Category Archives: pharmacy drug benefits

Opioids Continue to Be a Workplace Scourge

158362155We’ve all heard a lot during this presidential election season about the heroin epidemic that has seemingly left no corner of the United States untouched. Experts say an important factor that led to today’s skyrocketing rates of addiction has been the widespread abuse of opioid prescriptions for painkillers, including those prescribed by doctors for employees covered by workers comp claims. A new report from Castlight Health reveals that this prescription abuse continues today, accounting for a significant chunk of healthcare spending.

Castlight’s report, The Opioid Crisis in America’s Workforce, finds that nearly one third (32 percent) of opioid prescriptions subsidized by U.S. employers are being abused by a small number of employees — just 4.5 percent of the population, accounting for 40 percent of opioid prescription spending. Baby boomers are four times as likely to abuse opioids as millennials, the report finds, and workers with a mental health diagnosis are three times more likely to abuse opioids as those without.

The report is based on aggregated reporting from medical and pharmacy-based claims, including de-identified and anonymous health-data reporting covering nearly 1 million Americans who use Castlight’s health-benefits platform. The report defines “opioid abuse” as receiving more than a cumulative 90-day supply of opioids and receiving an opioid prescription from four or more providers over the five-year period between 2011 and 2015.

In addition to the cost (opioid abusers typically cost employers twice as much as non-abusers in medical expenses annually), opioid abuse lowers productivity and potentially puts other employees at risk, says Kristin Torres Mowat, Castlight’s senior vice president of health plan and strategic data operations. Opioid prescription abuse results in more than 16,000 deaths in the United States each year, the report notes.

The report finds that patients living in low-income areas are twice as likely as patients living in high-income areas to abuse prescription painkillers. The South is home to a significant chunk of opioid abusers, with 22 of the top 25 U.S. cities for opioid abuse located in Southern states.

The Pitfalls of Consumerism

Do you put as much thought into selecting your cellphone plan as you do for selecting which doctors and specialists to see for your medical plans?

This question was posed at the National Business Coalition on Health’s annual conference in Washington by Shawn Leavitt, senior vice president of global benefits at Comcast Corp., during his keynote address.

“More than half of all consumers say they’re dissatisfied with the cellphone plan they chose,” he said. “So, if people are having a hard time selecting a cellphone plan that’s right for them, then how do we expect them to make the right decisions with respect to their health plan and health providers?”

The subject of Leavitt’s presentation was that healthcare consumerism — high-deductible plans that put more of the onus for financing and managing healthcare on employees — will not work unless employees receive more expert direction and guidance to help them.

At Comcast, said Leavitt, HR has enlisted so-called “expert shoppers” to help employees with these crucial decisions. It’s coupled that with outreach to certain locations within its vast empire to focus on subsectors — such as call centers — where employees were making heavy use of emergency rooms (and driving up costs) to educate employees on alternatives such as urgent care centers.

“We understand that it’s hard to expect employees who are juggling multiple responsibilities to make the sort of far-sighted decisions we’d like them to make when they’re faced with something as immediate as a sick child,” said Leavitt.

Comcast is using its own marketing wizardry to help educate employees on making wiser healthcare choices, he said. “We have become very good at getting consumers to pay to watch bad movies and reality television shows,” said Leavitt. “We’re focused on bringing that same level of expertise to help our employees make good decisions on healthcare.”

The risks of consumerism were also highlighted by Dr. Mark Fendrick during a panel discussion on pharmacy drug benefits. One of the main questions the panel grappled with was whether it was right for plan sponsors to exclude certain medications from plan coverage.

“If you’re doing that just to save money, I don’t think it’s a good idea,” said Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design. “I think it’s OK if the drug has been proved to be ineffective or counterproductive or if cheaper generics of equivalent effectiveness are available. But do it for the right reasons.”

The trend of pushing more costs onto employees can end up doing more harm than good if it isn’t managed carefully, he said. “Raising deductibles and pushing more of the cost onto employees without giving them support necessary for needed treatment and medications will simply cause more of them to forgo what they need,” he said. “I’ve had patients tell me that until they exhaust their deductible, they’re not going to do many of the things I’ve told them they need to do to maintain their health. And that goes against what this whole idea of consumerism is supposed to be about.”


On to Summer School for Med Adherence?

Some disturbing news on the prescription-drug front:

A first-of-its-kind patient survey, Medication Adherence in America: A National Report Card by the National Community Pharmacists Association, finds that “Americans 40 and older with a chronic medical condition earn a troubling C+ on average and that one in seven members of this group received an F when it comes to taking their medications correctly.”

168763456Collectively, the report card reveals, one-third of overall respondents received either a D or F.

NCPA CEO B. Douglas Hoey puts it well when he states in a press release on the report card: “The academic year has drawn to a close for most students, but when it comes to taking their prescription drugs, it’s many of the parents who may require summer school.”

The NCPA press release doesn’t go into the cost impact on employers’ healthcare, but I would suspect it’s significant.

Grades were calculated based on an average of answers to questions on nine non-adherent behaviors: whether or not, in the past 12 months, patients failed to fill a prescription; neglected to have a prescription refilled; missed a dose; took a lower dose than prescribed; took a higher dose than prescribed; stopped a prescription early; took an old medication for a new problem without consulting a doctor; took someone else’s medicine; or forgot whether they’d taken a medication.


Bitter Pill to Swallow for Retirees

78377596--elderly man and drugsIt’s not looking good for retirees in need of prescriptions.

