HEALTHCARE
• Drug Companies Conspire to Keep Generics Off the Market
• Website Compares Health Insurance Plans
• How the ACA Will Affect Cancer Care
• Heart Surgeon Report Cards Often Misinterpreted
• Alliance of Health Groups Offers Plan to Lower Costs, Improve Care
• Seniors Like Their Medicare Part D Coverage
IN CALIFORNIA
• The Recession’s Toll on Job-based Coverage
• Health Net Creates ACO-Like Arrangement
• Security Life Launches Ancillary Products in California
NEW PRODUCTS
• Variable Annuity
• Critical Illness Plans for Small Groups
• Health Reform Modeling Tool
MOVERS & SHAKERS
• Life Settlement Founder to be Expert Panelist on Fox’s Varney & Co.
• Movsesian Named Man of the Year
LTC INSURANCE
Drug Companies Conspire to Keep Generics Off the Market
2012 California PPO Survey
If it seems harder to get a generic medication it’s not your imagination. With pay-for-delay tactics, brand prescription drug manufacturers pay generic drug manufacturers for not creating generic versions of their medication. This limits the number of prescription options available to patients and contributes to the growth in health care costs, according to the American Medical Assn. (AMA), which has adopted a policy to work toward ending the practice.
Pay-for-delay agreements are estimated to cost American consumers $3.5 billion per year. The Federal Trade Commission (FTC) has recommended that Congress pass legislation to protect consumers from such – agreements. But www.foxbusinessnews.com reports that Congress has failed to stop pay-for-delay and generic drug makers and big-name pharmaceutical companies have been winning court rulings that allowed it.
The Federal Trade Commission recently filed an amicus brief in the U.S. District Court for the District of New Jersey stating that a branded drug company’s agreement not to launch an authorized generic drug “provides a convenient method for branded drug firms to pay generic patent challengers for agreeing to delay entry.” The FTC also filed a brief in the case of Lamictal Direct Purchaser Antitrust Litigation. In the case, the private plaintiffs alleged that GlaxoSmithKline paid Teva Pharmaceuticals to delay entry by promising not to compete with authorized generic versions of the drug Lamictal.
CBO Says That Removing Commissions from the MLR Would be Costly
H.R. 1206 – a bill that would get health insurance agent and broker compensation out of minimum medical loss ratio (MLR) calculations — could cost the federal government about $1.1 billion from 2013 to 2022, according to budget analysts at the Congressional Budget Office (CBO). H.R. 1206 would amend current law to exclude compensation paid to insurance agents and brokers from the administrative expenses used to determine the calculation of the medical loss ratio (MLR) for health insurance plans. The bill would also make waivers of certain requirements under the MLR rules easier for states to obtain. The Secretary of the Department of Health and Human Services (HHS) would defer to a state’s findings that the rules would destabilize the state’s insurance market. Finally, the legislation would extend the availability of such waivers in other ways.
CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting H.R. 1206 would increase deficits by $531 million over the 2013-2017 period and by about $1.1 billion over the 2013-2022 period. Of this increase in the deficit, $127 million would be a decline in off-budget Social Security revenues between 2013 and 2022. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending and revenues.
Overall, CBO estimates that the MLR requirements under current law will reduce premiums by about one-half of a percent, on average, over the next few years, declining to approximately one-tenth of a percent by the end of the 10-year projection period.
Website Compares Health Insurance Plans
A new website called “HealthPocket.com” enables consumers to compare every health insurance plan in their geographic region. Consumers can get information on the price and quality of their health insurance options without any insurance company paying to showcase its own plans or highlight information. Similar to online sites like Amazon or Kayak, HealthPocket.com filters all plans offered in a geographic area by cost of premiums, cost of drugs covered, and quality of the plan. Consumers can use the site to get information and even get connected with an insurance provider, but HealthPocket.com does not broker sales of health insurance.
“Existing online health insurance sites have at least one fatal flaw — they steer consumers only toward the health plans that have paid to be one of the options, which skews the results. Other sites require the user to divulge personally identifiable information before providing any results. HealthPocket.com shares all the information people need to make a decision, without requiring anything from them and without any pay for placement from insurers,” said Steve Zaleznick, who leads consumer outreach for HealthPocket, Inc.
More than half of the U.S. population will need to make choices about their health insurance carrier by 2014 with millions of Medicare beneficiaries facing a Dec. 7 deadline for enrolling in Medicare Part D prescription drug plans and/or Medicare Advantage plans. For more information, visit www.healthpocket.com.
How the ACA Will Affect Cancer Care
The following is a summarized version of an article by Deborah J. Cornwall
The 2012 election results provide certainty that the Affordable Care Act will be implemented, freeing cancer caregivers to focus on providing patient care and support. The passage of the Affordable Care Act will ensure that all Americans will have the following:
- Health insurance coverage: Access to insurance coverage will be available even for those who change jobs, and coverage must be approved or continued regardless of gender or pre-existing conditions like cancer. No one will need to worry about an insurer cancelling coverage or being charged more when they receive a cancer diagnosis (effective January 1, 2014).
