Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Repost] Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

Medical Cost Offsets from Prescription Drug Utilization Among Medicare Beneficiaries

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Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA

SUMMARY
This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P<0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% fordyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and1.17% for hypertension.
J Manag Care Pharm.
2014;20(10):994-95
Excerpts:
With about half of patients not taking their medications as directed, avoidable adverse health events and use of medical services are estimated to add up to $290 billion in U.S.health care expenditures annually. Improvements in clinical and economic outcomes from medication adherence have been demonstrated across a variety of conditions and patientcohorts. As an example, in 2011 my colleagues and I (Roebuck et al.) determined that adherence to medication for chronic vascular disease was associated with fewer inpatient hospital days and emergency department visits and lower overal health care costs. Specifically, annual net savings in healtcare expenditures for an adherent (compared to nonadherent) elderly beneficiary were estimated to be $7,893 for congestive
heart failure, $5,824 for hypertension, $5,170 for diabetes, and $1,847 for dyslipidemia—or approximately 9% to 28% of total
health care costs. This research employed a rigorous observational study design that addressed a key concern and limitation
ofprior analyses—the potentialendogeneity (confounding) of adherence. More plainly, results reported in earlier publications mayhave been biased if patients who took medications as directed also engaged in other unmeasured healthy behaviors

(i.e., the “healthy adherer effect”)
..
Figure 1 presents the new findings and includes the CBO estimate for reference. Specifically, 1% increases in condition-specific prescription drug utilization were significantly (P<0.001) associated with reductions in seniors’ gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. These results demonstrate that medical cost offsets from prescription drug utilization likely vary bychronic condition and that impacts for therapeutic classes used to treat these 4 conditions—which represent 40% of Medicare Part D utilization—may be between 3 and 6 times greater than the CBO’s assumption. In dollar terms, these relative impacts are not trivial. For example, 53% of Medicare (fee-for-service) beneficiaries have the comorbidity combination of hyperten sion plus high cholesterol—with average annual medical costs of $13,825. The current findings suggest that a 5% increase in the use of antihypertensive medication by patients with those conditions may prompt reductions in medical (Parts A and B) costs of more than $800 annually per beneficiary.
….
The present analysis examined retirees with employer-sponsored insurance in addition to Medicare. To the extent that these individuals differed from the broader Medicare population, the generalizability of study findings may be limited.

November 3, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014

Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014.

….
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors’ identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year.

CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
WHAT WE RECOMMEND
We recommend that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors reported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors’ data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.

 

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March 28, 2014 Posted by | health care | , , | Leave a comment

[Repost] Prescription Drug Use Among Medicare Patients Highly Inconsistent

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From the 17 October 2013 Science Daily article

 A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.

In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.

“There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States,” said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.

“This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it,” said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. “Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use.”

The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program’s Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:

  •  Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
  •  Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
  •  Potentially harmful medications, for which risks generally outweigh benefits. 1

Read the entire article here

The full Dartmouth report may be found here

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October 18, 2013 Posted by | health care | , , , | Leave a comment

[Not just for librarians!] Healthy Aging at Your Library: Connecting Older Adults to Health Information

My volunteer position at the NW Ohio Area Office on Aging brings me in contact with many older Americans with health issues.
The past few months I’ve been making follow up phone calls to screen folks for eligibility for the Extra Help Medicare Prescription Drug program **through the Social Security Office.   Quite a few screenings went beyond the rote answering of  about 15 questions related to income, resources and current prescription drug coverage. At times I got quite an earful of their present medical conditions, financial conditions, and inability to fully take care of themselves and others.  Was usually able to refer folks to in-house and area resources.

This morning I came across a training class for librarians on how to assist older Americans on how to locate health information.
While information doesn’t cure or assist on it’s own, it does empower people.  At the Area Office on Aging, we do not advise, but present information so they can make their own best possible decisions.

The class material is online and free. I’ll be going through the materials on my own. Partly so I can be a better volunteer.
Also, I’ll be adding some of the material to my Google site, Health Resources for All.

Some interesting factoids from the online class, Healthy Aging at Your Library, specifically the Power Point presentation

  • The number of Americans aged 65 years or older during the next 25 years will double to about 72 million.
  •  By 2030, older adults will account for roughly 20% of the U.S. population.
  • 2 out of 3 older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget ***
  • Heart Disease – #1 cause of death adults over age 65
  • Cancer – #2 cause of death adults over age 65
  • Patients with low literacy skills were observed to have a 50% increased risk of hospitalization
  • Only 3% of older adults surveyed had proficient health literacy skills
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**Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.

