![President’s Health Reform Proposal Issued]()
by Admin. | Feb 23, 2010 | Health Care Reform, healthcare, Pharmaceutical Industry
The President yesterday released with great anticipation his own version of the Reform Health Bill. This is the opening bid before Thursday’s Bipartisan Summit.
The proposed Bill for the most part is similar to the Senate Bill passed in December with a few minor changes anticipated to cost almost $1 trillion over 10 years. The comprehensive bill adds cost saving measures and more affordability for lower income Americans.
As expected and in step with both Houses the proposal eliminates pre-existing condition but raises the penalty for individuals not paying into a mandatory health plan to 2.5% of adjusted gross income by 2016. Included, also, is an increase in the tax credits for health insurance premiums a sort of carrot and the stick model.
Spurred by recent rate increases by insurers such as Anthem’s 39% planned rate hike in California there is a provision to establish a new Health Insurance Rate Authority to give guidance and oversight to states and monitor insurance market behavior. “If a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable.”
Also included is elimination of Nebraska’s politically wrangled special deal to help pay for a proposed Medicaid expansion, and would instead provide more help for all states to pay for their new Medicaid enrollees. It would delay enactment of a the Cadillac tax (40% tax in excess of $10,200/$27,500 for single/ families) on high-cost employer-sponsored insurance plans with no special exceptions to Union groups.
There is elimination of the Medicare Rx “doughnut hole” for Part D. There will be a 25% coinsurance fee instead for seniors in this gap. Currently, the gap starts after the first covered $2830 and continues on the next $4550 with only a 5% member responsibility thereafter.
Our small employer groups will be relieved to know that groups under 50 employees are exempt form the mandate. Under the Senate plan, employers with more than 50 employees that do not offer coverage would pay a $750 assessment for each full-time employee. The White House proposal would bump up that assessment to $2,000 for each full-time employee. However, in determining the assessment, an employer’s first 30 employees would be excluded from the calculation. Taking the case of an employer with 100 employees that did not offer coverage, for example, its assessment would be 70 times $2,000.
The proposal also is believed to retain a provision in the House and Senate bills that would impose a $2,500 annual cap, starting in 2011, on the maximum annual contributions that could be made to health care flexible spending accounts such as HRA and FSA.
Our position is that Health Care Reform done responsibly is important and inevitable for the sustainability of our country. While the current leaves millions uninsured it just as importantly leaves many who are already insured struggling to pay and possibly drop out going forward. Addressing the cost factors for those already insured is being understated.
Stay tuned till the end of the week for the Bipartisan Summit. We expect to see proposals on creating tax credits for employers who already offer benefits. Also allowing insurers to easily cross state lines and increase competition by creating a basic Federal health package. This will allow strong reputable companies like Humana to enter the NY/NJ/CT market and side step the choke full of mandates. NY already includes almost 20% of overall costs going to these add-ons.
by Admin. | Aug 17, 2009 | COBRA, Dependent Coverage, family health insurance, group health insurance, latest health insurance news, Pharmaceutical Industry, regional health insurance co-ops
Health Care Reform!
Ok so unless you’ve been stuck in the Arctic for a year you’ve been hearing a lot about this heated topic. Everyone has strong feelings about it evidently, I myself included, but I have stayed away from the fray for the most part.
As congress takes their August recess and those who still have jobs are on vacation I thought its a good time to put my two cents into it.
This well done score card brought to you by Empire Blue Cross is a great illustration of the leading proposals and voices in Washington. A nicely published overview by the Lewin Group is actually a great read on the proposed Government Sponsored Health Plan. The analysis covers the bill as it appeared on July 15, 2009.
Bills Key Provisions:
- Require all Americans to purchase health insurance or be fined, although those making less than $88,000 annually would be able to get a subsidy.
- Get rid of copays and deductibles for preventative care
- Make it illegal to deny coverage for pre-existing conditions
- Create a public plan
- Raise taxes for the wealthy – as much at 5.4 percent for incomes above $350,000
But what are we really talking about? A Government Plan to compete with private payers? Really?
The assumption in the study is that the government plan pays Medicare Rates. Provider reimbursements are on average 70% of private insurance reimbursements. The specter of physicians opting out of this plan is rather daunting as they would be giving up the single largest payer.
How does a private insurer compete with a government plan? Imagine a Government-owned subsidized Automobile competing with private companies? Would they not print more tax payer money and pump them up? Oh wait that’s already happened in Detroit, bad example.
