Analysis Underscores the Need for ‘Any Willing Pharmacy’ Policy in Part D

National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement in response to the detailed preferred pharmacy access analysis released by the Centers for Medicare & Medicaid Services (CMS) and conducted in response to concerns raised by NCPA, beneficiary advocates and others:

We appreciate Medicare officials acting on the concerns that NCPA members, beneficiaries, patient advocacy organizations and members of Congress have raised. We are still reviewing the full CMS analysis. Our initial reaction is that more work must be done in this area. The CMS analysis documents progress yet still identifies many plans that are ‘access outliers’ that impact a significant number of beneficiaries. Indeed, this total could be higher because CMS excluded from this analysis plans granted waivers to the retail pharmacy convenient access standard requirement. The marketing disclaimers, while appreciated, come well after the 2016 enrollment period concluded and six weeks into the plan year.

In addition, the format in which this data has been posted should be more accessible to the average Medicare beneficiary or their caregiver. Information of this importance should be incorporated into Medicare Plan Finder prominently – and before beneficiaries research their enrollment decisions.

Beneficiaries need swifter relief and protection. To that end, we encourage Medicare officials to implement an ‘any willing pharmacy’ policy and Congress to enact H.R. 793 / S. 1190. This would allow beneficiaries in medically under-served areas to access their prescription drugs at a community pharmacy that accepts the drug plan’s terms and conditions and can serve those patients. Medicare officials have already acknowledged that this is ‘the best way to encourage price competition and lower costs in the Part D program.

U.S. Sees Lowest Health Care Cost Increases in More Than a Decade

In 2013, U.S. companies and their employees saw the lowest health care premium rate increases in more than a decade, according to an analysis by Aon Hewitt. The average health care premium rate increase for large employers was 3.3% in 2013 after plan design changes and vendor negotiations. That’s down from 4.9% in 2012 and 8.5% in 2011. However, average health care premium increases are projected to move back to the 6% to 7% range in 2014.

Tim Nimmer of Aon Hewitt said that many fact0rs that helped lower rate of premium increases are not expected to continue. These include the recession and uncertainty around economic conditions and health care reform. Additionally, employers and insurers are subject to new transitional reinsurance fees and health insurance industry fees. “While we are seeing pockets of promising innovation in the health care industry, we expect to see 2014 premium increases shift back towards the 6% to 7% range overall,” he added.

The average health care cost per employee was $10,471 in 2013, up from $10,131 in 2012. Employees were asked to contribute an average of $2,303 toward the total health care premium in 2013, compared to $2,200 in 2012. Average out-of-pocket costs increased 12.8% ($2,239) in 2013, compared to just 6.2% in 2012 ($1,984).

Average health care costs are projected to increase to $11,176 per employee in 2014. Employees will be asked to contribute 22.4% of the total premium for an average of $2,499 for 2014. Average out-of-pocket costs are expected to increase to $2,470. Under these projections, employees’ share of health care costs will have increased almost 150% from $2,011 in 2004 to $4,969 in 2014.

In 2014, companies are expected to see cost increases of 7.5% for HMOs, 6.5% for PPOs, and 6.5% for POS plans. In 2013, some major U.S. markets experienced higher than average rate increases including Los Angeles (6.9%), Orange County (6.9%), and San Francisco/Oakland/San Jose (4.8%).

Jim Winkler of Aon Hewitt said that employers are realizing that a traditional managed trend approach is  less effective in mitigating costs increases over time. They are exploring innovative approaches, such as requiring participants to be more active in their own health care planning, and holding health care providers more accountable for reducing unnecessary expenses and creating more efficiency in health care purchasing. As the health care landscape continues to evolve, employers will use a mix of traditional and non-traditional approaches to reduce costs

About 28% of employers plan to move into a private health care exchange over the next three-to-five years. Private health exchanges are becoming more attractive to employers that want to offer health care choice, lower cost trends, and reduce administrative burdens. With this model, employers continue to finance health insurance while employees choose from multiple group plan options and insurance carriers through a competitive marketplace.

Consumer-driven health plans (CDHPs) have surpassed HMOs as the second most popular plan option offered by employers. A growing number of employers are offering CDHPs as the only plan option. While just 10% of companies do so, another 44% are considering it in the next three to five years.
The survey reveals the following about employers:
• 54% are considering reducing subsidies across all dependent tiers in the next three-to-five years.
• 69% have implemented surcharges for adult dependents or they plan to do so.
• 47% are considering charging per dependent, compared to just 4% of employers that do so today.
• Two-thirds have conducted audits to ensure that only eligible dependents remain on the plan.
• 47% have increased participants’ deductibles and/or co-pays in the past year, and another 43% are considering doing so in the next three-to-five years. Employees’ share of the health care premium is 22%, compared to just 18.6% a decade ago.
• 75% offer health risk questionnaires and 71% offer biometric screenings.
• 53% plan to move toward provider payment models that promote cost effective, high quality health care. As many as one in five say it’s one of their three highest priorities.

In addition, employers are increasing cost sharing by altering plan designs, including shifting from fixed dollar copayments to coinsurance models, in which employees pay a percentage of the out-of-pocket costs for each health care service. Employers are also increasing deductibles, out-of-pocket limits, and cost sharing for non-network providers. For more information, visit www.aonhewitt.com.

Analysis: Stroke more likely after bypass but risk is still low

Patients who underwent bypass surgery had a higher risk for stroke than those who received angioplasty, according to an analysis of 19 clinical studies involving almost 11,000 patients. The risk, however, was low after either procedure. The findings appeared in JACC: Cardiovascular Interventions and will be published in the Journal of the American College of Cardiology. HealthDay News (8/20

Last Updated 09/12/2019

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