Microsoft word - behind the counter spring 2010

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 First-Time Generics
Generic Name
Brand Name
Behind The Counter, Spring 2010 Content 2010 Zywave, Inc. All rights reserved.


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


Journal of Universal Computer Science, vol. 16, no. 20 (2010), 2902-2903submitted: 4/10/10, accepted: 18/10/10, appeared: 1/11/10 © J.UCS Evolving Theories of Conceptual Modelling J.UCS Special Issue Markus Kirchberg (Institute for Infocomm Research, A*STAR, Singapore Klaus-Dieter Schewe (Software Competence Center Hagenberg, AustriaThe aim of the first international workshop on

Copyright © 2010-2014 Medical Articles