The President claims that a government plan does already work and its name is Medicare. Yet, Medicare we are also told will go broke as early as by 2018 reported by Washington Post. Medicare, meanwhile, now pays private insurers to take care of seniors under the Medicare Advantage Plans. It is cheaper for the government to do this than to manage it themselves
As brokers, we work with the AARP Oxford Secure Horizons Program where some plans are $0 premium and include a fairly sizable network.
So which one is it? Does the Medicare plan work now and is proof of what’s to come or is it costly and inefficient and unsustainable?
Clearly the costs are indeed high and I question what insurers are thinking with some of the rate increases. This year, especially, I’ve seen increases of over 20% from the top carriers.
Speaking of Medicare, the Part D Plan in 2003 was just a gift to the Pharmaceutical industry’s under the Bush administration. Many people didn’t realize that the language used barred the U.S. from negotiating drug pricing. How can Canada with an entire population of 33 mill pay 50% on the dollar while 40 million US seniors pay full retail? Coincidentally, the legislators of Medicare Part D earned themselves nice cushy paying Pharmaceutical jobs within 1 year.
Obama has easily gotten concessions from Big Pharma, Insurers and the AMA (provided there is tort reform) already and I applaud him for it. There probably is even more good news to come on this.
What may be an interesting possible outcome are Regional Health Insurance Co-ops. These are a bridge between government and non-government options. The co-op alternative, led by Sen. Kent Conrad (D-ND), continued to gain traction on both sides of the aisle. The plan would call for the creation of nonprofit health cooperatives in lieu of public health insurance options. Said Sen. Baucus, “.The Conrad approach has got legs…it’s quite viable.”
On the House side, Rep. Roy Blunt (R-MO), chairing the Health Care Solutions Group, released an alternative to the House Democratic plan that he “hopes will receive bipartisan support.”
An example of this is GroupHealth in Washington State. “At Group Health, doctors are rewarded for consulting by telephone and secure e-mail, which allows for longer appointments. Patients are assigned a team of primary care practitioners who are responsible for their well-being. Medical practices, and insurance coverage decisions, are driven by the company’s own research into which drugs and procedures are most effective.” A good piece in last months’ NYT. discusses this.
There are many versions of this and perhaps there ought to be Federal provisions and overall guidelines but with regional flexibility afforded to each state. This topic requires further discussion and I will tackle it next month.
Enjoy the rest of your summer!!!
by Admin. | Jan 16, 2009 | healthcare, Pharmaceutical Industry
GENERIC VERSUS BRAND NAME MEDICATIONS
Many people have heard that switching to a generic medication will save them money. One of the questions we hear most often is, “How do generic medications compare to their brand name counterparts?” Knowing the facts about generics versus brand names can help make us all better consumers.
All generic drugs are reviewed and approved by the United States Food and Drug Administration (FDA) or in other countries, by an equivalent federal regulatory body. The regulatory boards all require that generic drugs have the same active ingredients, quality, strength, purity, and stability as brand name drugs. They also must have the same dosage form, whether you swallow it (pill/tablet/capsule/caplet), drink it (liquid), or inject the medication.
Many people are concerned that because generic drugs are often much cheaper than the brand-name versions, the quality and effectiveness have been compromised to make a less expensive product. The FDA requires that generic drugs be as safe and effective as the original brand name drugs. Generic drugs are copies of brand name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, the pharmacological effects of generic medications are exactly the same as those of their brand name counterparts. Another common myth is that generic drugs take longer to work. The FDA requires that generic drugs work as fast and as effectively as the original brand name products.
Generic drugs are cheaper because the manufacturers do not have the expense of developing and marketing a new drug. When a company brings a new drug to the market, the firm has already spent substantial money on research, development, marketing and promotion of the drug. A patent is granted which gives the company that developed the drug exclusive rights to sell the drug for as long as the patent remains in effect.
As a patent nears expiration, manufacturers may apply to the FDA for permission to make and sell generic versions of a drug. Since there are no startup costs for development of a new drug, other companies can afford to make and sell it for a less expensive amount. When multiple companies produce and sell a drug, the competition drives the price down even further.
The FDA applies the same standards for all drug-manufacturing facilities. Many companies manufacture both brand name and generic drugs. In fact, the FDA estimates that 50% of the generic drugs are produced by the same company that created the initial brand name drug.
Generic versions of drugs have different colors, flavors, or combinations of inactive ingredients than the original medications because United States trademark laws do not allow the generic drugs to look exactly like the brand name medication. However, the active ingredients must be the same in both generic and brand name medications, ensuring that both have the same effectiveness in treating a medical condition.
A physician’s decision to prescribe a brand name over a generic is based on the needs of the patient. Three in four physicians allow generic substitutes for brand-name drugs, even though most of them do not have a “dispense as generic” box on their prescription pad.
