Each year roughly 700,000 Americans suffer a new or recurrent stroke, a condition that arises when blood flow to the brain is disrupted. Nearly a quarter of those incidents are fatal, making stroke the third-leading cause of death behind diseases of the heart and cancer.
Are pharmacy benefits managers (PBMs) that rely on
revenue-generating mail-order prescription service going to get a
run for their money as 90-day retail programs hit the marketplace?
Walgreen Health Initiatives (WHI), a PBM headquartered in
Deerfield, Ill., is not particularly bothered by the new retail
product. WHI launched Advantage90, a 90-day retail fulfillment
program, in late 2003 with more than 26,000 pharmacies nationwide
now participating in the program.
If misery loves company, then Beverly Thomas of Carbondale, Ill.,
isn't alone. She is one of thousands of dual eligibles
(beneficiaries covered by both Medicaid and Medicare) who went to
the pharmacy after January 1, 2006, only to find that it would not
fill their prescriptions. Unfortunately, her medication for mental
illness is so critical that if she misses even a day, she could be
hospitalized. With the help of Southern Illinois Regional Social
Services, Thomas got squared away, but admits she still is confused
about how the new Medicare Part D benefit operates.
WASHINGTON, D.C. -- Some pharmaceutical companies are dropping Patient Assistance Programs (PAPs) for seniors who enroll in the Medicare drug benefit program. They fear they'll be hit with fraud charges by the Office of the Inspector General (OIG) at HHS if they provide free or low-cost drugs to Medicare beneficiaries enrolled in prescription drug plans.
News that Blue Cross and Blue Shield affiliates have begun funding the formation of Regional Health Information Networks (RHIOs) should serve as a wake-up call for all managed care organizations (MCOs).
WASHINGTON, D.C. -- The main Bush administration proposal for dealing with the high cost of healthcare and rising number of uninsured is to create a new commission. In his State of the Union address in January, President Bush called for a new bipartisan panel to propose changes that will equip Medicare, Medicaid and Social Security to deal with the millions of baby boomers headed for retirement.
The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.
Government, Employers, medical associations, payers, and many others are part of a nationwide momentum toward making electronic health records (EHRs) a reality. President Bush has cited the necessity to create EHRs, leading politicians of both parties have issued joint statements, and some states have accelerated activities. A number of initiatives by the Department of Health and Human Services (HHS), standards development organizations, and other groups are moving several issues ahead.
The rise of the healthcare consumer, pay for performance and the focus on care management and prevention will not just be blips on managed care executives' radar screens this year. They will not only need to address these issues, but build a framework around them for long-term sustainability, according to PricewaterhouseCoopers.
In 2005, Medicaid surpassed Medicare as the largest government healthcare expenditure, and it is the fastest growing population of covered lives, say industry experts.