Saturday, November 12, 2005

PacifiCare Press Release 11-10-2004

''File of Life'' program provides quicker access to medical information for San Antonio-area seniors
Convenient magnetic refrigerator pouch stores important medical information that is easily accessible in case of an emergency
SAN ANTONIO, Nov. 10, 2004 ? PacifiCare Health Systems Inc. (NYSE: PHS) introduced the File of Life program for seniors in San Antonio.
File of Life provides seniors a way to ensure that their personal medical information is easily accessible in the event of an emergency. It consists of a magnetic refrigerator pouch that holds critical contact and medical information for emergency medical technicians should they be called to a senior's home. Seniors are asked to attach a File of Life sticker on their front doors as a signal for emergency personnel crews to immediately check the refrigerator for important information. The file can hold contact information for family and loved ones, a list of current medications and medical history.
PacifiCare has also produced a smaller version of the file for seniors to keep in their purses or wallets.
"We believe the File of Life program can help save valuable time in an emergency," said Sam Ho, M.D., PacifiCare's senior vice president and chief medical officer. "Sometimes minutes can make all the difference between life and death, and now San Antonio's seniors will have an easier way to immediately communicate potentially life-saving information to emergency medical technicians."
The File of Life pouches will be distributed to 10,000 San Antonio-area residents through the City of San Antonio Department of Community Initiative's nutrition program, local Catholic charities and Christian Senior Services. Seniors can also obtain the file at their local fire department. For more information or to obtain a file, San Antonio residents can call the City of San Antonio Fire Department at 210/207-8492.
PacifiCare's Secure Horizons Medicare Advantage health plan currently serves more than 36,000 members in the San Antonio area.
About PacifiCare
PacifiCare Health Systems is one of the nation's largest consumer health organizations with more than 3 million health plan members and approximately 10 million specialty plan members nationwide. PacifiCare offers individuals, employers and Medicare beneficiaries a variety of consumer-driven health care and life insurance products. Currently, more than 99 percent of PacifiCare's commercial health plan members are enrolled in plans that have received Excellent Accreditation by the National Committee for Quality Assurance (NCQA). PacifiCare's specialty operations include behavioral health, dental and vision, and complete pharmacy and medical management through its wholly owned subsidiary, Prescription Solutions.

Friday, November 11, 2005

Kaiser Press Release 10/9/2005

Kaiser Permanente Study Confirms Direct to Consumer Advertising Influences Physician Prescribing
Oakland, CA--One of the first studies to analyze whether direct-to-consumer (DTC) advertising of drugs actually influences the prescribing practices of physicians appears in the October issue of Medical Care Research and Review.
In 2001, researchers from Kaiser Permanente and UCLA surveyed 3,000 Kaiser Permanente patients. The patients were first asked if they had seen ads for the COX-2 inhibitor drugs, Celebrex or Vioxx. Patients who had seen the ads were then asked whether they had asked their physicians about the drugs. Prescription data was then analyzed to see if the patients actually were prescribed the COX-2 inhibitor drugs, whether the prescription was consistent with clinical protocols which called for reserving COX-2 inhibitors for patients at increased risk of gastrointestinal bleeding. This is the primary group thought to obtain benefit of the drugs compared to older non-steroidal anti-inflammatory drugs (NSAIDS). Results of the analysis show patients not at increased risk of gastrointestinal bleeding who saw the ads and asked their physician about the advertised drugs were 4 times more likely to be prescribed a COX-2 inhibitor than similar patients who did not see the ads.
According to lead author, Michele Spence, PhD, manager, pharmacy outcomes at Kaiser Permanente, "This study shows just how much patients are influenced by DTC advertising, and how they, in turn, can influence their physicians. Much more study is needed, but this is a good start at understanding what influences patients and physicians." The study also found that some patients may benefit from DTC advertising - those who are among the population that clinical evidence shows stand to benefit from the advertised drugs. Dr. Spence added, "Our findings raise questions regarding trade-offs. The potential benefits of DTC advertising might be offset by the overuse of new drugs before they have a demonstrated record of safety and effectiveness."
Since this study was conducted, serious questions have been raised about the safety of the COX-2 inhibitor drugs. A landmark study conducted jointly by Kaiser Permanente and the Food and Drug Administration and published in the Lancet showed significantly increased risk of cardiovascular events among patients taking high doses of COX-2 inhibitor drugs. Two of these drugs, Vioxx and Bextra, were subsequently removed from market. However, while the drugs were available Kaiser Permanente made significant progress in keeping the number of COX-2 inhibitor prescriptions low compared to all NSAIDS by carefully monitoring for safety and appropriateness. The results are that COX-2 inhibitor prescriptions account for less than 1 percent of the market share of all NSAIDS within Kaiser Permanente, compared to about 25 percent market share in the community at large. (At the time of the study, before both Vioxx and Bextra were removed from the market, COX-2 inhibitors represented approximately 5% of NSAID use among Kaiser Permanente patients compared to about 45% in the rest of the population.)
"This remarkable study, in fact, almost certainly understates the problem," stated Sharon Levine, MD, associate executive director of The Permanente Medical Group in Northern California. "The investigators found that even in Kaiser Permanente, widely acknowledged for highly effective drug use management programs, and for robust efforts to arm clinicians with independent and unbiased information about the health value and clinical effectiveness of prescription drugs, direct to consumer advertising can have a measurable impact on use. If Kaiser Permanente clinicians' low overall use of COX-2 inhibitors was increased as a result of DTC advertising, it is very likely the approximately ten-fold higher rate of use in the community (as a percentage of overall NSAID use) would in some significant part have been driven by DTC-induced demand."
In 2003, $166 million was spent on COX-2 advertising, with total sales of $4.43 billion. Total spending on DTC is now around $4.1 billion.

