Weekend update

As we head into the third week of the Federal Benefits Open Season and the second week of Congress's lame duck session, Congress has made movement in extending the life of the Medicare Part B physician reimbursement patch beyond November 30. The Hill reports that the Senate passed a bill that would extend the patch's life until the end of the year. The $1 billion cost of the extension will be paid for by reductions in Medicare payments to physical therapists. The House is expected to take up this bill right after Thanksgiving. "[Senate Finance Committee Chairman Max] Baucus and [Finance Committee ranking member Chuck] Grassley also agreed they would work together to pursue a year-long fix to the formula that could be enacted before the month-long patch expires."

The New York Time reports today on the "growing frenzy" of hospital and doctor group consolidation created by the Affordable Care Act ("ACA"). 

Business Insurance reports on the first round of guidance that the ACA regulators have issued to the States about the State health insurance exchanges that the ACA requires to be operational in 2014. 

In the initial guidance, HHS notes that states will have the option to establish exchanges as a governmental agency, either as part of an existing agency or through the creation of a new state agency. Alternatively, an exchange could be part an independent public authority, as is the case in Massachusetts. The guidance also says exchanges could negotiate rates with insurers or could act as a “clearinghouse” that would be open to all qualified insurers.

CVS Caremark announced last week the results of

A new study by Harvard, Brigham and Women's Hospital and CVS Caremark researchers has found a direct correlation between the amount of a patient's out-of-pocket co-pay and likely abandonment of the prescription, with patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10. The study also found that e-prescriptions are 65 percent more likely to be left abandoned at a retail pharmacy by patients than are hand-written prescriptions. * * * The researchers said that if the 3.27 percent abandonment rate observed during the study period is applied to the 3.6 billion prescriptions filled at pharmacies in 2008, approximately 110 million prescriptions would be abandoned. The researchers outlined a predictive model for pharmacists to apply to help them recognize likely candidates for abandonment that includes

• Reviewing the individual's benefit plan and tiered co-pays. The study said cost is the strongest predictor of abandonment. The data shows a 1.4 percent prescription abandonment rate for patients with co-pays of $10 or less, a 3.4 percent rate for patients with co-pays between $30 and $40 and a 4.7 percent rate for patients with co-pays of $50.
• Understanding past pharmacy behavior. Patients with first-fill prescriptions are three times more likely to abandon prescriptions than those who are re-filling their medication.
• Identifying the age of the patient. Younger patients are more likely than older patients to abandon their medications.
• Reviewing the drug class. The study found that opiates, anti-platelets and statins were the least likely to be abandoned, while insulin and proton pump inhibitors were more likely to be abandoned.

The FEHBlog wonders why retail pharmacies don't require customers to pay at the time that prescription fill or re-fill request is made. That's the common practice among mail order pharmacies.