for lung disease, overuse of routine electrocardiograms and other cardiac tests such as stress testing.”
Ordering unneeded tests while health care costs continue to escalate constitutes “medical gluttony,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “We have got to think about the rational use of medicine in order to avoid rationing medicine.”
By handling the situation in-house, as it were, the ACP is hoping to avoid further government intervention. But MIT healthcare economist Dr. Jonathan Gruber believes that’s precisely what is needed.
“I don’t trust professional societies to do it because that’s how they make money – by doing tests and procedures,” Gruber said.
An interesting article in today’s New York Times: Pediatricians are increasingly “firing” families whose parents refuse to allow their children to be vaccinated.
Medical associations don’t recommend such patient bans. But a 2011 study of Connecticut pediatricians found that 30% of 133 doctors said they had asked a family to leave their practice for refusing vaccines, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
While rates for several key innoculations in young children rose between 2009 and 2010, lower overall immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years. And some pediatricians are concerned that unimmunized patients may pose a danger in the waiting room to infants or sick children who haven’t yet been fully vaccinated.
Parents who refuse vaccinations often voice concerns that the innoculations increase the risk of autism or may overwhelm their child’s immune system. But recent studies have dispelled these concerns among scientists.
As we noted here last week, President Obama has proposed a compromise regarding the mandate that religiously-affliated businesses cover contraceptive services. But even if the Catholic Church accepts the work-around, questions and controversy remain.
From Insureblog, third party administrator Nate Ogden points out that “free” contraceptives are anything but:
“When employers pay claims under a self funded plan, the majority of the time that is coming right out of the employer’s general account. So while it may seem like it’s ‘free’ to the employees (just like it seems like it’s ‘free’ to folks on fully insured plans), it’s really coming out of their raises, bonuses, even salary.
“Which brings up the first big question, one that hasn’t seen much (if any) press: What birth control is provided for free? Can we cover the generic 100%, or if their doctor prescribes something new at $500 per month are we stuck covering that 100% as well? Remember, it’s not the insurance company getting stuck with the bill here.”
And at Slate, Matthew Yglesias offers the counterpoint:
“While birth control costs more than nothing, it costs less than an abortion and much less than having a baby. From a social point of view, unless we’re not going to subsidize consumption of health care services at all (which would be a really drastic change from the status quo) then it makes a ton of sense to heavily subsidize contraceptives… The unfortunate thing is that under the American setup the subsidies tend to be passed through the employer, which has set the stage for this controversy.”
Physicians are prescribing more than ever these days – and drugs have nothing to do with it. A new report from the Centers for Disease Contral and Prevention says that one-third of adults who saw a doctor or other health care professionals in 2010 were advised to exercise more.
According to WebMD, the number of patients being told to increase their physical activity as a way to maintain or improve their health has jumped significantly since 2000, when less than a quarter of consulations included such advice.
“Trends over the past 10 years suggest that the medical community is increasing its efforts to recommend participation in exercise and other physical activity that research has shown to be associated with substantial health benefits,” states the report, from the CDC’s National Center for Health Statistics.
Doctors most typically prescribe exercise to their overweight and obese patients. The report indicates that this increased emphasis is an important development, as patients tend to follow their doctor’s counsel – especially if the doctor follows up after the initial prescription.
On Thursday, the Department of Labor released the Final Regulations describing a plan sponsor’s responsibilities for preparing and distributing the 4-Page Summary of Benefits and Coverage (SBC). The template for the 4-Page (double-sided) Summary has not changed significantly from the earlier proposed regulations and the Final Regulations require compliance for plan years on or after September 23, 2012.
MedBen is in the process of reviewing the Final Regulations and will provide for its clients a summary of the requirements, but in the meantime, additional information can be found on the Department of Labor’s Employee Benefits Security Administration website:
Summary of Benefits and Coverage and Uniform Glossary
MedBen clients who have any immediate questions may contact MedBen Vice President of Compliance Caroline Fraker at (800) 851-0907.