Thursday, November 10, 2005

Rand Corporation Research Brief

Costs of a Medicare Prescription Drug Benefit
A Comparison of Alternatives
Medicare is the only large health insurance carrier that does not include an outpatient prescription drug benefit. This exclusion is particularly important because the elderly are among the biggest consumers of pharmaceuticals. Medicare beneficiaries comprise 13 percent of the U.S. population, yet account for over 36 percent of total outpatient drug expenditures. Private arrangements--principally employer-sponsored insurance--often fill this gap, but additional coverage comes from Medicaid, individually purchased private plans like Medigap, and health maintenance organizations. In addition, many states offer some type of prescription drug benefit to the elderly and disabled.
Numerous plans have been proposed to add a prescription drug benefit to Medicare, but none has been implemented, primarily because of concerns about program cost.
To provide information that could inform policy decisions, a RAND Health team led by economists Dana Goldman and Geoffrey Joyce constructed a microsimulation model to predict drug expenditures in 2001 for a representative cohort of Medicare beneficiaries under the status quo and three different plans: (1) a catastrophic plan modeled on the Medicare Catastrophic Coverage Act, (2) a zero-deductible plan that caps out-of-pocket expenses at $4,000 per year, and (3) a zero-deductible plan that does not cap out-of-pocket expenses.
Their key findings:
A Medicare prescription drug plan with no deductible would cost $11-$14 billion per year, depending on whether or not the plan caps out-of-pocket expenses.
Beneficiaries are not well protected against very high drug expenditures unless out-of-pocket expenses are capped.
A catastrophic plan could provide this protection at roughly half the cost.
Even under the catastrophic plan, nearly two million beneficiaries could still face substantial out-of-pocket drug expenses.
Defining Features of the PlansTable 1 summarizes the features of the plans that the RAND team compared. The zero-deductible plan with no cap pays half the cost of prescription drugs up to a maximum annual benefit of $1,000. Payment under the other zero-deductible plan is more complicated. The government pays 50 percent of the first $2,000 in drug expenditures, the beneficiary pays for all expenditures between $2,000 and $5,000, and the government pays for all expenditures over $5,000. Thus a beneficiary's total out-of-pocket expenses are capped at $4,000, and there is no maximum annual benefit. Both zero-deductible plans have a monthly premium of $25.

