Spring 2010 Cost-Cutting Trends for Key Changes to Medicare Pharmacy Benefits Part D Coverage Gap
Employers are focusing more than ever on saving money in
With the enactment of the health care reform law comes
their pharmacy benefit plans. One growing trend is better
several changes to the Medicare Part D drug benefit,
negotiating with PBM vendors, with employers pushing
aimed at lessening the burden on Part D members when
harder for maximum rebates and discounts. Many PBMs
are willing to be flexible in order to keep their members,
In 2010, Part D members with spending in the
and employers can benefit from the resulting competition.
coverage gap will receive a $250 rebate.
In addition, employers are looking at plan design changes
Starting in 2011, Part D enrollees who reach the
as a cost controlling measure. Because a large percentage
coverage gap will receive a 50 percent discount on
of prescriptions are for chronic diseases, employers are
looking to address the source within their employee groups, through disease management and wellness. Also, in an
Additional subsidies will also phase in over time for
effort to improve medication adherence, many pharmacies
both generic drugs (beginning in 2011) and brand-
are moving to a 90-day refill period for certain drugs, which
name drugs (beginning 2013), to eventually reduce the
in the past was only seen for mail-order prescriptions.
coinsurance rate in the gap to 25 percent by 2020.
Between 2014 and 2019, the out-of-pocket amount
Other cost-cutting trends include encouraging generics or
that qualifies an enrollee for catastrophic coverage will
even over-the-counter drugs over brand names, and
adding more employee cost-sharing mechanisms. For instance, employers may move certain drugs up a tier to
Source:Kaiser Family Foundation
increase the price, thus strongly encouraging the generic
variety or forcing the employee to pay the brand name cost. A 2009 survey found that 76 percent of employers used
New Rules for OTC Drugs
employee cost-sharing as a mechanism to control costs and encourage smarter utilization, up from 51 percent the
and Health Accounts
Another component of the health care reform law
addresses eligible expenses under health flexible spending
Some PBMs have also started offering new services, such
accounts (health FSAs), health reimbursement
as nurses or pharmacists that call patients to discuss their
arrangements (HRAs), health savings accounts (HSAs)
medication, as some patients may feel uncomfortable
and Archer medical savings accounts (Archer MSAs). The
discussing issues in-person with their pharmacist. Another
law now defines qualified medical expenses to include only
growing trend is conducting genetic tests on a patient to
medication that is prescribed, with the exception of insulin.
determine if a particular drug will work on them. This can
eliminate higher future costs and save the wasted time of
Essentially, this means that over-the-counter (OTC) drugs
trying different drugs for efficacy on a particular patient.
are no longer acceptable expenses for any health account.
Source:Employee Benefit News
This provision goes into effect for tax years beginning after
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C5: Methodological and Philosophical Issues in PhysicsThis paper evaluates how the symmetry problem that has recently beenraised [2] for Friedmann-Lemaˆıtre-Robertson-Walker spacetimes in generalrelativity (GR) and according to which spacetime structuralism seems com-mitted to the claim that the universe has no spatial extension—it consistsof one lonely point—is transposed into the causal s
Spring 2010
First-Time Generics