A survey released last week by Buck Consultants, A Xerox Co. — Prescription Drug Benefit 2013 — shows a sharp decline in the number of U.S. employers intending to continue offering prescription-drug plans to Medicare-eligible participants. (Here’s Buck’s release about the survey, with a link to the full report.)

As the release points out, 48 percent of the more than 250 U.S. organizations polled (representing 3.9 million lives) currently offer prescription-drug plans to such retirees — yet, of them, only 55 percent intend to continue this benefit going forward, down from 75 percent the last time the survey was conducted, in 2011.

The problem, says Paul Burns, principal and national pharmacy practice leader at Buck, is that “moving forward, retiree-drug subsidies will no longer be tax-exempt, which represents a huge shift, so many employers are already moving on this.”

There are some options you can consider, though, for controlling these costs for your Medicare-eligible participants. “For example,” Burns says, “since [the] subsidy payments are no longer tax-exempt and do not keep pace with rising drug costs, some employers are considering moving to an employer-group-waiver plan to take advantage of additional subsidies available as a result of the Affordable Care Act.”

Burns says this tax-exempt shift — and others, such as all the consolidating going on in the PBM industry, resulting in downward-pricing pressure to gain members — has created a climate in which “more now than ever, it’s imperative for employers to look at their PBM contracts” and get ready for some hard-ball negotiating.

I plan to delve more in to what he calls a “buyer’s market for PBM pricing” in an upcoming news analysis, but for now, just wanted to raise the red flag for people my parents’ ages. Hopefully, you’ll consider all possible alternatives before cutting them off.

HRE Freelancer Wins Top Honor for Drug-Coupon Story

Carol Patton stands by the plaque, also at right, displaying her winning story.

Longtime Human Resource Executive® freelance feature writer Carol Patton took a top Print Journalism Award Monday night at the 18th Annual National Institute for Health Care Management Awards Dinner for her story on the pharmaceutical industry’s questionable use of co-pay drug coupons.

The story, published in the June 2 issue of HRE, examines how drug companies, through heavy marketing campaigns, have manipulated customers’ use of drug coupons and driven up drug costs by encouraging the use of brand-name prescriptions.

In accepting her award in the Trade Publications category for her winning piece, “Coupon Overdose,” Patton spoke of her own personal experience with medical manipulations as the wife of a heart-disease patient who had to contend with insurance coverage that arbitrarily ended.

“I could relate to the man mentioned in the story who had exhausted his entire family’s drug benefits because he didn’t understand how drug coupons worked behind the scene,” Patton said. “I’m so grateful to everyone here tonight for recognizing the hidden dangers of drug coupons. This is a serious issue that can cause serious problems for many families.”

Reinforcing the importance of human beings in all health and benefits coverage was Bill Coffin, the Honorable Mention Award winner in Patton’s category, whose Nov. 11 piece for National Underwriter Life & Health, “Tragic Tale,” has received national recognition for its daring exposé of the heart-wrenching neglect and disappearance from the national stage of American comic-book writer Bill Mantlo.

Coffin’s work uncovered the devastating, life-altering blows to Mantlo, an award-winning writer for Marvel Comics who has been in institutional care ever since a hit-and-run car accident in 1992 crippled him mentally and physically. His tragedy, as told by Coffin, was made far worse by an insurance company’s decision to eventually stop coverage after his recovery and improvement ceased.

“The response this story got, even from many in the insurance industry,” said Coffin, “reinforces my belief that the humanity behind all these stories is undeniable. Yes, these are business decisions, based on numbers and data; but bottom line, each and every one of them affects human beings.”

Also a winner of the top Television & Radio Journalism Award were the makers and producers of “Autism: Coming of Age,” which aired recently on public television. Telling the story of what happens to coverage for the care of autistic patients when they turn 22 years of age, the documentary video is now up for an Emmy Award.

As Coffin put it at the podium, he and his fellow winners — and the event celebrating them, held at the House of Sweden in Washington — served as “resounding confirmation that, through journalism, we really can make a difference and touch people’s lives.”

One in Five Older Americans Are Cutting Back

Some fresh data released by the Employee Benefit Research Institute that may not come as a huge surprise. Still, that doesn’t make the findings any less disturbing.

A new EBRI report found that one in five Americans age 50 or over report saving on health costs by switching to cheaper generic drugs, getting free samples, stopping pills or reducing dosages. What’s more, nearly as many said they skipped or postponed doctor appointments for the very same reason.

There’s no way to know how that might compare with the state of things five or 10 years ago, since this is the first time EBRI analyzed its data in this way. But the analysis offers further proof that the ability of older Americans to make ends meet these days is showing up in healthcare behaviors.

One in five seems “quite high,” especially when you consider these cuts involve “essentials,” says the study’s author, Sudipto Banerjee.

Suggesting that this is an issue employers can’t afford to overlook as they revisit their plan design and communication strategies later this year.

A full report can be found in the January 2012 EBRI Notes, “Spending Adjustments Made By Older Americans to Save Money,” at

More News on the Walgreens PBM Front

On first appearance, this report in today’s New York Times looked like it might be signs of more differences between CVS Caremark and Walgreens over how their pharmacy-benefit-management network would operate.

As the report has it, Catalyst Health Solutions has agreed to buy the PBM unit of Walgreens. And, according to Walgreens spokesperson Tiffany Washington, this will not have any impact on the agreement between Walgreen’s and CVS Caremark that Anne Freedman reported on in  this June 18 blog post.

Nor will it reignite any of the past bad blood between the two pharmacy giants that I reported on in this June 11 blog post. At least, not according to Washington. “We will continue to be part of the CVS Caremark network,” she says.

Personally, as complex and incendiary as this story was back in June, I plan to keep a close eye on it.