Prescription painkillers could be more difficult to obtain if new legislation successfully wotks its way through Congress. Called the Safe Prescribing Act, the bill would move medications that contain hydrocodone, such as Vicodin, from a Schedule III controlled substance designation to Schedule II – a more restrictive ranking on the national law enforcement schedule.
Pharmalot reports that the co-sponsors introduced the bill in hopes that it would help to reduce the abuse of prescription painkillers. The reclassification would place Vicodin and other drugs in the same category as other painkillers – such as oxycodone, morphine and fentanyl – which require patients to have a prescription in order to receive the medications, except in cases of emergency. Additionally, pharmacists would require patients to provide an original prescription for refills, and traffickers would be subject to harsher fines and penalties.
Overdose deaths in the U.S. paralleled a 300% increase since 1999 in the sale of prescription painkillers, according to a 2010 report from the US Centers for Disease Control and Prevention. The drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. The sponsors of the bill noted that emergency room visits linked to hydrocodone abuse rose from 38,000 in 2004 to more than 115,000 in 2010.
Barring congressional action, the recent budget sequestration will require reductions in the Small Business Health Care Tax Credit for some small tax-exempt employers, the Internal Revenue Service has announced.
Accounting Today reports that the credit, which was included as part of the Patient Protection and Affordable Care Act of 2010, will be reduced by 8.7%. The sequestration reduction rate will be applied until the end of the fiscal year (Sept. 30, 2013) unless there is some intervening congressional action, at which time the sequestration rate is subject to change.
The IRS also noted that while the health care reform law generally has no new impacts to the Form 1040 series for the 2012 returns that individuals may be currently filing, those who did receive a health insurance premium rebate during 2012 should check irs.gov/aca under Medical Loss Ratio to see if they are one of the few people who needs to include it on their 2012 return.
Today, the Supreme Court heard arguments on what’s been dubbed “pay for delay” drug contracts, in which brand name drug manufacturers settle litigation by making deals wirth generics rival to temporarily keep cheaper versions off the market. And Reuters reports that it’s anyone’s guess at this point how the justices will decide.
The Federal Trade Commission says such agreements cost consumers, insurers and government billions of dollars annually, and has fought drugmakers in court over the issue for over a decade. Drugmakers counter that the practice actually allows generic to reach the market quicker than they otherwise would.
Reuters notes that, based on their questions, the eight justices presiding (Samuel Alito recused himself) seemed uncertain of how the court should approach the matter. Some appeared skeptical of the Justice Department’s argument that the deals should be viewed as presumptively unlawful, which others asked questions raising concerns that the deals could be anticompetitive.
In the case before the court, Solvay Pharmaceuticals Inc, which is now owned by AbbVie, sued three generic drugmakers in 2003 to stop cheaper versions of AndroGel, a gel used to treat men with low testosterone. Solvay had paid the companies up to $30 million annually to keep the drugs off the market until 2015. The patent expires in 2020.
The Supreme Court is expected to issue a decision by the end of June.
Getting more than one blood pressure check a year may hurt rather than help, a new study suggests.
According to Reuters Health, researchers reviewing five years of patient data concluded that the practice of receiving screened at every doctor’s visit may result in more people mistakenly diagnosed and unnecessarily treated for high blood pressure.
Blood pressure measurements are often taken without following proper procedure – patient seated, arm supported, following a five-minute period of rest – according to lead study author Dr. Gregory Garrison. This can result in inaccurate readings and lead to some people being wrongly diagnosed with hypertension, while others who have the condition are written off as just “more false positives.”
“One, it results in unnecessary patient anxiety, repeated clinic visits, and laboratory testing,” Garrison, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health by email. “Two, it often lulls physicians into writing off a positive result because so few are confirmed.”
Reducing the number of screenings would weed out almost half the false positive, Garrison amd his colleagues found.
CQ HealthBeat (via The Commowealth Fund) reports that Health and Human Services is making contingency plans in the event that health care exchanges are not ready in time for launch.
Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, admitted that some state exchanges may not be operational by October 1. But he assured people that even if the state models aren’t ready by then, the federal government will ensure that all Americans who need insurance will have access to an exchange.
