Thursday, January 13, 2011


Today was the first day of the Institute of Medicine's open hearings on the develop of the essential health benefits package mandated by the Affordable Care Act for plans participating in the state health insurance exchanges. As discussed in Tuesday's FEHBlog, this process also will impact the FEHBP and other group health plans. An audiocast of today's hearing is available here.

The Hill blogs about AHIP's sensible testimony today urging "federal advisers against recommending specific 'essential' items or services that must be included in health plans offered on new insurance exchanges starting up in 2014." As AHIP points out, specifying coverage of certain broad categories of benefits (see 5 U.S.C. Sec. 8903, 8904) has worked in the FEHB Program for the past fifty years.

Healthleaders Media reports on the efforts of health insurers to mend fences with providers by streamlining the claims processing system and resolving provider misunderstandings. For example, 
CIGNA research showed that each billing department had its own approach to interim billing. Some facilities didn’t do any interim billing, while others begin billing as soon as the patient’s information hits the system. In some instances, this caused bills to appear as though they are outstanding with the payer by over 60 to 90 days, when in fact the bills had just been submitted.
On the flip side, the Wall Street Journal reports on how the big biological drug companies are trying to convince the FDA to narrow the pathway to generic or biosimilar versions of their very expensive "large molecule" drugs mandated by the Affordable Care Act. The law provides for a 12 year period of market exclusivity for the manufacturer that patents the drug. This pathway has been up and running in Europe for several years. According to the Journal ,
A bipartisan group of senators including Sen. Orrin Hatch (R., Utah) and Sen. Kay Hagan (D., N.C.) sent a letter Jan. 7 calling on the Food and Drug Administration to interpret the law in ways favorable to the brand-name makers.
The letter says companies should get an additional 12 years of exclusivity if manufacturers alter an existing product to improve safety or potency. It also calls on the FDA to define "exclusivity" in a way that might help delay generic applicants. The Biotechnology Industry Organization helped draft the letter, their counsel said.
 This seems like a big bowl of wrong to the FEHBlog.

While on the topic of generics, The Medical News reports on a new Caremark funded study concerning prescriber's suspicions about traditional, "small molecule generic drugs like Amoxocillin that you find in your medicine cabinet. "Physicians 55 or older were 3.3 times more likely to have negative perceptions about generics than those between 25 and 34.  While the doctors said they were aware some patients struggle with the costs of medications, there was little relationship between the doctor's perception of cost burden and their perceptions of generics, the researchers said."  This perception difference surprises me as generics have been around for almost 30 years and they do save health plans and consumers lots and lots of money. (Hence the biologic drug manufacturers concerns.)  The study concludes with the recommendation that  "Payors and policy makers attempting to stimulate cost-effective medication use should consider educating physicians, particularly older ones, to improve their comfort with generics."

Finally, Drug Store News reports that "CVS Caremark's retail-based clinic operator MinuteClinic is experiencing exponential gains in utilization and posted a 22% increase in acute visits during the past year." Wow.

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