The Official Medtipster Blog

have your healthcare and afford it, too
Subscribe

Drug Adherence Rises When Co-Pays Go Down

September 14, 2012 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Reuters Health, by Amy Norton – 9.11.2012

When people with chronic health conditions have lower out-of-pocket costs for medications, they are more likely to actually fill their prescriptions, according to a new research review.

The findings, reported in the Annals of Internal Medicine, sound logical. But they lend some hard numbers to the idea that lower drug costs should improve people’s adherence to their medication regimens.

“It was striking to us,” said lead researcher Meera Viswanathan, of RTI International, a Durham, North Carolina-based research institute.

“If you help people with costs, even a little, it seems to improve adherence,” Viswanathan said in an interview.

She and her colleagues reviewed several dozen U.S. studies on various efforts to improve people’s ability to stick with their prescriptions. A few of those studies focused on insurance coverage – either giving people drug coverage or lowering their out-of-pocket costs for prescriptions.

Some looked at what happened after Medicare prescription coverage took effect in 2006; others looked at cutting out-of-pocket payments for people with private insurance.

Overall, better coverage seemed to help. In a study of nearly 6,000 heart attack patients, for example, those given full drug coverage through their insurer got more prescriptions filled over about a year.

Of patients who were on their usual insurance, 36 percent to 49 percent filled their prescriptions, depending on the medication. Those rates were four to six percentage points higher among people with full drug coverage.

Patients with full coverage also suffered a new complication, like a stroke or second heart attack, at a slightly lower rate: 11 percent, versus just under 13 percent.

But while there is some evidence of actual health benefits, not many studies have followed people long-term to see if the better drug adherence translates into a longer or healthier life.

“There were some encouraging findings,” Viswanathan said. But more research is needed to know what the long-term health effects are, she and her colleagues write.

The results do not mean that better drug coverage is the only way to get people to fill their prescriptions, according to Viswanathan.

The studies in the review found some other tactics to work, too. Education plus “behavioral support” was one.

That goes beyond telling patients about their health problem, and why a particular medication is needed, Viswanathan said. “You would also try to get through the barriers that may keep a patient from taking it,” she said.

If a patient was afraid of side effects, for example, a nurse might discuss that with him or her.

Another measure that seemed effective was “case management.” That means the health provider would try to identify patients at high risk of not using their prescriptions, then follow-up with them – with phone calls, for instance.

It’s not clear, Viswanathan said, how programs like that could be “scaled up” to be widely used in everyday practice, and not just clinical trials.

And the specific fixes might differ depending on the health problem. With high blood pressure, a fairly simple move seemed to boost patients’ adherence to their medication: Giving prescriptions in blister packs rather than bottles, so people could more easily keep track of whether they’d taken their daily dose.

With more complex measures, the question of how to work them into the real world remains. “We need to know, what does it take to implement them into clinical practice?” Viswanathan said.

Figuring out how to get people to stick with their medications is considered a key part of improving healthcare. Studies show that 20 percent to 30 percent of prescriptions are never filled, and half of medications people take for chronic ills are not taken correctly.

All of that is thought to contribute to 125,000 deaths a year, and to cost the U.S. healthcare system as much as $289 billion annually.

Employer healthcare costs expected to rise 9% in 2011, according to PricewaterhouseCoopers

June 15, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: www.pwc.com – June 14, 2010

The nation’s employers can expect medical costs to increase by 9% in 2011, a decrease of 0.5% from the 2010 growth rate, according to the annual Behind the Numbers report published today by the PricewaterhouseCoopers LLP (PwC) Health Research Institute. For the first time, the majority of the American workforce is expected to have a health insurance deductible of $400 or more, as more employers return to “indemnity style” cost-sharing by raising out-of-pocket limits, replacing co-pays with co-insurance and adding high-deductible health plans.

The Behind the Numbers report includes findings of the PricewaterhouseCoopers’ Health and Well-Being Touchstone Survey of more than 700 employers from 30 industries, as well as interviews with health plan actuaries and other executives whose companies provide health insurance for 47 million American workers and their families.

Improving wellness programs and increased cost-sharing lead the planned changes employers will make in the benefit plan designs they will offer for next year. According to PricewaterhouseCoopers’ Touchstone research:

  • Two-thirds (67%) of companies intend to expand or improve wellness programs inside the US
  • 42% intend to increase employee contributions for health insurance coverage.
  • 41% intend to increase medical cost-sharing, including higher deductibles and co-pays, while only 26% intend to increase prescription drug cost-sharing.
  • More employers are dropping health benefits for retirees. One-third of employers with over 5,000 workers subsidize pre-65 retiree medical coverage, down from 47% in 2009. Only 22% of employers with over 5,000 employees subsidize post-65 retiree medical coverage, down from 37% in 2009.