Under the catastrophic plan, Medicare beneficiaries pay 100 percent of the cost of drugs up to a deductible that depends on the beneficiary's income; beneficiaries are fully covered for drug expenditures above the deductible. The deductible is $1,000 for those with incomes less than 150 percent of the federal poverty level (FPL); otherwise it is 10 percent of income up to a maximum of $3,000. The plan has no premium for beneficiaries with household income up to 150 percent of the FPL; all other beneficiaries pay a $10 monthly premium reflecting 25 percent of the plan's actuarial value.
All three plans would be included as a voluntary outpatient prescription drug benefit under Medicare, denoted in the table as Medicare Part D. The researchers assumed that under all three plans, people whose employer-based insurance had more generous drug coverage would not switch to the government plan. Since the catastrophic plan is less generous than virtually all existing employer-based plans, almost no one with private insurance would switch to the catastrophic plan.
Estimating Costs of Prescription Drug Coverage
To estimate the cost of prescription drug coverage, the researchers drew on data from the 1995 Medicare Current Beneficiary Survey (MCBS), a rotating panel survey of about 12,000 aged and disabled beneficiaries. The MCBS contains expenditures for prescription drugs in 1995; the research team inflated these expenditures to 2001.
To compute the average coinsurance rate (the percentage paid by the beneficiary after the deductible is met) under a Medicare prescription drug benefit, the researchers estimated drug expenditures, Medicare payments, and out-of-pocket spending given the benefit structure of each plan and status quo levels of spending. They then used these estimates to compute the average coinsurance rate by type of supplemental coverage. The average coinsurance rate ranges widely, from 17 percent for beneficiaries enrolled in Medicaid to 79 percent for enrollees who have Medigap insurance without drug coverage.
Table 2 summarizes overall costs and cost per beneficiary for each of the three plans. The figure shows the estimated number of beneficiaries who would have various levels of out-of-pocket expenditures under each plan.

The two zero-deductible Medicare drug plans would cost between $11.6 billion and $13.6 billion in 2001. Under the zero- deductible plan with no cap, almost two million beneficiaries would still face drug costs of more than $2,000, and about half of these would have out-of-pocket expenditures of more than $3,000. Increasing the annual plan payment to $2,500, as has been proposed, would increase protection against catastrophic costs but would increase the cost of the plan to $15.4 billion in 2001.
The zero-deductible plan that limits out-of-pocket expenses to $4,000 has the lowest per-beneficiary out-of- pocket costs ($440) and provides complete insurance against expenses above $5,000. However, under this plan beneficiaries pay all drug costs between $2,000 and $5,000, so even more beneficiaries could have expenses between $2,000 and $4,000 than under the zero-deductible plan with no cap. Eliminating this additional burden by allowing 50 percent coinsurance up to $5,000 would raise the plan's cost to $16.9 billion in 2001.
The catastrophic drug plan would cost approximately $5.0 billion in 2001. Removing the $10 monthly premium from the catastrophic plan--making it free to everyone--would raise the cost to $7.0 billion. The catastrophic plan would provide substantial protection against expenditures over $3,000. But the researchers estimated that about 250,000 beneficiaries who elected to stay with their employer-based plan could face out-of-pocket drug expenditures of more than $3,000.
Low-income beneficiaries are protected under all three plans: They pay a maximum of $1,000 in out-of-pocket expenditures.
A Medicare prescription drug plan with no deductible would cost $11­$14 billion per year. However, if the plan does not cap out-of-pocket expenses, beneficiaries have little protection against catastrophic drug expenditures. A catastrophic plan would be relatively inexpensive and could provide this protection.
The estimates presented here are for 2001. It is uncertain how these cost estimates will change over time. Prescription drug expenses have been growing rapidly; the size of the Medicare population is increasing; and enactment of a prescription drug benefit could cause prices to rise. Thus, any prescription drug benefit could become quite costly.
A catastrophic plan would be valuable to Medicare beneficiaries who do not now have prescription drug coverage and would be less costly than a zero-deductible plan. From a policy perspective, implementing a catastrophic prescription drug benefit would also allow policymakers to gauge future program costs before committing to more comprehensive coverage.