- Earlier cancer detection: Effective January 1, 2013, the act provides for reduced or no-cost preventive and screening services for breast, colorectal, and prostate cancer, three of the most prevalent cancers.
- More Extensive Medicare Drug Coverage: The Medicare Part D prescription cap in coverage (known as the “donut hole”) will be narrowed over time and eventually eliminated (by 2020).
- Longer coverage for children (including those with cancer): Children up to the age of 26 can continue to maintain coverage under parents’ health insurance policies.
- No lifetime limits (now) or annual limits on payments (by 2014): Patients won’t have to postpone treatments for fear of costs being incurred after an arbitrary limit has been reached.
- Coverage for Clinical Trials: Beginning January 1, 2014, coverage will be provided for anyone who is eligible to participate in a clinical trial that is appropriate to treat the patient’s condition. For patients facing certain life-threatening cancers, trials can be the key to a longer life.
As states and insurance carriers work out the mechanics for implementation, much remains to be defined and communicated over the months ahead. Mandated budget cuts are scheduled to take effect January 1 if Congress doesn’t reach prior agreements. These cuts would jeopardize National Institutes of Health funding for cancer research, clinical trials, and breast and cervical cancer screening programs for low-income, uninsured, and under-insured women. In addition, action is still needed on provisions for maintaining adequate drug reimbursements to office-based physicians who administer drug treatments covered by Medicare Part B. In spite of these two uncertainties, a sigh of relief is timely and appropriate for cancer-affected families. Their focus now can be on managing their loved ones’ treatment, supporting them in their day-to-day living, and maintaining their hope for a cancer-free future. These focal points are the core of what effective cancer caregiving is all about.
Deborah J. Cornwall is an advocate for cancer patients and their families, working with the legislative advocacy affiliate of the American Cancer Society. She is also the author of “Things I Wish I’d Known: Cancer Caregivers Speak Out,” a new book based on interviews with 86 cancer caregivers and dozens of patients and survivors. For more information, visit www.thingsiwishidknown.com.
Heart Surgeon Report Cards Often Misinterpreted
Report cards that rate heart surgeons on death and complication rates are now available on multiple government, insurance company, and commercial websites. But this information is not always presented in ways that are easy for people to understand and often leads to misinterpretation, reports the November 2012 Harvard Heart Letter.
Researcher created reports on several fictitious surgeons. The reports included the number of coronary artery bypass graft operations performed, the number and percentage of patients who died during or soon after the operation, and risk-adjusted mortality. How well volunteers were able to identify the best surgeon depended on how the information was presented. With the best format, 66% of those surveyed picked the best surgeon; with the worst, just 16% did. Many people focused on the number of deaths rather than on the more important number—risk-adjusted mortality.
Alliance of Health Groups Offers Plan to Lower Costs, Improve Care
The National Coalition on Health Care (NCHC) recently released a plan for health and fiscal policy at the National Press Club in Washington. The national alliance of consumers, providers and payers introduced a plan that pairs nearly $500 billion in spending reductions and health-related revenues with longer-term policy changes designed to make health care affordable in the public and private sectors.
The 50-page plan, “Curbing Costs, Improving Care: The Path to an Affordable Health Care Future,” outlines a seven-part strategy:
1. Change provider incentives to reward value, not volume.
2. Encourage patient and consumer engagement.
3. Use market competition to increase value.
4. Ensure that the highest-cost patients receive high-value, coordinated care.
5. Bolster the primary care workforce.
6. Reduce errors, fraud, and administrative overhead.
7. Invest in prevention and population health.
NCHC’s recommendations include $220.97 billion in reduced federal spending and $276 billion in health-related revenue. However, NCHC proposes pairing budget savings with broader reforms. “Ten-year budget savings have to be coupled with strategies for long-term sustainability: transitioning from fee-for-service, engaging consumers in their care and coverage choices, investing in our non-physician workforce as well as doctors, and crafting a medical liability system that supports patient safety,” said Former U.S. Senator David Durenberger, past chair of the Senate Finance Committee’s Subcommittee on Health and a member of NCHC’s Board of Directors.
Seniors Like Their Medicare Part D Coverage
Ninety percent of seniors are satisfied with their Medicare prescription drug coverage (Part D), according to a survey by Medicare Today and KRC Research. Satisfaction with Part D has increased from 78% to 90% since the program was implemented. Ninety-six percent say their coverage works well, and nearly three in four seniors say it works very well.
“It’s very rare to get nine out of 10 people to agree on anything, but Medicare Part D has sustained that level of acceptance and popularity. Beneficiaries view Part D as affordable, reliable and user-friendly. It’s become an essential component of seniors’ healthcare,” said Mary R. Grealy, Chairman of Medicare Today and President of the Healthcare Leadership Council.
The Recession’s Toll on Job-based Coverage
The number of Californians who had health insurance through their job or that of a family member fell below 50% for the first time in a decade in 2011, according to a study from the UCLA Center for Health Policy Research. When data for the first California Health Interview Survey was collected in 2001, 56% of non-elderly Californians had employment-based coverage. By 2011, that figure had declined to 49.7%.
