Early Alzheimer’s Treatment Saves Medical Costs

Alzheimer’s patients who received medication for the disease ended up costing the health system less and had lower mortality rates, according to a study presented the Alzheimer’s Association International Conference (AAIC) in Toronto last week. “Even with today’s first-generation therapies, early Alzheimer’s treatment has significant potential to benefit the individual with the disease as well as the economy,” said Maria Carrillo, PhD, chief science officer, Alzheimer’s Assn. Christopher Black from Merck said, “Since Alzheimer’s is incurable and progressive, some assume that treating dementia is an unjustified cost drain on our healthcare system, but this study presents compelling arguments for prescribing the standard of care.”

Average health care costs more than tripled in the month after an Alzheimer’s diagnosis. But those receiving an Alzheimer’s treatment had lower health care costs in the month after they were diagnosed compared to those who did not receive a treatment ($5,535 versus $6,711). Though people who initiated taking medications had higher pharmacy costs, their total health expenditure was less than the people who did not take approved medications ($2,207 vs. $2,349 per patient per month).

Medical Marijuana Reduces Medicare Part D Drugs Costs

 BY  IN INSURANCE INSIDER NEWSLETTER

medical marijuana

Medical marijuana saves state and federal governments millions of dollars on Medicare. For example, prescriptions for painkillers have dipped drastically in states where medical marijuana is available, according to a Univ. of Georgia study published in the July issue of Health Affairs. Researchers combed through data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013 for a total of over 87 million physician-drug-year observations. In medical marijuana–approved states, the average doctor prescribed fewer doses of antidepressants as well as seizure and anti-nausea medication. Researchers narrowed the results to conditions for which marijuana may be an alternative treatment, selecting nine categories in which the Food and Drug Administration had already approved at least one medication: anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and spasticity.

In 2013, Medicare saved $165.2 million in lower prescription drug use when 17 states and the District of Columbia implemented medical marijuana laws. The results suggest that if all states had implemented medical marijuana, Medicare would have saved about $468 million. “The results suggest people are really using marijuana as medicine and not just using it for recreational purposes,” said study author Ashley Bradford.

The next study will look at medical marijuana’s effects on Medicaid. Researchers expect the cost savings to be repeated, saying their findings suggests that more widespread state approval of medical marijuana could provide modest budgetary relief.

States Are Ignoring ACA Requirements to Cover Addiction Treatment

Addiction
Insurance plans are not covering the necessary addiction services, according to a report by The National Center on Addiction and Substance Abuse. None of the 2017 Essential Health Benefit benchmark plans have adequate addiction coverage; and more than two-thirds violate the affordable Care Act (ACA). There is no penalty for states or insurance plans that don’t comply with the law. “People with addiction may not be receiving effective treatment because insurance plans aren’t covering the full range of evidence-based care. Our review did not find a single state that covers all of the approved medications used to treat opioid addiction,” said Lindsey Vuolo, JD, MPH, of The National Center on Addiction and Substance Abuse.

The ACA requires plans to cover substance use disorder services, which are under essential-health benefits. The ACA also requires these services to be provided at parity, meaning that they are comparable to medical and surgical benefits. But the ACA does not identify which specific services should be covered. Each state chooses an essential health benefit benchmark plan to determine which addiction benefits must be covered by the ACA plans sold in that state. “The absence of sufficient coverage for medication-assisted treatment for opioid addiction is particularly alarming given the number of people dying or suffering on a daily basis. This kind of health care discrimination would never be tolerated during an epidemic for any other life-threatening disease,” said Samuel Ball, PhD, President and CEO at The National Center on Addiction and Substance Abuse. The report calls on states and insurers to comply with the law and cover the full range of effective addiction treatments. The following are key findings of the report:

  • Over two-thirds of plans contain language that violates ACA requirements for addiction benefits.
  • 18% of plans don’t comply with parity requirements.
  • No plans cover the full array of critical benefits without harmful treatment limitations.
  • 88% of the plan documents are not detailed enough to evaluate parity compliance and the adequacy of addiction benefits.

Bill Would Prevent Over-Prescribing

A California bill would require doctors to check California’s prescription drug database before prescribing opiates. The Controlled Substance Utilization Review and Evaluation System (CURES) is the nation’s most advanced prescription drug monitoring program, but just 35% of California providers and dispensers use it. Carmen Balber, executive director of Consumer Watchdogs said, “California loses 4,500 people a year to preventable drug overdoses–more than any other state….The legislature can help…by requiring doctors to check the prescription database before recommending patients take the most dangerous and addictive drugs. It’s clear that making use of the database voluntary does not work.”

SB 482, by California state Senator Ricardo Lara, would require doctors to check California’s CURES database when prescribing Schedule II or III drugs like Oxycontin to a patient for the first time, and annually thereafter if the treatment continues. The Centers for Disease Control and Prevention issued new prescribing guidelines that recommend doctors use prescription drug databases every time they prescribe an opioid. Last month, president Obama proposed $1.2 billion in new federal funding to fight opioid abuse, including funds to expand the use of state prescription drug databases.