Wednesday, November 09, 2005

Humana Press Release 11/2/2005

Navigating Through the Medicare Changes, and its Impact on America’s 42 Million Medicare Beneficiaries
Mariette Hartley Hosts
Pompano Beach, FL - Nov 2, 2005 - Emmy-winner Mariette Hartley hosts another upcoming episode of the "Healthy Solutions" series, scheduled to air as paid programming on CNBC, Saturday, November 5 at 12 noon (EDT) and on the Healthy Living Channel, Saturday, November 5 at 2:30pm (EDT), Saturday, November 12 at 2:30pm (EDT) and Sunday, November 13 at 6pm (EDT). The half-hour television program explores the most important issues and topics related to America's health and well-being.
Sweeping changes in Medicare will not only affect individuals presently on Medicare, but will impact generations to follow. An upcoming special report titled, "Understanding Health Care Options for Seniors," tackles one of the most critical concerns of Medicare beneficiaries today - understanding the changes to Medicare, and how to make the best choice for their own well-being.
These changes provide choices, and these choices can lead to confusion - but not if individuals understand the different options available. Dr. Scott Latimer, Market President, Senior Products for Humana stated that when it comes to making choices, "Medicare beneficiaries still make their own decisions in the end, but if they have the sense that they have enough information to make the right choices, they will be confident and we feel that's something people will really value."
According to the National Institute on Aging, 75% of Americans over the age of 65 take at least one prescription drug. One of the most significant changes in Medicare deals with prescription drug coverage. It is up to the savvy individual to do some shopping, compare the various plans that are available, and will become available, and decide which one is best for their own unique needs.
These changes clearly impact individuals who are reaching 65 years of age. Dr. Latimer emphasized, "It's going to get a lot more complicated in years to come because there are more choices. For people that are not yet 65 but are heading in that direction, it's not too soon to be looking at the various choices that will be available."
Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 7 million medical members. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.
Since 1997, "Healthy Solutions" has become an established leader in the production and distribution of healthcare related television and web content. Designed to fit into even the busiest family schedule, the show provides key information in a magazine-style format. Each segment is featured in streaming video on the show's website for quick and easy access. Simply log on to and watch "on-demand."
Newsrooms also turn to "Healthy Solutions" for timely solutions to life's daily challenges. Each segment is reformatted and distributed via satellite as a Video News Release to over 750 domestic television stations. Local newsrooms deliver the information into America's living rooms as news you can use.

Monday, November 07, 2005

AHRQ 9/12/2002 Press Release

Health Insurance Premiums Rose More Than 30 Percent Between 1996 and 2000
Press Release Date: September 12, 2002
The average annual health insurance premium in 2000 was $2,655 for single coverage and $6,772 for family coverage in private-sector establishments, an increase of 33.3 percent and 36.7 percent respectively since 1996, according to new data from the Agency for Healthcare Research and Quality (AHRQ). Establishments are either businesses in a single location or individual worksites of a larger corporation.
The data, from the Insurance Component of AHRQ's Medical Expenditure Panel Survey, (MEPS) provide detailed trend information on health insurance costs and characteristics between 1996 and 2000, as well as state-by-state breakdowns. The tables include estimates of health insurance premiums, contributions, enrollments, self-insurance rates, and other information.
Details of the data include:
Since 1997, the first year that data on retirees were measured, there has been a significant decline in the number of employers who offer health insurance to their retirees of any age. Offerings to retirees under age 65 have dropped from 21.6 percent in 1997 to only 12 percent in 2000. Offerings to retirees 65 and older have dropped from 19.5 percent to 10.7 percent over the same period.
The proportion of private-sector establishments that offered health insurance rose from 52.9 percent to 59.3 percent between 1996 and 2000. In 2000, almost 90 percent of all employees worked for establishments that offered this coverage, compared with 86.5 percent in 1996.
Although their employers generally offered health insurance coverage, the portion of private-sector employees actually eligible for coverage fell from 81.3 percent in 1996 to 78.9 percent in 2000. Some employees may not have been eligible because health insurance was offered only to management or was based on length of service or full-time status. Among those eligible workers, enrollment in plans dropped from 85.5 percent to 81.2 percent over the 5 years.