At the same time, more non-elderly adults and children enrolled in Medi-Cal and the state’s Healthy Families program, with one in five insured through these public health insurance programs for low-income Californians in 2011. Eligibility for public programs grew dramatically during the recent recession as many unemployed Californians’ household incomes dropped below the federal poverty level and qualified for Medi-Cal. (In 2011, the federal poverty level was $14,710 for a two-person household and $22,050 for a family of four.) In 2007, 15% of all non-elderly Californians had coverage through public insurance programs. Four years later, the proportion had surged to 19%. However, nearly 7 million state residents remained without health insurance in 2011.
“When the major insurance expansions occur in 2014, the ACA should finally provide relief to the millions of Californians,” said Shana Alex Lavarreda, director of the center’s Health Insurance Studies Program. Many more people should be able to get coverage in 2014 when provisions of ACA go into effect, such as expanding Medi-Cal eligibility to individuals whose incomes are below 138% of the federal poverty level and providing access to a new health insurance exchange, researchers noted. For more information, visit http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=578
Health Net Creates ACO-Like Arrangement
Health Net of California has formed an accountable care arrangement with San Francisco health care providers for University of California employees living or working in San Francisco. Implementation is pending regulatory approval. The providers are Hill Physicians Medical Group, UCSF Medical Center, UCSF Benioff Children’s Hospital, St. Mary’s Medical Center, and Saint Francis Memorial Hospital. The arrangement will encourage prevention and early detection of diseases and conditions. For more information, visit www.healthnet.com/uc.
Security Life Launches Ancillary Products in California
Security Life is now approved to sell group ancillary benefits in California. The company’s Premier Choice line of coverage is a complete package of customizable benefit plans, including dental, vision, life and LTD. Premier Choice offers significant flexibility in Dental Plan design, including: multiple deductibles, annual maximums and co-insurance options. Our Vision, Life and LTD follow suit and allow an agent to design a package of coverage that will meet the needs of their clients. For more information, call 800-328-4667 or visit SecurityLife.com.
Variable Annuity
Nationwide Financial is adding managed volatility funds to its variable annuity line-up. The company is also adding three fund options for its guaranteed lifetime withdrawal benefit, The Nationwide Lifetime Income Rider. These options can provide increased equity exposure including one managed volatility fund. For more information, visit www.nationwide.com.
Critical Illness Plans for Small Groups
Standard Life introduced critical illness plans for groups ranging from a minimum of two lives to 1,000 and more. The product is designed to fit a range of group sizes and budgets. For more information, visit http://www3.standard.com.
Health Reform Modeling Tool
National Financial Partners Corp. launched its Health Care Reform Modeling Tool. It assesses the financial consequences that employer groups may expect from the Accordable Care Act. It enables advisors to prepare employers for ACA’s Pay or Play provision and Cadillac Plan excise tax, which go into effect in 2014 and 2018, respectively. For more information, visit http://www.nfp.com.
Life Settlement Founder to be Expert Panelist on Fox’s Varney & Co.
Scott Page, CEO of The Lifeline Program, will be a panelist on Stuart Varney’s FOX Business Network show, Varney & Company. After several brief guest appearances earlier this year, Page was invited back as a contributing panelist for Thursday’s entire cable network show which airs from 9:20 to 11 a.m. EST. Page will contribute his opinions for the popular show, which covers the stock market opening and features interviews with Wall Street experts, industry executives and policymakers.
Movsesian Named Man of the Year
Big Brothers Big Sisters of Orange County named Julian Movsesian, president of Succession Capital Alliance as “Man of The Year.” His firm specializes in life insurance strategies for high net worth individuals, Movsesian, born in Cairo of Armenian descent, convinced his parents to let him move to Southern California at age 17, where he lived with guardians. He put himself through high school and flipped burgers at McDonalds. Movsesian says it’s only because of this success that it’s possible for him to give back to the community.
After being fired from McDonald’s for eating leftover burgers that were being thrown out, he quickly rose through the ranks at Sambo’s Restaurant before being recruited to the life insurance industry. Instead of staying in Southern California where the competition was tight, every week, he traveled to Central California. He quickly learned that he could sell more policies in that region while staying at a Motel 6. Within his first year selling insurance, he was named Rookie of the Year. He eventually came back to Los Angeles where he built a successful insurance practice working with affluent families and business owners in Beverly Hills. Movsesian is a past winner of Pacific Life’s highest honor for independent life insurance professionals.
Consumers are full of excuses about why they don’t have a plan for long-term care needs. In fact, 82% of respondents ages 45 to 54 without a plan cited reasons, said they didn’t want to think about being dependent on others; they hadn’t found the right time to discuss options with loved ones; they are planning to handle it themselves; and they were not unaware that they needed to plan for long term care. During November, Long Term Care Awareness Month, Genworth encourages advisors to begin discussing the importance of Resilient Planning with clients. By using their fear and anxiety as a signal that something must get done, clients can channel their emotions and plan effectively with their advisors. For more information, visit Genworth’s multimedia news release.