Twenty-two states mandate use of a state prescription database. States that track results have seen reduced doctor-shopping and lower opioid prescription rates. Also doctors say that the databases are useful to them in prescribing the right medications. The following states have seen improvements after mandating the use of a database:

  • New York saw a 75% drop in patients seeing multiple prescribers for the same drugs.
  • Kentucky found that opioid prescriptions to doctor-shopping individuals fell 54%. Also, overdose-related deaths declined for the first time in six years in 2013.
  • Tennessee saw a 36% drop in patients who were seeing multiple prescribers to get the same drugs. Tennessee prescribers say they are 41% less likely to prescribe controlled substances after checking the database, and 34% more likely to refer a patient for substance abuse treatment. Also, 86% of prescribers say the database is useful for decreasing doctor shopping.

What Consumers Are Saying About Obamacare and Cancer Coverage

When consumers talk about Obamacare online, cancer is the most frequently discussed health condition, according to a report by Treato. Online, consumers discuss cancer 2.5 times more often than any other health condition. When discussing cancer, the leading topics are breast, lung, and colon cancers. Online discussions about Obamacare generally skew negative among cancer patients, but those who are positive express extreme gratitude. Twenty percent of patients and caregivers on cancer forums express gratitude and 48% have various criticisms about Obamacare.

Conversations about the downside of Obamacare’s cancer coverage generally fall into two categories: dissatisfaction with coverage and frustration with the lack of plan options. Consumers discuss the challenges of deciphering insurance rules to get the coverage they want, and confusion about subsidies, exclusions, inclusions, and co-pays.

Consumers are also complaining that certain groups are gaining more from Obamacare. The strongest criticisms are about women having access to more preventative screenings and more coverage for conditions, such as for breast cancer, and the poor getting free coverage. Consumers are also critical of other health conditions getting less coverage than cancer.

Consumers complain about losing good private insurance plans because of Obamacare and paying more out-of-pocket for cancer treatment. Many say that Medicare and Medicaid are simpler to access and easier to understand. Those who like Obamacare cite preventative screenings, coverage of pre-existing conditions, removal of lifetime limits on coverage, and the affordability of coverage

Californians Are Encouraged To Explore Mental Health Coverage

The California Assn. of Marriage and Family Therapists (CAMFT) urges Californians to investigate mental health coverage during open enrollment. Under California law, psychotherapy may be much more affordable than most people assume. The Affordable Care Act and the Mental Health Parity and Addiction Equity Act require insurers to provide behavioral health coverage to treat mental health disorders or substance abuse  that is comparable to coverage for treatment of physical health with no annual limits. Despite robust access to affordable mental health care, many policyholders are not utilizing it to their full benefit. Often, the obstacle is a lack of information about the available options. The website, CounselingCalifornia.com, allows consumers to search for local therapists who accept clients with managed care plans.

Coverage Makes a Difference When It Comes to Surviving Cancer

Coverage Makes a Difference When It Comes to Surviving Cancer


Medi-Cal patients with breast, colon, and rectal cancer are more likely to be diagnosed at an advanced stage of disease and have lower five-year survival rates compared to those with other sources of health insurance, according to a survey by the UC Davis Health System. Medicare-Medi-Cal dual eligible patients are the least likely to get recommended treatment for breast and colon cancer.

VA patients have the longest intervals between diagnosis and treatment for breast, colon, rectal, lung, and prostate cancers, but their treatment outcomes compare favorably to patients with other types of health insurance, and they are generally more likely to get recommended treatment.

Researchers were not surprised that Medi-Cal and Medicare-Medi-Cal dual eligible, and uninsured patients were getting diagnosed at a later stage of cancer and had lower survival rates since adverse social factors affect these populations. But the lower quality of care cannot be as readily explained. In light of the rapid growth of Medi-Cal, the findings highlight the need to investigate the disparities in cancer care, according to the study

Judge Tells Aetna to Pay for Cancer Treatment

Judge Tells Aetna to Pay for Cancer Treatment
A Texas judge granted a restraining order preventing Aetna from denying cancer treatment to a man with advanced prostate cancer. Bobby Allen Bean’s doctors recommended proton radiation therapy. His doctors said that the only other options to treat the cancer are too risky because he has insulin-dependent Type 2 diabetes.

Aetna refused to cover the treatment, calling it experimental. However, the patient’s medical facility has been using proton radiation therapy for nearly 10 years. “This is not some unknown experimental treatment. It works. And my client should be given the opportunity to have the treatment to save his life,” said his attorney, Robert Hilliard of Hilliard Munoz Gonzales LLP

Mental Health Bill Reintroduced

Chairman Tim Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX) reintroduced the Helping Families in Mental Health Crisis Act, H.R. 2646. The revamped bill builds upon the previous bipartisan version. H.R. 2646. It breaks down federal barriers to care, clarifies privacy standards, expands parity accountability, invests in services for the most difficult to treat cases, and drives evidence-based care. Rep. Murphy said, “We are moving mental health care from crisis response to recovery, and from tragedy to triumph.”