Speaking at a national policy meeting of America’s Health Insurance Plans earlier this month, Cohen said that making contingency plans is necessary. “I think it’s only prudent to not assume everything is going to work perfectly on day one and to make sure that we’ve got plans in place to address things that may happen.”
Also appearing on the AHIP panel was Henry Chao, a Centers for Medicare and Medicaid Services official who’s overseeing the technology for the exchange launch. “The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” he said. “Let’s just make sure it’s not a third-world experience.”
Speaking with reporters afterward, Cohen said, “I’m absolutely confident every state will have an exchange that will be functioning and ready for enrollment” on Oct. 1. However, he added, “I think there is some possibility that the type of exchange may be different than what we’re looking at today.”
Presenters at MedBen Universities in 2013 will include members of the MedBen team speaking on a variety of benefits management topics. But we also invite outside health care professionals to share their knowledge. One such featured speaker at many MBUs and roundtables is Allan Zaenger, President of Pharmaceutical Horizons, a pharmacy plan consulting service.
At MedBen’s recent hospital and government roundtables, pharmacy benefits expert Allan Zaenger examined the methods some pharmacy benefit managers (PBMs) use to secure their own profitability, such as margin manipulation and rebates, while leaving their clients with reduced financial returns.
“Not all PBM discounts are equal", Zanger said, noting that contracts a PBM makes with with a retail pharmacy can differ greatly from a contract a PBM makes with a health plan sponsor. For example, a PBM may arrange a 70% discount on generic drugs from a pharmacy, but only a 65% discount for the plan – and keep the difference.
Zaenger also warned about “rebate distortion", a practice in which member copays do not align properly with preferred brand drug formularies. “If you try to maximize rebates based on the PBM’s recommendation, you may actually increase costs in that drug category,” he said
To guard against such tactics, Zanger also offered plan design strategies. “Monitor any claims you receive from pharmacies that may have contracted for higher reimbursement from the PBM,” he advised, “and restrict member access to those pharmacies.” By doing so, employers could reduce their “Amount Paid” costs by 2-5%.
Allan is among the speakers scheduled to appear at future MBUS. For additional information about upcoming events, check the MedBen Blog or e-mail MedBen Sales Analyst Sally Wood at firstname.lastname@example.org.
On the occasion of the Affordable Care Act turning the big “0-3″, John Merline of Investor’s Business Daily has compiled “10 Disturbing Facts Americans Have Learned” about the health care reform law. We highlight five here – you can read the rest at Investors.com.
Boost insurance costs. Regulators decided to impose a 3.5% surcharge on insurance plans sold through federally run exchanges. There’s also a $63 fee for every person covered by employers. And the law adds a “premium tax” that will require insurers to pay more than $100 billion over the next decade. The congressional Joint Committee on Taxation expects insurers to simply pass this tax onto individuals and small businesses, boosting premiums another 2.5%.
Push millions off employer coverage. In February, the Congressional Budget Office said that 7 million will likely lose their employer coverage thanks to ObamaCare – nearly twice its previous estimate. That number could be as high as 20 million, the CBO says.
Cause premiums to skyrocket. In December, state insurance commissioners warned Obama administration officials that the law’s market regulations would likely cause “rate shocks,” particularly for younger, healthier people forced by ObamaCare to subsidize premiums for those who are older and sicker.
Cost more than promised. The Congressional Budget Office now says ObamaCare’s insurance subsidies will cost $233 billion more over the next decade than it thought last year.
Be a bureaucratic nightmare. Consumers got their first glimpse of life under ObamaCare when the Health and Human Services Department released a draft insurance application form. It runs 21 pages. “Applying for benefits under President Barack Obama’s health care overhaul could be as daunting as doing your taxes,” the Associated Press concluded after reviewing the form.
Advocates for increased Alzheimer’s research say that deaths linked to the memory-robbing disease have gone up in the last decade, while those for stroke, breast cancer and HIV have dropped, Bloomberg (via Employee Benefits News) reports.
