It’s that time again: open enrollment for Medicare Part D. Ordinarily, items such as this don’t really generate newsworthiness. However, these aren’t ordinary times; given the state of the (healthcare) economy, anytime one connects the dots between the country’s largest care guarantor and the potential for greater coverage pools — it’s time for intense wonkishness to rear its ugly head yet again.

The big question is whether or not Part D makes sense for the consumer. New this enrollment period: (1) premiums will rise another 10% percent;^[1] (2) the vast majority of standalone prescription drug plans (60% or so) will require a deductible in ‘10, maxing out at just over $300; (3) finally, with respect to so-called “benchmark” plans,^[2] qualified beneficiaries will still have to pony up a percentage of their premium if they want to stay in their plan or will have to switch plans altogether.

Bottom line, it’s all about cost-sharing as a mechanism for controlling costs, at least with respect to Pharma and Medicare Advantage plans; and, in a pharma marketplace which is forecasted to remain rather staid next year,^[3] profits have to be generated from many levels. Medicare Part D has its share of choices for the beneficiary, but due diligence will be the guide to retaining skin in the game for the patient as savvy health care consumer. | LINK

1. up 50% overall from when MMA (2003) created the part D provision for launch in ‘06 [↩]
2. those in which basic Part D is offered for those who qualify for a premium [↩]
3. Many popular brand name medications are scheduled for generic release in 2010. [↩]

The country’s largest drug lobby, PhRMA, spent $6.9 million during the first three months of this year on lobbying expenses, an almost 40 percent jump from what it spent on average per quarter last year. The biggest reason for all the new hires? Democrats. The lobby is particularly targeting Sen. Baucus — the leading reform figure and Sen. Kennedy alternative to a more conservative approach to Obama’s proposed healthcare reform package. Recall that PhRMA recently pledged $80M to the healthcare reform effort, with 2/3 going to fund, among other things, a so-called “reform fee”, which will charge pharma companies a fee to cover any difference between the cost of Medicare, Medicaid and biogenerics programs and the $80M spending commitment. Are PhRMA lobbyists trying to pre-empt efforts of some congressional Democrats’ attempts at industry price controls as part of the reform package? | LINK

How about this as a case of cost shifting? Some states are considering whether to cut off aid for patients who will reach the doughnut hole in their Medicare Part D coverage (that gap in coverage that starts when benefits exceed $2700 of the beneficiaries’ cost of care). Considering the average patient over 65 years of age takes at least 5 prescription medications, the cost savings to bring aid to patients in the Part D coverage gap may pale in comparison to the costs to treat them when they get sick as a result. Hospitalization occurs, and, well, we all know what happens to the cost of healthcare once preventive services are shifted to the acute care realm. | LINK

• Medicare alters benefit formula for 2020 pharma plans.
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The global plan to eradicate measles by 2010 is unlikely to come about say epidemiology experts because of high rates of infection in some parts of Europe where many children go unvaccinated.

• Blue Cross of California plans to reinstate coverage for patients it had dropped in response to investigations by the LA Times.
• An speaking of California, many healthcare workers are not screened adequately for criminal pasts.

Happy New Year! from Doctor Pundit. Posting to resume on 1/2/09.

• Minnesota’s most populous county will end fee-for-service Medicare. Sign of the troubled economy? Docs gotta put food on the table, too.
• Medicare Part D open enrollment to end on 12/31.
• Healthcare plan beneficiaries scramble to take advantage of last minute procedures before benefit resets on 1/1. Looks like some docs will put food on the table.

At a time when the weak economy is hurting the industry, medical groups say they are grateful for the bump in business, however temporary. To cope with demand, doctors are adding hours and delaying vacations. High-deductible plans with health savings accounts were introduced in 2004 and now cover about 10 percent of insured Minnesotans. At the same time, deductibles for traditional plans — known as preferred provider organizations — also have jumped, with a $1,000 deductible now the national norm, according to benefits consultant firm Mercer.

Never has the need for transparency been greater for the Medicare Part D drug plan than when the new so-called reference-based pricing will begin on covered branded drugs possessing generic equivalents, in January. Under this plan, beneficiaries will have to pay an additional fee for these drugs under Part D, as opposed to other drugs which have no generic equivalent. Let the confusion begin.

[C]ritics complain reference-based pricing can result in hidden charges. “I am concerned that beneficiaries could find themselves paying far more out-of-pocket than they expected,” Rep. Pete Stark, chairman of the House Ways and Means health subcommittee, recently wrote in a letter to the Centers for Medicare and Medicaid Services. “CMS needs to make sure that beneficiaries are aware of these penalties before they choose their plans.”

Is this a job for the new HHS Secretary? | LINK