The Helping Families in Mental Health Crisis Act was first introduced in December 2013, following a yearlong investigation led by Oversight Chairman Murphy into the nation’s broken mental health system. The investigation revealed that the federal government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.

As documented in a recent Government Accountability Office (GAO) report, 112 federal programs intended to address mental illness aren’t connecting for effective service delivery. Also, there is a lack of inter-agency coordination for programs supporting people with serious mental illness.

While the federal government dedicates $130 billion towards mental health each year, the mental health system is best described by its deficits. To name just a few:

  • There is a nationwide shortage of nearly 100,000 needed psychiatric beds.
  • Three of the largest mental health hospitals are criminal incarceration facilities.
  • Privacy rules frustrate physicians and family members and generate nearly 8,000 official complaints a year.
  • Only one child psychiatrist is available for every 2,000 children with a mental health disorder.
  • The leading federal mental health agency does not employ any psychiatrists.

The Helping Families in Mental Health Crisis Act of 2015, H.R. 2646 would do the following:

  • Create an Assistant Secretary for Mental Health and Substance Use Disorders with mental health credentials within HHS. The assistant secretary would elevate the importance of mental health in the nation’s leading health agency, coordinate programs across different agencies, and promote effective evidence-based programs.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to make public all federal investigations into compliance with the parity law so that families and consumers know what treatment they have rights to access.
  • Establish a National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs.
  • Dedicate funding for the Brain Research Through Advancing Innovative Neurotechnologies Initiative.
  • Require psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to appropriate post-hospital care and services.
  • Provides additional psychiatric hospital beds for those with an acute mental health crisis who need short term (less than 30 days) immediate inpatient care.
  • Support advances in tele-psychiatry to link pediatricians and primary care doctors with psychiatrists and psychologists in areas where patients don’t have access to care.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to study and recommend a national strategy to increase the number of psychiatrists, child and adolescent psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and mental health peer-support specialists.
  • Include child and adolescent psychiatrists in the National Health Service Corps.
  • Authorize the Minority Fellowship Program.
  • Authorize, for the first time in federal law, the Recovery After Initial Schizophrenia Episode (RAISE), an evidence-based early intervention program.
  • Reauthorize the National Child Traumatic Stress Network.
  • Launch an early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
  • Provide incentives to states to offer community-based alternatives to institutionalization.
  • Reauthorizes the Garrett Lee Smith Suicide Prevention Program, invest in research on self-directed violence, and authorize, for the first time in the statute, the Suicide Prevention Hotline.
  • Extend health information technology for mental health providers to coordinate care with primary care doctors using electronic medical records.
  • Establishe an inter-agency Serious Mental Illness Coordinating Committee to organize, integrate, and coordinate the research, treatment, housing and services for people with substance use disorders and mental illness.
  • Ends the decades-old prohibition on physicians volunteering at community mental health clinics and federally qualified health centers.

Congressman Murphy, a psychologist with nearly three decades experience, has been a champion for reforming the broken mental health system. He yearly introduces the bipartisan congressional resolution declaring May as Mental Health Month, to end the stigma associated with mental illness and promote public awareness of mental health. He will soon advance a similar resolution recognizing the month of June as PTSD Awareness Month. A provision in the previous version of his Helping Families in Mental Health Crisis Act was recently adopted on the House floor. Murphy offered a bipartisan amendment with Rep. Michelle Lujan Grisham (D-NM) and Rep. Earl Blumenauer (D-Ore.) to the Commerce, Justice, Science and Related Agencies Appropriations Act of 2016, to advance and expand Mental Health Courts, a successful model of collaboration between criminal justice and mental health systems for those with serious mental illness.

Legislation Would Provide Coverage for Alzheimer’s Care Planning

Newly diagnosed Alzheimer’s patients and their caregivers would get comprehensive care planning services under Medicare in a bill reintroduced by Senators Debbie Stabenow D-Mich. and Susan Collins R-Maine and Representatives Chris Smith R-N.J. and Paul Tonko D-N.Y.

The bipartisan Health Outcomes, Planning, and Education HOPE for Alzheimer’s Act H.R. 1559/S. 857 would require providers to document an Alzheimer’s diagnosis in their medical records. Surprisingly, only 45% of people with Alzheimer’s disease or their caregivers say their doctor told them about the diagnosis. In contrast, more than 90% of people with the four most common cancers were told their diagnosis. People with Alzheimer’s or their caregivers are more likely to be told of the diagnosis only after the disease has become more advanced. Studies have shown that there are benefits to early detection and diagnosis including the ability to plan for the future, take advantage of support services, and participate in clinical trials.

Although Medicare provides coverage for diagnostic services, it does not provide coverage for comprehensive care planning following an Alzheimer’s diagnosis.

Last Updated 11/13/2019

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