Health Care Growth
One dollar of every $5 will be spent on health care by 2015, with spending reaching more than $4 trillion, according to a study from the National Health Statistics Group at the Centers for Medicare and Medicaid Services. Forecasters predict that national health spending growth will consistently outpace the growth in the gross domestic product (GDP) over the next 10 years, with health spending expected to consume 20% of GDP, compared with 16% today. Growth in total physician spending is expected to decline from 9% in 2004 to 7.5% in 2005, or a total of $430 billion. It's likely that physician spending will approach $850 billion by 2015. This figure is probably an underestimate, however, “since it incorporates Medicare payment cuts for physicians from 2006 through 2013. In fact, Congress has already eliminated the cut planned for 2006,” according to a summary of the survey. In other findings, spending on prescription drugs is expected to reach $446 billion in 2015, up from $188 billion in 2004. Spending on hospital care is expected to reach $1.2 trillion in 2015, double the 2005 level. Implementation of the new Medicare Part D drug benefit, and the added burden of paying costs that had been absorbed by other sectors, will lead to a spike in Medicare growth of up to 25% in 2006. In the next 10 years, Medicare spending is projected to rise from $309 billion in 2004 to $792 billion by 2015.
Deciphering Drug Coverage
In an effort to answer some of the many questions physicians have about the new Medicare Part D prescription drug benefit, Medicare has posted a new fact sheet on its Web site. The fact sheet includes links to formulary information, requests for prescription information and change forms, and a chart on Part B versus Part D drug coverage. The fact sheet describes the prescribing physician's role in coverage determination, exceptions, and appeals processes and provides an outline of the deadlines for prescription drug plans to respond to physician requests. The fact sheet is available online at
www.cms.hhs.gov/MedlearnProducts/downloads/Part_D_Resource_Factsheet.pdf
www.cms.hhs.gov/center/provider.asp
Part D: Not Perfect
The Medicare drug benefit isn't without its flaws, Republican staff acknowledged at a conference sponsored by AcademyHealth. “We want to make sure the program continues on to a successful conclusion, to get prescription drugs for people. It's a big part of our agenda,” said Mark Hayes, a majority spokesman for the Senate Finance Committee. “Medicare prescription drug spending under this new benefit has already decreased by 20%,” said Chuck Clapton, majority chief counsel for the House Energy and Commerce Committee's Subcommittee on Health. “That's not to say the new benefit has been a complete and full success. There have been some problems—some populations have had some issues in getting the prescription drugs they need. Beneficiaries haven't been able to enroll seamlessly.” To clear up confusion over the drug benefit, Sen. Max Baucus (D-Mont.) in forthcoming legislation will propose standards for approval and classification of plan offerings so that “seniors can make apples-to-apples comparisons and reach informed decisions” about their prescription drugs, according to a statement from his office.
Medicare Formulary Guidance
The U.S. Pharmacopeia (USP) last month released its final model guidelines for use in developing Medicare prescription drug formularies in 2007. The model guidelines are used by the Centers for Medicare and Medicaid Services to evaluate the formularies created by private drug plans that participate in the Medicare Part D program. There are fewer unique categories and classes in the 2007 document—133, compared with 146 in the 2006 version. In addition, the number of formulary key drug types, which are used by CMS to test the comprehensiveness of the formulary, has been increased from 118 to 141. The final model guidelines also eliminate the distinction between nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors. The USP model guidelines are available online at
Lester Crawford, Lobbyist
Former Food and Drug Administration Commissioner Lester Crawford, D.V.M., has taken a position at Policy Directions Inc., a Washington-based lobbying and consulting firm. Mr. Crawford will be senior counsel to the organization, which counts pharmaceutical manufacturers and biotechnology and food companies among its clients. By law, he will be barred from directly lobbying Congress for at least a year. Policy Directions declined to make him available for an interview. Mr. Crawford resigned abruptly from his FDA post in September, just 2 months after he was confirmed by the Senate. In the 5 years of the Bush Administration, the FDA has had a permanent commissioner for only 18 months. (Mr. Crawford served in an acting capacity for 16 months without Senate confirmation.) In early February, Sen. Chuck Grassley (R-Iowa) wrote to White House Chief of Staff Andrew Card asking that a permanent commissioner be nominated, adding that the agency was adrift without such leadership. For now, Dr. Andrew von Eschenbach is the acting commissioner, but also continues to hold his previous job as head of the National Cancer Institute.