The Official Medtipster Blog

have your healthcare and afford it, too

70% of Employers Do Not Know What They are Spending on Specialty Pharmacy

October 03, 2011 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings Source: PRNewswire, 9/29/2011, Midwest Business Group on Health (MBGH)

Few employers have a thorough understanding of specialty pharmacy benefits, and only a fraction are of them are aggressively managing what is becoming one of the fastest-growing areas of health care spending, a new survey shows.

A national survey released Sept. 29 by the nonprofit Midwest Business Group on Health in Chicago, one of the nation’s largest business coalitions, found:

Survey Findings

  • 70% do not know how much their company was spending on specialty drugs
  • 25% of employers have little or no understanding of specialty pharmacy and
  • 53% have only a moderate understanding.
  • 30% indicated that they did not know how much their total specialty pharmacy claim costs had increased during the past three to five years.

“In addition to the uncertainty and challenges that health reform and the economy are placing on employers, health plans and pharmacy benefit managers, the real driver of drug cost trend growth for employers lies in biologics and specialty pharmacy,” said Cheryl Larson, MBGH Vice President, in a statement. “Our research confirms there is a broad lack of awareness and specific knowledge about benefit design related to specialty pharmacy that illustrates key gaps that need to be addressed.”

The objectives of the survey were to identify and assess the level of knowledge and benefit design gaps of employer plan sponsors in the area of specialty medications and biologic products used to treat conditions such as multiple sclerosis and arthritis. These drugs often require special approvals for their use, instructions on dosing and side effects, and appropriate storage and distribution.

The proportion of employers’ pharmacy benefit expenditures attributable to 

  • Specialty drugs grew by 17.4% in 2010, the fastest pace since 2004, according to Medco Health Solutions Inc.’s 2011 Drug Trend Report, which found that
  • Specialty drugs represented 16.3% of total health benefit costs.

How survey was conducted

The survey was conducted by MBGH in July 2011 with guidance from Randy Vogenberg, principal at the Institute for Integrated Health Inc., a Baltimore-based consultant that provides integrated pharmaceutical benefits consulting and education to self-insured employers and business coalitions.

Of the 120 employers responding to the survey,

  • 69% were self-insured,
  • 19% were fully insured, and
  • 13% offered a combination of self-insured and fully insured benefit plans.
  • Employers responding ranged in size from 500 to 25,000 employees.

About Midwest Business Group on Health (MBGH)

The Chicago based Midwest Business Group on Health (MBGH) was founded in January 1980 by a small group of large Midwest employers to help employers and their population obtain more value from their health care benefit dollars.

Vaccines are not just for children

September 27, 2010 By: Nadia Category: H1N1 News, HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings Source: The New York Times, 9.24.10 – by Lesley Alderman

About 11,500 cases of whooping cough, or pertussis, have been reported nationwide so far this year. In California, where the infections are nearing a record high, nine infants have died.

It is likely that some of those children had not received all their shots, experts say. But some of those deaths might have been prevented if more adults, too, had been immunized.

Though public health authorities have long recommended that adults get a pertussis booster shot, just half have done so. Without it, they risk passing this illness to vulnerable children.

“Almost everyone understands how important it is for children to be immunized,” said Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, “but adults need vaccines too.”

Far too few get them. The C.D.C. recommends that people 19 and older receive immunizations against as many as 14 infectious diseases. (Not all adults require every vaccine.) Yet most adults rarely think about getting the shots — until they step on a rusty nail or begin planning travel to a developing country.

Only 7 percent of Americans over age 60, for instance, have received the herpes zoster vaccine, which prevents shingles, a painful nerve infection. Just 11 percent of young women have received the vaccine against the two types of human papilloma virus that cause 70 percent of all cervical cancers.

Why are adults so behind on vaccinations? For one thing, the shots can be expensive (from $20 to $200 a dose for some, and some require three doses). But a bigger part of the problem is a lack of awareness. Doctors often fail to remind patients that they require booster shots, and consumers are not well informed about the need.

In a 2007 survey by the National Foundation for Infectious Diseases, 40 percent of respondents incorrectly stated that, if they had received vaccines as a child, they did not need them again; 18 percent said vaccines were not necessary for adults.

