![Legislative Alert: Stimulus Package/COBRA UPDATE]()
by admin | Mar 9, 2009 | COBRA, healthcare
The American Resources and Recovery and Reinvestment Act of 2009 was signed into law by President Obama February 17th. Under the Act, certain individuals who are eligible for COBRA continuation health coverage, or similar coverage under State law, may receive a subsidy for 65 percent of the premiums for themselves and their families for up to nine months.
Click on the link below for detailed information on the American Recovery and Reinvestment Act of 2009 which went into effect February 17, 2009
http://www.dol.gov/ebsa/cobra.html
These individuals are required to pay only 35 percent of the premium.
The employer may recover the subsidy provided to assistance-eligible individuals by taking the subsidy amount as a credit on its quarterly employment tax return. The employer may provide the subsidy – and take the credit on its employment tax return – only after it has received the 35 percent premium payment from the individual.
To qualify, a worker must have been involuntarily separated between Sept. 1, 2008, and Dec. 31, 2009. Workers who lost their jobs between Sept. 1, 2008, and enactment, but failed to initially elect COBRA because it was unaffordable, get an additional 60 days to elect COBRA and receive the subsidy.
This subsidy phases out for individuals whose modified adjusted gross income exceeds $125,000, or $250,000 for those filing joint returns. Taxpayers with modified adjusted gross income exceeding $145,000, or $290,000 for those filing joint returns, do not qualify for the subsidy.
On February 26, the Internal Revenue Service released its first round of information for employers to use in administering the new subsidy program. Included are the subsidy reporting form, instructions and a very detailed questions-and-answers piece. The Department of Labor is still working on model notices and other guidance for release by March 17.
by admin | Jan 16, 2009 | healthcare, Pharmaceutical Industry
GENERIC VERSUS BRAND NAME MEDICATIONS
Many people have heard that switching to a generic medication will save them money. One of the questions we hear most often is, “How do generic medications compare to their brand name counterparts?” Knowing the facts about generics versus brand names can help make us all better consumers.
All generic drugs are reviewed and approved by the United States Food and Drug Administration (FDA) or in other countries, by an equivalent federal regulatory body. The regulatory boards all require that generic drugs have the same active ingredients, quality, strength, purity, and stability as brand name drugs. They also must have the same dosage form, whether you swallow it (pill/tablet/capsule/caplet), drink it (liquid), or inject the medication.
Many people are concerned that because generic drugs are often much cheaper than the brand-name versions, the quality and effectiveness have been compromised to make a less expensive product. The FDA requires that generic drugs be as safe and effective as the original brand name drugs. Generic drugs are copies of brand name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, the pharmacological effects of generic medications are exactly the same as those of their brand name counterparts. Another common myth is that generic drugs take longer to work. The FDA requires that generic drugs work as fast and as effectively as the original brand name products.
Generic drugs are cheaper because the manufacturers do not have the expense of developing and marketing a new drug. When a company brings a new drug to the market, the firm has already spent substantial money on research, development, marketing and promotion of the drug. A patent is granted which gives the company that developed the drug exclusive rights to sell the drug for as long as the patent remains in effect.
As a patent nears expiration, manufacturers may apply to the FDA for permission to make and sell generic versions of a drug. Since there are no startup costs for development of a new drug, other companies can afford to make and sell it for a less expensive amount. When multiple companies produce and sell a drug, the competition drives the price down even further.
The FDA applies the same standards for all drug-manufacturing facilities. Many companies manufacture both brand name and generic drugs. In fact, the FDA estimates that 50% of the generic drugs are produced by the same company that created the initial brand name drug.
Generic versions of drugs have different colors, flavors, or combinations of inactive ingredients than the original medications because United States trademark laws do not allow the generic drugs to look exactly like the brand name medication. However, the active ingredients must be the same in both generic and brand name medications, ensuring that both have the same effectiveness in treating a medical condition.
A physician’s decision to prescribe a brand name over a generic is based on the needs of the patient. Three in four physicians allow generic substitutes for brand-name drugs, even though most of them do not have a “dispense as generic” box on their prescription pad.
Pennsylvania law allows pharmacists to substitute generic drugs for original brand named drugs, unless the person writing the prescription, or the patient, directs otherwise. If the physician writes “Brand Necessary” or “Dispense As Written (DAW)” on the prescription, the pharmacist may not substitute the brand name medication with a generic alternative.