In 2011, the Behind the Numbers report outlines three primary deflators that will help employers hold down medical costs:

  • Employers are moving toward pre-managed care benefit design by increasing deductibles and replacing co-pays with co-insurance. By requiring workers to spend more out-of-pocket at the point of care, employers believe they will rein in utilization of services and drugs. The number of employers using co-insurance for physician visits has nearly doubled, and one-third use co-insurance for brand-name drugs.
  • Drug costs are tempered by generics. Insurers are benefitting from the growing use of generic drugs. Drugs representing about $26 billion in annual sales are expected to go off patent in 2011, including the world’s best-selling drug, Lipitor. Generics account for as much as 80% of all prescriptions.
  • COBRA costs are expected to return to more normal levels in 2011. COBRA subsidies passed by Congress in 2009 created a 1% increase in the medical cost trend, according to PricewaterhouseCoopers’ analysis. A combination of declining unemployment and expiration of the COBRA subsidies is expected to lead to reduced enrollment in COBRA.

The biggest inflators of the medical trend in 2011 will be in hospital and physician costs, which make up 81% of premium costs. 

  • Hospitals shifting costs from Medicare to private payers and employers is seen as the Number One reason for higher medical costs trends. In 2011, Medicare, which is the single largest payer for hospitals, will reduce payment rates to hospitals for the first time after seven years of increases that nearly matched or exceeded inflation increases. Some hospitals that benefitted from higher payments in 2008 and 2009 may be able to manage this type of cut by tapping their reserves. Yet, more are likely to shift more costs to commercial payers during their negotiations.
  • Provider consolidation is increasing, which is expected to increase their bargaining power. More physicians are getting out of private practice and joining forces with local hospitals or larger physician groups. The number of physicians involved in mergers or acquisitions in 2009 was 2,910, nearly twice that of 2008. There has been record consolidation activity in 2010, and PricewaterhouseCoopers expects the trend to accelerate in 2011. Payers expect to see more negotiating power and higher prices in the short term, though the benefits of consolidation should create efficiencies that moderate rate increases in the future.
  • Spurred by stimulus funding that begins in 2011 and Medicare penalties that begin in 2015, hospitals will invest billions of dollars in certified electronic health record (EHR) systems. While many hospital systems were planning to implement EHRs in the near future, the government’s new regulations dramatically condensed their timelines to invest in technology, IT staff, training and process redesign. Healthcare CIOs surveyed by PwC said they will make their largest investments to meet the new EHR regulations in 2011. In the long term, EHRs are expected to help control costs. 

“For more than 50 years, US employers have used health benefits as a critical part of their compensation package to recruit and retain workers,” said Michael Thompson, principal, Human Resource Services, PricewaterhouseCoopers. “The value of these benefits is becoming an even more visible part of overall compensation as medical costs grow, and, by 2014, health insurance benefits will shift from being a voluntary benefit to an individual mandate, enforced by new tax levies. Companies are now working with their health plan providers for new post-recession, post-health reform strategies to sustain their programs and promote health and well-being as their next competitive advantage.” 

Each year, PricewaterhouseCoopers’ Health Research Institute provides estimates on growth of private medical costs over the next year and what the leading drivers of the trend are expected to be. Insurance companies use medical cost trends to help set health plan premiums by estimating what the same health plan this year would cost in the next year. In turn, employers use the information to make adjustments in benefit plan design to help offset any cost increases. 

“Health reform delivers only a minor impact on the underlying medical cost trends in 2011 and introduces hundreds of changes in the healthcare system designed to reduce costs and improve efficiencies in the long-term,” said Kelly A. Barnes, US health industries leader at PricewaterhouseCoopers. “These changes could bring significant new cost savings opportunities for employers and payers as well as new choices and transparency for workers buying insurance.” 

PricewaterhouseCoopers’ Behind the Numbers report and survey highlights are available at www.pwc.com/us/medicalcosts2011. The full findings of the PricewaterhouseCoopers 2010 Health and Well-being Touchstone survey are available at  www.pwc.com/us/touchstone2010.For more on the details on the implications of health reform, go to http://www.pwc.com/healthreform

Methodology

The 2010 Health and Well-Being Touchstone survey was completed in the first quarter of 2010. Survey participants included 700 U.S- based companies across the country from 30 different industries. Companies ranged in size from small employers with fewer than 500 employees to large companies with more than 20,000 employees. 

About PricewaterhouseCoopers’ Health Research Institute (HRI)

PricewaterhouseCoopers’ Health Research Institute (www.pwc.com/hri) is an unparalleled resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries. 

About PricewaterhouseCoopers’ Health Industries Group

 PricewaterhouseCoopers’ Health Industries Group (www.pwc.com/healthindustries) is a leading advisor to public and private organizations across the health industry, including payers, providers, academic institutions, health sciences, biotech/medical devices, pharmaceutical companies, employers and new non-traditional market participants in the dynamic healthcare space. PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the US dedicated to the health industries.

PricewaterhouseCoopers’ Health Industries’ clients include 40 of the top 100 hospitals in the US and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world’s major pharmaceutical companies; all of the top 20 commercial payers in the US; municipal, state and federal government agencies and many of the world’s preeminent medical foundations and associations. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About PricewaterhouseCoopers
PricewaterhouseCoopers (www.pwc.com) provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 163,000 people in 151 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.

“PricewaterhouseCoopers” refers to PricewaterhouseCoopers LLP or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate and independent legal entity.

© 2010 PricewaterhouseCoopers LLP. All rights reserved

 Lisa Stearns
The Hubbell Group, Inc.
Tel: +1 (781) 878 8882
lstearns@hubbellgroup.com

Get Adobe Flash playerPlugin by wpburn.com wordpress themes