To see if you qualify, and apply… do one of the following

  • Go to  the Extra Help screening tool/application page
  • Call the US Social Security Office 1-800-772-1213 (somtimes one can bypass menu options by saying “Customer Service”_
  • Contact your nearest Area Office on Aging, United Way, or similar agency

*** Right now at the Area Office, I am doing Medicare Advantage Plans and Part D (Prescription Drug) plan comparisons. Part of the comparison includes entering all prescription drugs used. This can get quite lengthy. Averages around 8 drugs, the record for me was 27 prescription drugs entered for one person.

I encourage folks to compare Medicare Advantage Plans/Part D plans every year. Even if one is happy with one’s plan, it does not hurt to look at others.
Medicare.gov (the official government site) has a tool where one can compare plans for free. The results are in an easy to read chart, which includes prices, coverage, co-pays, and more.

Need assistance in doing the online comparisons? Contact your local Area Office on Aging, United Way, or other related social service agency.

October 3, 2013 Posted by | Finding Aids/Directories, Librarian Resources | , , , , | Leave a comment

Some Prescription Drug Cost Assistance Programs

Recently I updated my Health Resources for All Web site.

If anyone has any suggestions (including additions), please let me know in the comments section or email me at jmflahiff at yahoo dot com.

 

Here’s the list from Prescription Drug Cost Assistance

[Sorry, it did not copy/paste very well!!]

General Guides

BenefitsCheckUp, a service of the National Council on Aging, can help you find public and private programs that may be able to help pay for your prescription drugs.

Government Programs

Extra Help (sometimes called the Low-Income Subsidy, LIS)

Find a Medicare Prescription Drug Plan (Center for Medicare & Medicaid Services)
Helps find prescription drug coverage regardless of income, health status, or how you pay for prescription drugs today.Click here for when you may enroll.  Additional information on Part D prescription drug plans here.

Nonprofits and Commercial Programs

NeedyMeds

  • Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care. Includes coverage gap programs.

(More at their About page, Printable brochure here)

             Contact them through their Web site or by telephone (800-503-6897)
 
  • A way to receive discounts on prescription drugs at participting pharmacies. 
  • Printable coupon at Web site
  • Contact by email or phone (1-888-412-0869). FAQ page here.
  • How it Works
    1. Use FreeRxPlus® Bin and Group numbers for FREE access to savings on prescriptions, lab tests, and imaging services.
    2. For access to Lab Test savings: Locate a lab or order your test call toll-free 1-888-412-0869
    3. For access to Imaging Savings: Locate an imaging center or order your service call toll-free 1-888-412-0869
    4. For access to Prescription Savings: Click HERE and locate a participating pharmacy or search for medication pricing. Then simply present your FreeRxPlus® card to the pharmacist for immediate saving
 A collaboration of pharmaceutical companies, health care providers and advocacy organizations. 

Use their services online or contact them at 1-888-477-2669Prescription Assistance Page includes


 PatientAssistance.com, Inc

PatientAssistance.com is a free resource designed to help connect patients who can’t afford their prescription medications with patient assistance programs. Generally for the uninsured and underinsured.

 Patient Advocate Foundation (PAF)

1-800-532-5274

The PAF helps to solve health insurance and access problems. The website has information on resources, programs, and provides personal help. PAF offers assistance to patients with specific issues they are facing with their insurer, employer and/or creditor regarding insurance, job retention and/or debt crisis matters relative to their diagnosis of life threatening or debilitating diseases.

Services provided by PAF include:

  • CINV CareLine

    CINV (chemotherapy-induced nausea and vomiting) CareLine is a patient hotline designed to provide case management assistance to patients diagnosed with cancer and experiencing chemotherapy-induced nausea and vomiting who are seeking education and access to care.

  • Co-Pay Relief Program

    The Co-Pay Relief Program currently provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical co-payment assistance. The program offers personal service to all patients through the use of call counselors; personally guiding patients through the enrollment process

RxAssist

RxAssist is a website with information, news, and a database that are all designed to help you find out about ways to get affordable, or free, medications. The database includes information on the pharmaceutical companies’ patient assistance programs, or programs that provide free medication to low-income patients. RxAssist was created by Volunteers in Health Care, a national, nonprofit resource center for health care programs working with the uninsured.