The new health care law should help get more adults to roll up their sleeves. Under the law, group and individual health plans, as well as Medicare, must provide preventive health services, including immunizations recommended by the C.D.C., free of charge. That means no co-payments, co-insurance or deductibles.

The hope is that since vaccines will be free, more doctors will suggest them and more patients will ask for them, said Jeffrey Levi, executive director of Trust for America’s Health, a nonprofit group that works to prevent epidemics.

Here’s the catch. If you are in a group or individual health plan, your plan must be new, or it must have undergone substantial changes, in order for the new requirements to apply. In addition, certain recent vaccine recommendations will not be covered right away. If you are uncertain, call your insurer.

Adult immunizations are not just an important way to prevent the spread of disease. Immunizations are also a phenomenally cost-effective way to preserve health.

“When you compare the cost of getting sick with these diseases to the cost of a vaccine, it’s a modest investment,” said Dr. Robert H. Hopkins, a professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences.

If you end up in the emergency room with a bad case of the flu or pneumonia, your bill could be thousands of dollars. A flu shot is just $20, or often free; the pneumonia vaccine is about $77.

Here is how to get up-to-date on your shots — whether you have a new insurance plan, an old plan or no plan at all.

THE VACCINES YOU NEED Tear out the immunization chart accompanying this article or print it out online. Note the vaccines you should be getting, based on your age and health status.

This year, for the first time, the C.D.C. recommends that everyone, regardless of age or health, get an influenza shot. Most people need only one. This year the flu shot provides protection against the H1N1 virus and two seasonal viruses.

Most other vaccines are intended for specific age groups or for those with particular risk factors. The zoster vaccine, for example, has been tested only in older people. There is little evidence that it could benefit younger people, whose immune systems are still strong.

Next, figure out which vaccines you have already received. Your doctor should be able to help. But if you have switched physicians a number of times, you may have to reconstruct your history on your own.

“When in doubt, get vaccinated,” said Dr. Hopkins. “There’s very little risk with getting a second dose of a vaccine.”

IF YOU HAVE INSURANCE Call your primary care physician and explain that you would like to get your vaccinations updated.

Some offices do not stock vaccines, so it is wise to tell the staff in advance what you will need. You may find that certain vaccines are not available right away; your doctor can tell you where to find them, or how long the wait will be.

Next, call your insurer and ask if they will cover vaccines free of charge. If not, ask how much they charge. If the fees are high, see below for alternate options.

IF YOU LACK COVERAGE You can still pay out-of-pocket for immunizations at the doctor’s office, of course. But the shots may be less expensive at other places.

YOUR HEALTH DEPARTMENT If money is tight, find out if your state or community health department provides vaccinations for adults. Unfortunately, there is no federally funded program for adult immunizations, only for children.

The C.D.C. Web site provides an interactive map to help locate the health department or immunization clinic in your area.

YOUR LOCAL PHARMACY Many retail clinics administer vaccines, including CVS MinuteClinics and Walgreens Take Care Clinics. MinuteClinics offer 10 vaccines for adults, including shots for hepatitis A ($117) and B ($102), meningitis ($147), pneumococcal disease ($77) and DTaP, which protects you from diphtheria, tetanus and pertussis ($82).

There are 500 CVS clinics across the country, and all are open seven days a week. No appointments or prescriptions are necessary. Walgreens clinics offer travel vaccines, like the one for typhoid fever, as well.

Even if your local pharmacy does not have a clinic, you may be able to get some of the shots you need there. In all states, pharmacists are licensed to give flu shots; in some states, they can administer other vaccines as well, like the one to protect against pneumonia.

Check with a local pharmacy and find out what shots they are licensed to provide and at what cost.

Find a local pharmacy nearest your home that offers your vaccine at the lowest price at >

YOUR EMPLOYER Inquire at your company’s human resources or wellness office. Some companies provide free flu shots for employees, as well as their families. Few companies provide other vaccines, but it can’t hurt to ask.

Remember that when you get immunized, you are not only ensuring your own good health but the health of those around you.

Get Adobe Flash playerPlugin by wordpress themes