Pennsylvania law allows pharmacists to substitute generic drugs for original brand named drugs, unless the person writing the prescription, or the patient, directs otherwise. If the physician writes “Brand Necessary” or “Dispense As Written (DAW)” on the prescription, the pharmacist may not substitute the brand name medication with a generic alternative.
All patients are encouraged to discuss generic alternatives with their physicians prior to filling a prescription. The doctor and the patient should agree on the best course of treatment for any diagnosed medical condition.
A Guide to Legal Issues in Health Care: Prescription Drugs Retrived September 16, 2006 from http://www.upenn.edu/ogc/legal/pred.html Are Generic Medications the Same as Branded Counterparts? Retrieved September 16, 2006 from http://counsellingresource.com/medications/discount-drugs/generics.html COMMONWEALTH OF PENNSYLVANIA GENERIC DRUG EQUIVALENCY/SUBSTITUTION LAWS & REGULATIONS Retrieved September 16, 2006 from http://ecapps.health.state.pa.us/pdf/ddc/generic33.ps.pdf#search=%22pennsylvania%20drug%20dispensing%22How Physicians Feel About Prescribing Generics Retrieved September 16, 2006 from http://www.aarp.org/health/affordable_drugs/physiciansandgenericdrugs.html
Prescription Drugs – Generic vs Brand Name Retrieved September 16, 2006 from http://www.crossborderpharmacy.com/Canadian-Generics-vs-Brand-Name.htmlStoppler, MD, M., Generic Drugs, Are They As Good as Brand-Names? Retrieved September 16, 2006 from http://www.medicinenet.com/script/main/art.asp?articlekey=46204
by Admin. | Jan 16, 2009 | healthcare, HSA, NY News, Pharmaceutical Industry
Happy Holidays!
We are pleased to present the Winter issue of the MMS newsletter. As we enter 2009 we want include some timely information on year end tips, house cleaning and helpful articles.
As guidance for 2009, we are seeing various industry patterns. These are heady economic times and we remain cautiously optimistic with the new presidential administration. There are many proposed legislations on the table as well as free reports from PriceWaterHouse Cooper reports on what “Employers Want” and “9 Trends for 2009”.
We have seen recent consolidations with recent mergers between GHI and HIP to form EmblemHealth. Both non profits follow the Empire Blue Cross for-profit conversion of 5 years ago and covered in my blog.
Insurers such as Aetna, Empire and Oxford have been dropping Pharmaceutical Benefits Management companies and using their own resources instead. As self acting PBMs’ they can negotiate effectively by using their large numbers. This trend has not gone unnoticed by Pharmacy retailers such as CVS and Walgreens who must compete with mail order PBMs’.
Pharmaceutical Corps are bracing themselves for brand expirations on 80% of the most commonly prescribed drugs within 2 years. They have issued double digit rate increases while simultaneously manufacturing generics of their own drugs. This will make sense as generics average 1/4 the cost of brands. In fact, this will be a significant future cost saver as Rx have doubled in 10 years and represents over 25% of our insurance costs.
Insurers are saving members 20-40% by including value added discounts or reimbursements for gym membership, weight management programs, alternative medicine & holistic healing, vision, laser vision care, dental , hearing care and vitamins/natural supplements.
The technology investments will improve patient care and the public is already seeing early payoffs. Various online medical sites have helped inform patients and advocacy. Insurers such as Empire actually offer a $5 Copay to interact with one’s doctor online.
In addition, “consumer driven healthcare plans” are taking off as copays have risen. Its not unusual to find plans with specialist $50 copay. As a result our consumers have been re-evaluating whether it makes sense to self insure on rare items such as hoispiatls and surgeries. The HSA (health Savings Account) a model, especially the one form Aetna, has become actually a high end plan since the savings are significant enough to self insure and have universal coverage. The average PPO plan is $650/single while an HSA at $370/single only asks that you self insure on $1500. The invisible hand leading you say? Agreed!
Perhaps things will be more localized as hospitals have consolidated and have a virtual monopoly in LI and Bronx as an example. Insurers such as Oxford, Aetna and Atlantis already offer localized NYC plans which are 30% less expensive but have a limited NYC network.
Our agency has strived to be ahead of the curve and keep our clients within budget regardless. We have employed creative tools, personalized advise and latest technologies in the past and plan on adding to this model going forward. We thank you all for reading our material, referring us business and most of all believing in us!
Once again thank you and we wish you and your family a wonderful Holiday Season!
The President yesterday released with great anticipation his own version of the Reform Health Bill. This is the opening bid before Thursday’s Bipartisan Summit.