National Organization for Rare Disorders (NORD) Patient Assistance Program may be able to help you find free or reduced-fee prescription drugs for your condition.

Prescription Drug Assistance Programs(American Cancer Society)

RxHope: Patient Assistance Information(Pharmaceutical Research and Manufacturers of America)

 

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August 30, 2013 Posted by | Finding Aids/Directories, Librarian Resources | , , , , , , | Leave a comment

Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk

Excerpt from
ProPublica, May 11, 2013, 9:06 p.m., by Tracy Weber, Charles Ornstein and Jennifer LaFleur

….An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.

Searches through hundreds of millions of records turned up physicians such as the Miami psychiatrist who has given hundreds of elderly dementia patients the same antipsychotic, despite the government’s most serious “black box” warning that it increases the risk of death. He believes he has no other options….

…..

The data, obtained under the Freedom of Information Act, makes public for the first time the prescribing practices and identities of doctors and other health-care providers. The information does not include patient names or the reasons why doctors prescribed particular drugs, so reporters interviewed the physicians to learn their rationales.

…

Medicare has access to reams of data about its patients, their diagnoses and the medical services they received. It could analyze all of this information to determine whether patients are being prescribed appropriate drugs for their conditions.

But officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government. Congress never intended for CMS to second-guess doctors – and didn’t give it that authority, officials said.

“CMS’s payments don’t go to physicians, don’t go to pharmacies. They go to plans, which is how our oversight framework has been established,” Jonathan Blum, the agency’s director of Medicare, said in an interview. The philosophy “really has been to defer to physicians” about whether a drug is medically necessary, he said.

Asked repeatedly to cite which provision in the law limits their oversight of prescribers, CMS officials could not do so.

The Office of the Inspector General of the Department of Health and Human Serviceshas repeatedly criticized CMS for its failure to police the program, known as Part D. In report after report, the inspector general has advised CMS officials to be more vigilant. Yet the agency has rejected several key recommendations as unnecessary or overreaching.

Other experts in prescription drug monitoring also said Medicare should use its data to identify troubling prescribing patterns and take steps to investigate or restrict unsafe practitioners. That’s what state Medicaid programs for the poor routinely do.

“For Medicare to just turn a blind eye and refuse to look at data in front of them . . . it’s just beyond comprehension,” said John Eadie, director of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

“They’re putting their patients at risk.”

….

The Part D records detail 1.1 billion claims in 2010 alone, including prescriptions and refills dispensed. ProPublica has created an online tool, Prescriber Checkup, to allow anyone to search for individual providers and see which drugs they prescribe.

…

Typically in Medicare, the government is responsible for contracting with doctors, reviewing claims for treatment and paying the bills.

But Part D is different: Patients get their drugs through stand-alone drug plans, which cover only drugs, or through Medicare HMOs that also cover medical services.

Medicare pays private insurers a set amount per enrollee to run the program and pay for the drugs. All the insurance plans are supposed to alert pharmacies to potentially harmful drug interactions, query doctors who prescribe high levels of narcotics to individual patients and be on the lookout for fraud, among other things.

……

Potential for Fraud

Since Part D was launched, the HHS inspector general and the Government Accountability Office have grown increasingly worried that it lacks adequate oversight.

Several reports have found that Part D is vulnerable to fraud. Insurers have paid for prescriptions from doctors who were barred by Medicare. Separately, in 2007 alone, the program covered $1.2 billion worth of drugs prescribed by providers whose identities were unknown to insurers or Medicare, according to a June 2010 report.

The inspector general even found fault with the contractors Medicare hired to dig out fraud: The contractors generated few of their own investigations, relying on outside complaints for direction.

Although many reports focus on fraud, analysts also have found that the program was vulnerable to inappropriate prescribing that put patients’ lives in danger.

A May 2011 report said Medicare has not ensured that Part D paid only for drugs prescribed for FDA-approved and widely accepted off-label indications as federal law requires. About half of the 1.4 million antipsychotic prescriptions made to nursing home patients in the first six months of 2007 “were not used for medically accepted indications,” the report said.

