Better Appeals Process Needed
Analysis by the Government Accountability Office has pointed out deficiencies related to Medicare Part D. The watchdog agency says that the Centers for Medicare and Medicaid Services has improved its efforts to inform beneficiaries about sponsors' performance, but its oversight of sponsors is hindered by poorly defined reporting requirements. To improve the process, CMS should allow independent reviewers to conduct reviews without the standard “appointment of representative” form, and also should provide the plans with standardized definitions for data that they must provide, the GAO report said. A bipartisan statement from Senate Finance Committee members said that the lawmakers back simplification of the process. “Patients and their doctors should not have to navigate an impossible maze of bureaucratic red tape in order to get the prescription drugs they need,” said Sen. Jay Rockefeller (D-W.Va.) in a statement.
FDA Issues Food Co. Injunction
Two food companies and their top executives have signed a consent decree that effectively prohibits them from manufacturing and distributing any products that claim to cure, treat, mitigate, or prevent diseases, the Food and Drug Administration said last month. The consent decree against Brownwood Acres Foods Inc., Cherry Capital Services Inc., and two of their top executives is the result of unapproved drug claims and unauthorized health claims such as “Chemicals found in cherries may help fight diabetes,” the FDA said. Eastport, Mich.- based Brownwood Acres Foods, and Cherry Capital Services, which is based in Traverse City, Mich., manufacture and distribute various products, including juice concentrates, soft fruit gel capsules, fruit bars, dried fruits, liquid glucosamine, and salmon oil capsules.
Copays, Caps May Reduce Use
Copayments and caps on drug expenditures—common methods used by drug plan sponsors to control costs—may discourage patients from using those drugs, potentially leading to adverse health effects, a new review of existing research showed. The Cochrane Library review of 21 studies that looked at a variety of prescription drug payment policies found that, among insurers that tried to keep costs down through copayments and caps, “reductions in drug use were found for both life-sustaining drugs and medications that are important in treating chronic conditions,” said Astrid Austvoll-Dahlgren, a research fellow with the Norwegian Knowledge Centre for the Health Services, in a statement. Although the review did not provide clear evidence that patient health suffered under the cost-sharing policies, plans designed to make patients shoulder some of the cost of prescriptions reduced both the amount of medication used—including life-sustaining drugs—and medicine expenditures. Ms. Austvoll-Dahlgren suggested designing policies in which people pay directly for only nonessential drugs, or in which exceptions are built in to ensure that people receive needed medical care.
Medco Launches e-Rx Drive
As Congress considers legislation that would tie physicians' Medicare payments to their use of e-prescribing technology, Medco Health Solutions Inc. said it was launching a national initiative to assist physicians of Medicare Part D patients in switching to electronically generated prescriptions. The pilot program also will be used to study the effect of e-prescribing on patient safety, increased generic drug use, and formulary compliance, the prescription drug manager said. Initially, the study will include 500 physicians currently treating enrollees in the Medco Medicare Prescription Plan. Medco will provide these physicians with free e-prescribing software and training, and Medco will compare the physicians' rate of generic drug dispensing, formulary compliance, and generated safety alerts with that of a control group. Ultimately, 2,000 physicians—mostly primary care doctors—will participate in the e-prescribing program, Medco said. Estimates have shown that e-prescribing could save up to $30 billion in the Medicare program, and Medco said it hopes its study will help to quantify how much the technology actually will help reduce medication errors and lower costs.
CVS Caremark Settles Suit
CVS Caremark last month agreed to a $38.5 million settlement in a multistate civil lawsuit that accused pharmacy benefit manager Caremark Rx of engaging in deceptive business practices. Caremark encouraged doctors to switch patients to different brand-name prescription drugs and represented that the patients and/or their health plans would save money by switching, according to the complaint, which was filed by attorneys general in 28 states. But Caremark did not adequately inform doctors of the effects that switching would have on costs to patients and health plans, and did not clearly disclose that rebates would be retained by Caremark and not passed directly to health plans, the complaint said. Under the settlement, Caremark must significantly alter the practices it uses to ensure that patients, physicians, and health plans have the information needed to make the most cost-effective purchasing decisions, said Illinois Attorney General Lisa Madigan, who led the investigation with Maryland Attorney General Douglas Gansler. Caremark also is prohibited from soliciting drug switches under a variety of circumstances.