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Medicare, Medicaid, Health Reform

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Monthly Archives: November 2004

Medicare Drug Benefit: Out-of-Pocket Spending

A new report projects the savings to Medicare beneficiaries who sign up for Medicare's new prescription drug benefit in 2006. Prepared by the Actuarial Research Corporation (ARC) for the Kaiser Family Foundation, the report estimates that: - Low-income beneficiaries who sign up for Medicare drug plans and receive the new federal subsidies (about 8.7 million seniors and persons with disabilities)...

Teaching Hospitals vs. Community Hospitals on Cost and Quality

Community hospitals outperform teaching hospitals, according to a new study that compares cost and quality of hospitals in six states. The researchers conclude that patients served by lower-cost community hospital for secondary care receive care of similar quality to that provided in academic health centers. Findings include: - Inpatient costs per case are 19 percent higher in teaching hospitals, even after...

Improving Managed Care for Children with Special Needs

Over nine million American children - 12.8 percent of kids - have special health care needs. They face a wide range of conditions, including congenital anomalies, severe physical disabilities, severe asthma, complex organ system diseases (e.g. cystic fibrosis, sickle cell anemia), major depression, and the devastating effects of physical and sexual abuse. Medicaid health plans serve a large portion of...

How to Think About Drug Prices

In a thoughtful article in The New Yorker, Malcolm Gladwell debunks common assumptions about prescription drug prices. Gladwell, bestselling author of The Tipping Point, cuts through the faulty thinking of the pharma bashers. His 4,000-word piece makes for interesting reading. Known for getting to the heart of matters, Gladwell says it all: "For sellers to behave responsibly, buyers must...

State Budget Cuts and Impact on Medicaid Health Plans

A new report examines the impact of state budget cuts on Medicaid managed care programs in four states: Florida, Massachusetts, Michigan, and Oregon. Developed by Bailit Health Purchasing LLC for the National Academy for State Health Policy, the study offers valuable insights. It's recommended reading for state Medicaid executives, state budget staff, Medicaid health plans, consultants, and advocates.

Role of PBMs in Medicare Prescription Drug Benefit

Pharmacy benefit managers (PBMs) already administer Rx benefits for most employers and several Medicaid programs. Medicare's voluntary prescription drug benefit, set to begin in 2006, creates a huge new market opportunity for PBMs. However, the Medicare drug benefit will also create significant new challenges to PBMs and other organizations bidding to cover Medicare beneficiaries. And the PBM industry is...

Retiree Drug Coverage: Understanding New Medicare Options

Under Medicare's new prescription drug benefit, employers will have several options for maintaining drug coverage for their retirees. Staff at the Centers for Medicare & Medicaid Services (CMS) created a detailed briefing for employers, unions, health benefit consultants, and others interested in understanding the options, including the new retiree drug subsidy. For the CMS briefing in PDF format, click here....

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