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Women face access barriers

Medicare & Reimbursement Advisor Weekly, May 20, 2009

If you have products geared to or indicated to treat women, you may consider how your educational or marketing team can react to this: Women are apparently more likely than men to face difficulties getting necessary care because they cannot afford it. About half (52%) of working age women, compared with 39% of men, report a variety of problems, such as not being able to fill prescriptions, visit physicians or specialists, or get medical tests, according to The Commonwealth Fund. To read the full story, click here. www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/May/Women%20at%20Risk/PDF_1262_Rustgi_women_at_risk_issue_brief_Final.pdf.

First fill challenges

Getting Part D plans to reimburse for first fills isn’t always easy. Susan Rhodus, RPh, CGP, vice president of contract administration at GPO GeriMed, helped one facility get a patient’s first fill approved, but it took several months. The drug was on formulary in 2008, but it’s nonformulary this year, and the plan didn’t want to pay for it. Ultimately, it led to a call by Rhodus into a local Medicare office that handles complaints. The complaint handler was a pharmacist with a Medicare Part D focus.

$16 less per day to treat

Nursing home payment changes mean nursing homes will have $16 less per patient per day to work with to manage their Medicare population. This means that if your customer in an average nursing home has 100 residents, that’s $1,600 less per day to care for the patient under the Medicare Part A per diem. “Drugs will definitely take a hit with this change,” says Diane Brown, long-term care regulatory director at HCPro. The change would take effect for the 2010 fiscal year.

Treating depression

Treating depression in nursing homes gets more lucrative in 2010 under a new documentation system, which reimburse facilities more if they recognize the signs and symptoms of depression and other central nervous system conditions, then document it. Contact the editor for a therapeutic-specific discussion of the impact.

Offering free drugs to the uninsured

Pfizer will provide 70 of its most widely prescribed prescription drugs for free to people who have lost their jobs and health insurance. To read the full story, click here. www.chicagotribune.com/health/jobs/chi-sns-free-viagra-other-drugs,0,3786643.story.

Employer spotlight

The company Safeway has created a benefit design to reward employees’ healthy behaviors and improve adherence to recommended treatments for chronic diseases. More than 74% of Safeway’s 30,000 nonunion workers have signed up for its “Healthy Measures” program. With this program, participants undergo screening tests (including cholesterol, blood pressure, and weight control); employees who score well pay lower health premiums. Safeway has saved millions by making employees accountable for their weight, cholesterol, and blood pressure. Results of our interview on pharmacy-related results and details on its benefit design are coming in a future issue.

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