“There’s certainly room for improvement,” Robert Vito, a regional inspector general who has directed many of the reports, said in an interview.

Medicare should, for example, require that prescriptions include a patient’s diagnosis as a way to monitor how Part D drugs were being used, his agency said.

But Medicare officials told the inspector general that neither state boards of pharmacy nor private industry requires this practice, so neither would they.

CMS also has rejected proposals to require insurers to report suspicious prescribing to its fraud contractor. Such sharing is now voluntary.

Medicare’s safeguards lag well behind those of many state Medicaid programs.

Louisiana requires that doctors include diagnosis codes when they write prescriptions for painkillers and antipsychotics. Similar checks have proved effective in other states. Florida found that antipsychotics given to children younger than 6 dropped when specialists reviewed prescriptions.

Even some of Medicare’s top prescribers think the program should do more to research unusual or suspicious prescribing patterns.

Indiana physician Daniel J. Hurley led the country with more than 160,000 prescriptions under Part D in 2010, ProPublica’s analysis shows. In an interview, he said nursing home pharmacies had credited him with prescriptions by other health professionals in his practice, a quirk Medicare should want to address.

It’s unclear how often this might happen, and some nursing home doctors do write lots of prescriptions on their own. Medicare said it recently addressed this issue, but according to Medicare’s own numbers, Hurley’s prescriptions have dropped only slightly.

“Why wouldn’t they call us up and ask us?” Hurley said. “If you hustled, you couldn’t come anywhere near that number, nor should you.”

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July 7, 2013 Posted by | health care, Librarian Resources | , , , , | 1 Comment

[Reblog] Rising Medicare Part D Drug Premiums & How to Compare Plans

From the 10 October 2013 article at As Our Parents Age

 

Check out this interactive plan finder.

Take a few minutes to read As Medicare Drug Premiums Soar It’s Time to Shop Around, another informative article about prescription drug plan open season.

[Flahiff’s note…
If you do not have ready access to a computer or find computers challenging, try these resources for assistance in comparing plans

    • Local Area Office on Aging (may have a slightly different name in your area)
      As a volunteer at our area office, this is our top priority during open enrollment…which ends December 7th
    • Local United Way for referral to agencies in your area (211 for most localities)
    • Local public library for referral to agencies in your area (ask for a  reference librarian)]

This October 2, 2012 Reuters article by Mark Miller goes into considerable detail about the rising premiums and explains what steps Medicare beneficiaries can take to shop around.

Best Quote from the Article: Premiums for many popular Medicare prescription drug plans will soar next year – but seniors don’t have to take the rate hikes lying down.

It goes hand-in-hand with the other article I reviewed in my September 30, 2012 blog post, Medicare Prescription Drug Plan: 2013 Info.

Medicare beneficiaries and their adult children can use these two articles, together with the Plan Finder at Medicare.gov. At the top right on  the page is a button that takes visitors to an online demonstration of the Plan Finder.

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November 7, 2012 Posted by | health care | , , , , | Leave a comment

Planning for an Aging Nation: New Estimates to Inform Policy Analysis for Senior Health

Hillary Clinton Health care elderly

Hillary Clinton Health care elderly (Photo credit: Wikipedia)

From the excerpt at Full Text reports (with link to report)

This dissertation contains three papers on the health and welfare of the elderly population. Overall, these papers provide insights into the costs and challenges of providing health care to the elderly population. These papers help us understand the effects of obesity on longevity and health care, as well as better understand the benefits of social insurance. The first paper uses a micro-simulation model to estimate the longevity effects of poor health trends among younger Americans, and finds that difference in these trends can explain 92% of the difference between US and European longevity. The second paper estimates the welfare effects of Medicare Part-D from gains in market efficiency and dynamic incentives for pharmaceutical companies. It finds that these gains alone nearly cover the welfare cost of funding Medicare Part-D. The last paper presents and estimates a structural model of health, exercise, and restaurant consumption. It provides estimates for future welfare analyses of programs targeting obesity through restaurants and exercise in the elderly population. It also estimates the long run effects of making policies which make restaurant food healthier. It finds only minor effects of restaurant policies on health for the elderly. Overall, these papers further our understanding of the challenging objective of improving senior health while containing costs.

 

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April 20, 2012 Posted by | health care | , , , , | Leave a comment

   

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