Researchers are calling for more funding following a new Alzheimer’s Association report which states that, lacking treatment breakthroughs, the number of Americans aged 65 and older whose memories and personalities are claimed by the disease will more than double to 13.8 million in 2050.
Whether the recent automatic budget cuts, known as sequestration, will affect Alzheimer’s research funding is uncertain. But an earlier Alzheimer’s Association report said the estimated $600 million of funding available for research this year is only a quarter of what is needed to make a dent in slowing, preventing or treating Alzheimer’s within 10 years.
Alzheimer’s as a cause of death increased 68% from 2000 to 2010, compared with declines of 23% for stroke, 8% for prostate cancer, 2% for breast cancer, 16% for heart disease and 42% for HIV, according to the new report. Alzheimer’s now is the sixth-leading cause of death in the U.S.
MedBen conducted its annual Government Roundtable for current and prospective municipality clients omn March 21. And just like at its hospital-focused seminar a week earlier, Vice President of Sales and Marketing Brian Fargus had some good news to report.
“Per employee medical and prescription costs for municipalities administered by MedBen were down 5% from a year ago,” Fargus said in his government benchmark presentation. “And over two years, costs are down 7%.”
Fargus noted that the ongoing cost decreases go against current national cost trends, which have risen slightly in the past two years.
As a means to better employee health and continued lower costs, Fargus encouraged attendees to promote preventive care and, by doing so, reduce the “care gap” created by missing yearly wellness checkups, cancer screenings and other health interventions. By maintaining a low care gap, government plan members have cut their health care costs by nearly 75% on average.
Fargus further recommended that groups encourage members with diabetes, high cholesterol and other chronic conditions to take the necessary steps (i.e., medication, exercise) to reduce the risk of greater complications down the road.
The majority of Americans are still in the dark about how health care reform will affect them, finds a new Kaiser Family Foundation poll.
On the eve of the third anniversary of the passage of the Affordable Care Act, two-thirds of the uninsured under age 65 – and 57% of the overall population – say do they do not understand how the law will impact them.
As Kaiser Health News notes, with enrollment for new coverage in the exchanges and Medicaid expansion set to begin on October 1, states and the federal government have only a short window to educate consumers about comparing insurance plans and signing up for coverage.
The poll also revealed that 48% of Americans say hey have heard nothing at all about whether their state will run its own exchange, and 78% say they heard enough to say whether their state plans to expand Medicaid. In fact, as health care reform has received less coverage, the public appears to be less knowledgeable about such popular provisions as tax credits to small business to buy insurance and guaranteed coverage.
Physical therapy can prove just as effective for repairing the knee as surgery, a new study concludes.
The Associated Press reports that a torn meniscus – one of the crescent-shaped cartilage discs that cushion the knee – can improve through therapy, though not necessarily right away. Researchers found that it can take between six months and a year for the injury to mend, but the results are ultimately the same as those who were quickly given arthroscopic surgery.
“Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you’ll do quite well,” said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women’s Hospital and Harvard Medical School.
About one-third of people over 50 have a tear in a meniscus, and arthritis makes this more likely. Often, a tear can be mistaken for arthritis, and it can be difficult to tell whether surgery is needed or will help.
Therapy “is a reasonable first strategy, with surgery reserved for the minority who don’t have improvement,” Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the New England Journal of Medicine, which published the study online.
A featured presenter at many MedBen Universities this year will be Caroline Fraker, MedBen Vice President of Compliance. Since the passage of the Affordable Care Act (ACA) in 2010, Fraker has spoken at numerous seminars about how changes to health care laws will affect businesses. At an MBU sponsored by Corporate One on March 19, she discussed the new health care reform rules employers will soon face.
In her presentation, Fraker outlined major employer responsibilities in 2014, including the elimination of annual and lifetime dollar maximums and removal of pre-existing condition limitations. A good portion of her presentation spelled out how shared-responsibility penalties work for businesses.
As Fraker explained in some detail, an employer with 50 more more full-time employees may be subject to a penalty for failure to meet ACA rules. An employer that doesn’t offer minimum essential coverage to all full-time employees may be subject to the “Greater Penalty” – $2,000 per full-time employee per year. Or, should the employer offer coverage that does not have “minimum value” or is not “affordable”, they may have to pay a “Lesser Penalty” of $3,000 for each employee who receives a subsidy premium tax credit from the state or federal government to help pay for coverage.
