On a national level, the Medicaid population has grown by 11 million since 1996 and has increasingly spread into managed care. Ten years ago, 40.1% of the 33 million Medicaid enrollees were covered by managed care plans, and as of June 2004, 60.6% of 44 million enrollees were covered by managed care, according to the Centers for Medicare and Medicaid Services.
Seattle—With pharmaceutical costs being the fastest increasing component of healthcare costs, it is important that managed care executives adopt policies that use the best-available evidence to compare the benefits, risks and costs of drugs to include in their health plan formularies.
Washington, d.c.—The advent of Medicare prescription drug coverage for seniors is not prompting large employers to abandon retiree drug benefits, at least not for this year. Most large businesses are accepting federal government subsidies for retiree drug coverage in 2006, although there are signs that this could change over the next five years.
Today's Approach to interventions that address chronic disease and conditions is both broader and deeper than ever before. But there is another group of patients who rarely, if ever, directly benefit from these programs. According to Alan Wright, MD, former chief medical officer of TheraCom, these are patients who might use more than $100,000 a year in pharmaceutical spending and/or resources, patients who have a disease that is progressive with no known cure. These are the patients who have a rare disease, such as pulmonary arterial hypertension (PAH), a rare blood vessel disorder characterized by increased pressure in the pulmonary artery.
For some insurers, television ads have taken center stage.
One reason so many insurers and health plans are sponsoring Medicare prescription drug plans (PDPs) is to attract traditional Medicare beneficiaries into the Medicare Advantage (MA) program. While there is considerable uncertainty about how stand-alone prescription drug plans (PDPs) will fare, insurers are willing to invest in the new drug coverage program to expand enrollment in local Medicare HMOs and PPOs, as well as new regional PPOs designed to attract seniors fearful of managed care.
Washington--Pharmaceutical companies have been promoting drug giveaway programs this past year to help low-income consumers get needed medicines—and also to improve their image. Now the advent of the Medicare prescription drug benefit threatens a big drop in PAPs (pharmaceutical assistance programs) for the elderly. The seven manufacturers who sponsor the Together Rx card for 1.5 million Medicare patients are calling it quits, continuing only a sister program for non-Medicare patients. Other companies tell seniors they can't get free drugs if they sign up for a Medicare drug plan.
Washington-- In an effort to meet President George W. Bush's Management Agenda goal of expanded electronic government, FDA is requiring drug manufacturers to submit prescription drug label information to the agency in a new electronic format. This electronic format will allow healthcare providers and consumers to more easily access the product information found in package inserts for all approved medications in the United States.
Just imagine being able to jump on your health plan's Web site and find out exactly what it would cost for a 30-day supply of Lipitor from your local Walgreens store. Or if you prefer a generic delivered via mail order, the cost is also at your fingertips.
Hundreds of private insurers are marketing Medicare Advantage plans and state-wide PPOs with unexpectedly low prices for expanded drug coverage to gain a bigger slice of the radically changing Medicare pie. While the public has been focused on deciphering new prescription drug coverage options through stand-alone prescription drug plans (PDPs), Medicare officials also note an "enormous rise in MA plans with Part D benefits," reports Medicare Senior Advisor Abby Block. More than 5 million seniors now belong to MA plans, and the number is growing monthly.
The WellPoint Inc. and WellChoice Inc. deal is further proof that merger mania among major health insurers is alive and well.
We all seem to be taking a wait-and-see approach.
When a crisis strikes, all involved should have a plan to follow
Specialty pharmaceutical spending continues to grow at almost 20% per year and more aggressive payer organizations are applying tighter controls on utilization and access to keep costs in check, according to industry experts.
Read more about management strategy.
Specialty pharmaceutical drug coverage by managed care plans
No wonder metabolic syndrome is called syndrome X. Instead of being recognized as a separate disease, it is considered a constellation of many conditions. "The biggest problem is a failure to address the underlying problem—insulin resistance," says Robert Epstein, MD, chief medical officer for Medco Health Solutions in Franklin Lakes, N.J. He calls metabolic syndrome one of the country's top five health problems.
In a case that likely will be appealed, a San Antonio jury recently awarded $7.4 million in actual damages resulting from the alleged negligence by a health maintenance organization and several providers. In the lawsuit, a deceased woman's family accused Humana, two physicians, and a physician practice group of negligence in a wrongful death action. The jury decision resulted from a three-week trial presided over by a Republican-appointed judge with an insurance defense background. In accordance with Texas law requiring the apportionment of liability, the jury found Humana liable for 35% of the actual damages and the entire $1.6 million in punitive damages.
National Reports—Health plans continue to modify medical and pharmacy benefit policies to serve members affected in the Gulf Coast region. Those adjustments range from allowing those members to have access to any provider, even if that provider is out-of-network, to suspending pharmacy restrictions on medication refills.
Last Month brought us news of the indescribable aftermath of Hurricane Katrina. I consumed all the information I could find at first, but then, like many Americans, I had to step away from the media for a while. I had to let the reality sink in without the narration of a news anchor.
New pharmacy systems are emerging that allow for deeper analysis
The 2006 introduction of Part D under the Medicare Modernization Act will definitely affect medications targeting osteoporosis, the majority of which are prescribed to those 65 or older.
Coinsurance is a valid tool for using financial incentives to help patients focus on selecting less costly therapies.
Mild to moderate psoriasis is generally treated first with topical corticosteroids and other topical remedies. When the disease is widespread or unresponsive to topical agents, ultraviolet phototherapy may be used at home or in the physician's office.
The biggest bang for the buck is treating the older population for which fractures are more prevalent.
