Congress will be back in session this week following a district work session. The Hill provides a closer look at Congress’s work week here. The FEHBlog got a kick out of reading a Hill story headlined “Left boils as Obama floats major change to Medicare Parts A and B.” The Republicans have proposed modernizing Medicare by consolidating Medicare Part A (hospital care) and B (doctors’ services) and adding catastrophic protection to traditional Medicare. That’s modernization. Medicare is effectuated by laws and regulations which are hard to change. The FEHBP is effectuated by contracts which are much more flexible. Although lately that flexibility has been constrained by new federal laws such as the Affordable Care Act. Nevertheless, the FEHBP is much more malleable than Medicare.
Aetna announced on Friday that “the U.S. Department of Justice (DOJ) has cleared Aetna’s proposed acquisition of Coventry Health Care, Inc. Aetna expects to complete its acquisition of Coventry within the next three business days.” Aetna and Coventry each participate in the FEHBP as HMO carriers. Coventry also administers three employee organization sponsored plans in the FEHBP.
The prescription benefits manager Express Scripts recently reported that that the U.S. wasted $418 billion last year on poor medication related decisions. The research, presented this week at the Express Scripts Outcomes Symposium in Orlando, Florida, revealed the following:
$55.8 billion was spent unnecessarily on higher-priced medications when more affordable, clinically equivalent alternatives were available.
$93.1 billion could have been saved if patients would have used the most cost-effective and clinically appropriate pharmacies, including home delivery and specialty. This savings includes $33.5 billion in lower drug costs, as well as $59.6 billion in avoided medical costs attributed to the higher adherence rates associated with home delivery and specialty pharmacies.
An additional $269.4 billion was spent on avoidable medical and pharmacy expenses as a result of patients not remaining adherent to their medication treatments. This total does not include the $59.6 billion in adherence savings directly associated with better pharmacy choices.
According to the research, the most wasteful one-third of states spent between $1,404.82 and $1,622.76 per capita in avoidable costs. States with high levels of waste were found to be primarily located in the southern region of the country – an area also associated with higher rates of chronic disease. States with the lowest levels of avoidable costs were predominately in the Midwest and Northeast. Vermont wasted the least amount per capita among all states in the U.S., yet still experienced an average of $1,004.39 in unnecessary costs per resident.
Forbes reports that last week, key trade associations such as the Pharmaceutical Research and Manufacturers of America (PhRMA), the National Association of Chain Drug Stores, the Council for Affordable Health Coverage, and the American Academy of Family Physicians launched Prescriptions for a Healthy America. which seeks to improve medication adherence habits among Americans. Good luck with that effort.