In Other Legislative and Regulatory News . . .

June 10, 2009

The FDA would have broad public support for a behind-the-counter (BTC) classification for drugs. According to the results of a telephone survey conducted by Leo J. Shapiro & Associates, 67% of respondents said they would welcome the convenience of obtaining a drug without a prescription and after counseling by a pharmacist, even while they recognize that their insurance plan would not cover the cost of the BTC medication.

The FDA would have broad public support for a behind-the-counter (BTC) classification for drugs. According to the results of a telephone survey conducted by Leo J. Shapiro & Associates, 67% of respondents said they would welcome the convenience of obtaining a drug without a prescription and after counseling by a pharmacist, even while they recognize that their insurance plan would not cover the cost of the BTC medication.

The OIG plans to review how well CMS is running the Part D program. In its annual Work Plan, the OIG reports that among the Medicare prescription drug benefit questions it is set to audit are whether the agency is preventing duplicate payments for a claim submitted under both Part B and Part D, as well as whether the pharmacy price listings on the CMS Medicare Prescription Drug Plan Finder Web site are up-to-date.

Hewitt Associates predicted a turnaround in 2008 of the steadily declining rate of health care cost increases for employers. The increase in 2007 was just 5.3%, the consulting firm calculates, marking the fifth straight year that the rate of health care cost increase has been less than that of the previous year. However, Hewitt Associates is projecting an 8.7% rise in health care costs, from $7982 per person in 2007 to $8676 per person in 2008, for large employers.

State insurance solvency laws apply to Medicare Advantage plans. Universal Health Care, fighting a bid by the Florida Department of Financial Services to liquidate its business because its reserves were below those required by Florida law, went to federal court to argue that such state laws are preempted by the Medicare Modernization Act of 2003. On December 5, Judge Stephen P. Mickle of the US District Court for Northern Florida dismissed the case (Florida v Universal Health Care, No. 4: 07cv176-SPM/WSC), noting that because there are no solvency standards under the Medicare program, state standards cannot be considered conflicting.

Small employers in Massachusetts are continuing to offer health benefits despite the new state program that subsidizes the cost of individually purchased policies. It was feared that the new program might encourage small firms to drop coverage, but among the 44,000 small businesses with 11 or more full-time–equivalent workers on their payroll that reported their intentions to the state, only 518 indicated that they would not be providing at least the minimum coverage demanded by the new law. Those 518 companies will pay a $295 fine per employee per year for their nonparticipation.

Many California seniors are skipping prescribed drugs because they think they cannot afford them. In a study published in the December issue of the Journal of the American Geriatrics Society, researchers compiled responses about managing drug costs from 1106 Medicare beneficiaries. They found that 25% had declined to fill a prescription or stopped taking a medication because of cost. In addition, 81% said they wished their physicians would inquire whether they could afford a particular medication before handing them a prescription; only 16% said their physicians had asked them such a question.