Confusing? Definitely. Suffice it to say that the topic of penalties is too complex to be properly described here. But MedBen clients who have questions about how the so-called “pay or play” rules affect your business are welcome to contact Caroline at (800) 851-0907. And remember, she will also be a featured speaker at upcoming MBUs, so we encourage you to attend one this year!
A new study suggests that women age 50 and over can safely get a mammogram every two years without increasing their risk of developing advanced breast cancer. Biennial screenings was also associated with a lower risk of heaving a false-positive result for breast cancer.
HealthDay News reports that researchers factored whether the women had high breast density, considered a risk factor for the disease. They did note that biennial screenings for women aged 40 to 49 with extremely dense breasts was linked with an increased risk of advanced-stage cancers, large tumors and false-positives.
The findings are in line with U.S. Preventive Services Task Force guidelines that women over 50 at average risk should get a mammogram every two years, but are at odds with American Cancer Society (ACS) recommendation that annual screenings begin at age 40.
Dr. Robert Smith, ACS senior director of cancer screening, said that the study is “not an accurate look at one year versus two years.” For the study, annual was defined as intervals of nine to 18 months, for instance, and two years as more than 18 to 30 months.
In response, study researcher Dr. Karla Kerlikowske of University of California, San Francisco School of Medicine said this interval variability reflects real life.
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”.
A reminder for many MedBen FSA or HRA plan members: If you have a balance in your 2012 account that you still need to submit claims for, please do so right away!
Most employers allow a “grace period” to submit reimbursement requests for 2012 expenses. Typically, the deadline is March 31 (check with your plan administrator for the precise cutoff date). If this is the case for your group, all 2012 FSA and HRA claims must be submitted on or before March 31, 2013 to be considered for reimbursement.
Please also keep in mind that if you do not use all of the money in your 2012 FSA account for expenses incurred during the 2012 plan year, IRS regulations dictate that all of the remaining FSA funds will be forfeited. As for HRAs, their balance will usually not be forfeited – they will be rolled over and combined with your 2013 HRA benefit. (Again, this varies from group to group, so check with your plan administrator.) But after March 31, you will no longer be able to use them for 2012 expenses.
MedBen clients with additional questions regarding their FSAs or HRAs may call MedBen Customer Service at 800-297-1829.
Estimates of original tax increases stemming from the implementation of health care reform rules were well off the mark, according to the TaxProf Blog:
“The Joint Committee on Taxation recently released a 96 page report on the tax provisions associated with Affordable Care Act. The report describes the 21 tax increases included in Obamacare, totaling $1.058 trillion – a steep increase from initial assessment. The summer 2012 estimate is nearly twice the $569 billion estimate produced at the time of the passage of the law in March 2010.”
Only about 1 out of 10 Internet users consult online rankings of hospitals, says a Pew Research Center Survey – and those who do may come away confused.
According to Kaiser Health News, multiple nonprofit groups now offer online evaluations of hospitals and medical facilities, created with the express purpose of helping patients make informed health care decisions. But because thse organizations use different criteria to determine a hospital’s strengths and weaknesses, it can be difficult to know to believe when faced with opposing opinions.
Complicating matters further, some “report card” sites charges licensing fees, ranging from $12,500 to $145,000, to hospitals that want to advertise their awards. Additionally, some of the evaluation groups also offer consulting services to hospitals that want to improve their overall performance – so even if these groups don’t earn anything from the rating sites, they can profit from these ancillary services. (One notable exception is Consumer Reports, which bars hospitals from using its ratings in marketing, but does charge for online access to their ratings.)
Of course, many hospital patients don’t have the luxury of shopping around – when an emergency occurs, the best choice is typically the closest one. But for those who have the time to compare and don’t mind putting in a little extra browsing time, visiting several of these sites should give them a pretty good idea of a hospital’s overall quality.