All patients are encouraged to discuss generic alternatives with their physicians prior to filling a prescription. The doctor and the patient should agree on the best course of treatment for any diagnosed medical condition.
A Guide to Legal Issues in Health Care: Prescription Drugs Retrived September 16, 2006 from http://www.upenn.edu/ogc/legal/pred.html Are Generic Medications the Same as Branded Counterparts? Retrieved September 16, 2006 from http://counsellingresource.com/medications/discount-drugs/generics.html COMMONWEALTH OF PENNSYLVANIA GENERIC DRUG EQUIVALENCY/SUBSTITUTION LAWS & REGULATIONS Retrieved September 16, 2006 from http://ecapps.health.state.pa.us/pdf/ddc/generic33.ps.pdf#search=%22pennsylvania%20drug%20dispensing%22How Physicians Feel About Prescribing Generics Retrieved September 16, 2006 from http://www.aarp.org/health/affordable_drugs/physiciansandgenericdrugs.html
Prescription Drugs – Generic vs Brand Name Retrieved September 16, 2006 from http://www.crossborderpharmacy.com/Canadian-Generics-vs-Brand-Name.htmlStoppler, MD, M., Generic Drugs, Are They As Good as Brand-Names? Retrieved September 16, 2006 from http://www.medicinenet.com/script/main/art.asp?articlekey=46204
by admin | Jan 16, 2009 | healthcare, HSA, NY News, Pharmaceutical Industry
Happy Holidays!
We are pleased to present the Winter issue of the MMS newsletter. As we enter 2009 we want include some timely information on year end tips, house cleaning and helpful articles.
As guidance for 2009, we are seeing various industry patterns. These are heady economic times and we remain cautiously optimistic with the new presidential administration. There are many proposed legislations on the table as well as free reports from PriceWaterHouse Cooper reports on what “Employers Want” and “9 Trends for 2009”.
We have seen recent consolidations with recent mergers between GHI and HIP to form EmblemHealth. Both non profits follow the Empire Blue Cross for-profit conversion of 5 years ago and covered in my blog.
Insurers such as Aetna, Empire and Oxford have been dropping Pharmaceutical Benefits Management companies and using their own resources instead. As self acting PBMs’ they can negotiate effectively by using their large numbers. This trend has not gone unnoticed by Pharmacy retailers such as CVS and Walgreens who must compete with mail order PBMs’.
Pharmaceutical Corps are bracing themselves for brand expirations on 80% of the most commonly prescribed drugs within 2 years. They have issued double digit rate increases while simultaneously manufacturing generics of their own drugs. This will make sense as generics average 1/4 the cost of brands. In fact, this will be a significant future cost saver as Rx have doubled in 10 years and represents over 25% of our insurance costs.
Insurers are saving members 20-40% by including value added discounts or reimbursements for gym membership, weight management programs, alternative medicine & holistic healing, vision, laser vision care, dental , hearing care and vitamins/natural supplements.
The technology investments will improve patient care and the public is already seeing early payoffs. Various online medical sites have helped inform patients and advocacy. Insurers such as Empire actually offer a $5 Copay to interact with one’s doctor online.
In addition, “consumer driven healthcare plans” are taking off as copays have risen. Its not unusual to find plans with specialist $50 copay. As a result our consumers have been re-evaluating whether it makes sense to self insure on rare items such as hoispiatls and surgeries. The HSA (health Savings Account) a model, especially the one form Aetna, has become actually a high end plan since the savings are significant enough to self insure and have universal coverage. The average PPO plan is $650/single while an HSA at $370/single only asks that you self insure on $1500. The invisible hand leading you say? Agreed!
Perhaps things will be more localized as hospitals have consolidated and have a virtual monopoly in LI and Bronx as an example. Insurers such as Oxford, Aetna and Atlantis already offer localized NYC plans which are 30% less expensive but have a limited NYC network.
Our agency has strived to be ahead of the curve and keep our clients within budget regardless. We have employed creative tools, personalized advise and latest technologies in the past and plan on adding to this model going forward. We thank you all for reading our material, referring us business and most of all believing in us!
Once again thank you and we wish you and your family a wonderful Holiday Season!
