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Feb Newsletter 2011


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Feb Newsletter 2011

  1. 1. Industry Updates February, 2011The Gardner Group is pleased to present our ninth newsletter. We look forward to continue sharing our experience and timely industry updates. How to Avoid Medication Variations in Drug Costs Mistakes 2011 resulted in an increase in the growth of consumer-directed health plans (CDHP). By the end of 2011, it is expected that Find out the name of your medication: close to 60% of U.S. employers will offer a CDHP. The increase may be partially due to Health Reform and the premium hikes Most of us just pass the prescription from the expected as a future result. physician to the pharmacy without paying much attention. To avoid mistakes, write down the drug With this increase comes the need for employers and their name before you give the prescription to the employees to become familiar with and accountable for their pharmacy and double check that it matches when own healthcare decisions. Most don’t realize that, in addition they provide your supply. Do the same with refills to using available generics, comparing costs between and make sure the medication inside looks the same pharmacies (even those within the same chains) can lead to as before. significant savings. In one circumstance alone it was discovered that a popular name brand drug could be purchased Ask questions about how to use the medication: for $2,500 less annually by switching pharmacies. Traditionally, insurance professionals have focused on the cost Choose a physician and pharmacy that you are savings associated with managing high dollar claims such as comfortable with so you feel free to ask questions. those for in-patient stays. Recently it has been realized that Some examples – what to do if skip a dose? What side variations in drug costs can add up to significant savings. effects are possible? Are there activities, food and/or other medications to avoid? Should this be stored in The future includes readily accessible databases comparing the refrigerator? pharmacies to each other outside of and within the same chains. In the meantime, shoppers can utilize the online tools available through their health insurance providers, keep the lines of communication open with pharmacies and physicians and compare the costs at those 2 or 3 pharmacies that are most convenient for possibly significant savings. -Employee Benefit Advisor Know exactly what your medication is meant to do: Super Bowl Heart Trouble? According to Dr. Robert A. Kloner, Heart Institute of Good One physician reported that his patient mistakenly Samaritan Hospital, physicians and patients should be aware thought her glaucoma medication was for treating that stressful games might elicit an emotional response that headaches, so she was taking her eye medication only could trigger a cardiac event. And we all thought it was just the when she had a headache when she should have been beer and greasy food! taking it every day! Surprisingly, the risk association appears to be even stronger Read the labels and follow directions: for women than men according to the report published online in the journal, Clinical Cardiology. History reveals that in Be sure to read the label every time you use your hometown locales where fans bear witness to the loss of their medication. In the middle of the night you could team, there is an identifiable bump in cardiac-related illness. accidently use the wrong one or overdose yourself or Historically, in 1980, cardiac illness rose 15% in men and 27 your children. Use the measuring device that comes percent in women when the Rams lost to the Steelers. By with the medicine or ask for one from the pharmacy. contrast, in 1984, the Raiders win was linked to a drop in cardiac-related issues overall for the Los Angeles area. Keep your providers informed: Dr. Shukri David, chief of cardiology at Providence Hospital, Carry a list of all medications (including over the calls it the “perfect storm” when the extra excitement for the counter and vitamins) and provide a copy to any many viewers who are normally sedentary is combined with provider you see, including physicians, pharmacists, the junk food and excess drinking. For those with personal and/or hospitals. At the very least, put all of your funds at risk, a disappointing outcome completes the storm. If medications in a bag when you go to your annual you can’t keep the game results in perspective, Dr. David checkup. recommends a game day plan for the possible results. Computerized Medication Box: The FDA has cleared for marketing the Electronic Medication Management Assistant (EMMA), a programmable device that stores and dispenses prescription medication for patients’ use in the home. This includes two-way communication software that allows a health care professional to remotely manage prescriptions stored and released by the patient operated delivery unit. It emits an alert when medications are to be taken, releases them onto a delivery tray when activated by the patient and keeps a historical record. Until widely available, we must organize ourselves! -U.S. Food and Drug Administration
  2. 2. Industry Updates February, 2011 Wellness Incentives Survey Trends for Prescription Drug Results: Plans:In a survey of over 1,000 organizations, the following The Pharmacy Benefit Management Institute (PBMI) conductedresponses were the result of questions regarding the a survey of U.S. Employers from March 2010 through Mayuse of incentives in wellness efforts: 2010. The survey was completed by 372 employers representing 5.8 million members. The survey is meant to -49% awarded gifts, 47% used raffles or prize collect trends in drug plan design and utilization for retail, drawings and 49% included discounts and mail-service and specialty pharmacy. Because the specialty subsidies for preventive health services. pharmacy area is growing rapidly, special attention was paid to cost control strategies in this area. -37% subsidized membership for gyms and 32% did the same for wellness classes. Trends include: -Employers expect to use 6 times the amount of technology driven activities within the next three -An increase in the number of cost sharing tiers years. -Cost share amounts for preferred and non-preferred -66% of employers brand drugs are increasing have a wellness strategy, a large -Employee cost sharing percentages have remained flat increase from 49% despite overall cost increases in 2007. 62% use incentives. -Pharmacies are being reimbursed at lower percentages -Although there is -Utilization Management efforts are increasing to curb cost a trend of rewarding and inappropriate utilization when specific health goals are met, most rewards are typically for -As brand name drugs lose patents an increase in generic participation in health screenings or educational and over the counter options activities. Below is an illustration of the comparison of employee drug -A lack of physical activity was cited as the top expenditures as a percentage of total claim costs: driver for including wellness programs in the workplace. 30% Average Annual -Working Well: A Global Survey of Health Percentage Increase Promotion and Workplace Wellness Strategies 25% in Prescription Drug Expenditures We are now on Facebook! 20% Retail Pharmacy Claim Costs Paid by BeneficiaryAs another means of communicating and keeping our 15%clients informed we created a Facebook page. We willbe posting our Industry Update Newsletter, Health Mail-ServiceTips, Healthcare Reform Newsletter and much more. 10% Pharmacy ClaimCome visit us by clicking anywhere on this newsletter. Costs Paid by Beneficiary 5% Specialty Pharmacy Claim Costs Paid by 0% Beneficiary 2006 2007 2008 2009 2010 2010 key findings include that about 48% have introduced value-based plan design tools in their drug benefit plans. 96% offer mail-service pharmacy for maintenance medication. 19% require mail-order for maintenance medications to control costs. 82% offer specialty pharmacy drug coverage, but there is a change to how these specialty drugs are dispensed in 2010 from previous years (consolidation of vendors). Participants pay a much smaller percentage of total cost for specialty drugs than retail or mail order. The most commonly used utilization management tools are refill too soon (89%), quantity limits (88%) and prior authorization (77%). The average rate of drug cost increases was 6%, an increase over last year of 4%. The health care industry is facing some of the largest changes in history and it will be important that all parties work together to determine the best drugs at the best time from the best source in order to keep this important benefit financially possible. -Pharmacy Benefit Management Institute