Kaiser has also compiled a list of some of the better-known hospital ratings websites, including Medicare’s Hospital Compare, The Joint Commission and Leapfrog.
“NorthBay Adventure is the kind of small business that could be expected to buy medical insurance for workers under sweeping health-act rules taking effect in 2014. But executive director George Comfort says that’s not likely to happen.
“Instead, NorthBay became self-insured last year, paying most of its workers’ health costs directly, a practice more typical of large employers. The decision to self-insure was about free choice, savings and what’s best for his company, Comfort says.
“But others see it as a threat to the Affordable Care Act. As more small employers like NorthBay avoid the health act’s requirements through self-coverage, small-business marketplaces intended to cover millions of Americans could break down and become unaffordable, they say.”
Is self-funding by small businesses a smart way to benefit from a healthy workforce or, as some claim, a way to “game” the system? Read more at Kaiser Health News.
The question of whether generic drugmakers can be held liable in the designs of their medications, even when the brand drugmaker’s design is followed, is about to be debated in the nation’s highest court.
Reuters reports that the Supreme Court will hear arguments Tuesday on the issue, which could determine the extent to which generic drug companies responsible for injuries allegedly caused by their products. Generics are required to contain the same active ingredient as their brand name equivalent.
Mutual Pharmaceutical Co has asked the court to overturn a $21 million jury award to Karen Bartlett, a New Hampshire woman who took Mutual’s generic non-steroidal anti-inflammatory drug, sulindac, in 2004 after her doctor prescribed it for shoulder pain. Due to a rare hypersensitivity reaction, she developed burn-like lesions over most of her body, spent two months in a hospital burn unit, and is today nearly blind.
Asking the Supreme Court to overturn the award, Mutual argues that federal law bars such claims because its drug had already been approved by the U.S. Food and Drug Administration. A 2011 ruling by the court had dramatically constrained consumers’ ability to sue generic manufacturers over alleged injuries, but Bartlett’s lawyer successfully argued that prior incidents of the skin reaction submitted to the FDA had proven the generic drug was inherently dangerous.
Most states come up short regarding laws that guarantee patient access to information on hospital and clinic prices, finds a new report from the employer group Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.
According to Modern Healthcare, 29 states got an “F” grade in price transparency – including seven without any such laws whatsoever – while another seven states received a “D". Grades were based on how how easily disclosed prices could be seen by the public; whether laws required disclosure of prices or discounts paid by insurers; and how many providers and procedures were included.
Only two states, Massachusetts and New Hampshire, got an “A” grade – and even in those cases, disclosure was lacking, the authors said.
“We graded on a curve,” said Suzanne Delbanco, executive director of the institute. “I think there’s room for improvement, even among the As.” She added that as people pay a larger portion of their health care costs, more price transparency is essential.
Glenn Melnick, a health care finance professor at the University of Southern California, described the report as “pretty lenient”, noting that “The real challenge will be to combine detailed services into common bundles of services that consumers are likely to buy and then give actual prices. Right now, pricing is far too detailed and after the fact to be helpful to consumers.”
Health care price inflation from January 2012 to January 2013 was only 1.5% – the lowest rate since December 1997, according to MedPage Today.
“The Health Care Price Index was driven lower by declines in hospital, home health, nursing home, and prescription drug price growth, and mostly stable rates for the other categories,” says a report released this week by the Altarum Institute, a research and consulting firm.
Pharmacy costs reflected a similar downturn. “The year-over-year prescription drug price rate of 1.6% for January is the lowest reading since 1.4% in January 2009. Physician price growth ticked down to 0.6% (from 0.7% in December), the lowest reading since 0.6% in September 2008,” the report notes.
In other categories, the year-over-year hospital price growth rate – which the authors called a “key health price index driver” – was 2.0%, down from 2.2% in December, the report noted.
The authors attribute the slow price growth in part to a drop of utilization of health care services. “Moderate growth in health spending implies low per-capita utilization growth by spending component, with the January 2013 reading 1.4% higher than January 2012, and a 12-month average growth of 1.4%.” But the slow increase also reflects smaller growth in the overall economy – the Consumer Price Index fell slightly last December from the previous year.