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The Obama administration on the official White House website identifies “5 Important Numbers on Health Reform.” These include:
Zero. The amount consumers would have to pay for premiums, co-insurance or co-payments on any preventive services;
Fifty. The number of states that now offer insurance options to all people, regardless of any pre-existing conditions;
One million. The number of doughnut-hole rebate checks mailed to seniors under Part D as of August 2010;
Eight billion. The amount of money the Patient Protection and Affordable Care Act is projected to save in just the next two years — $418 billion by 2019; and
Twenty-six. The age up to which kids can be covered by their parents’ insurance.
In this spirit, DSN has crunched some numbers of its own. What follows are five OTC remedies for American healthcare costs.
And that’s the low-end projection. The change in the tax code that eliminated eligibility for reimbursement of OTC purchases under flexible spending accounts — without a prescription, that is — enacted to help pay the freight of health reform likely will add more cost than it will save.
According to a Nielsen Group poll conducted in December 2010, more than half of FSA participants used their accounts to buy an OTC in the preceding 12 months. And of those approximate 9.8 million consumers, 46% indicated they would make the extra doctor’s visit to get prescriptions for their OTC medications, as is now required.
And it’s not just the cost of those otherwise unnecessary physician visits — you have to factor in the number of doctors that are more likely to steer patients toward the latest, more expensive prescription-only remedies that they are more familiar with. According to the Foundation for HealthSmart Consumers, if only 10% of consumers opted to see their doctor for an OTC prescription, overall healthcare costs would increase $4.5 billion in one year. If 50% of consumers opted to see their doctor, that number easily skyrockets to $27 billion or more.
In order to help thwart the diversion of legitimate pseudoephedrine-based cold and allergy remedies into the illegal manufacture of methamphetamine, several states currently are considering reclassifying PSE as a schedule-IV controlled substance, which would require a prescription for dispensing.
But does that really solve the illegal drug problem? Meth lab busts in both Oregon and Mississippi — two states that have reclassified PSE as Rx-only — have plummeted by 90% and 68%, respectively, in the year after the changes were made, according to published reports.
Electronic-tracking systems, experts argue, actually expose potential meth criminals while protecting access for legitimate customers who just want to breathe through their nose or stop sneezing. “In the four states that have fully implemented e-tracking technology, nearly 40,000 g of illegal PSE sales per month are blocked,” stated Carlos Gutierrez, a state government relations consultant at the Consumer Healthcare Products Association. Moreover, according to a state government review in Kentucky — one state that is considering a change in status for PSE-based products — at least 97.8% of all PSE sales are made for legitimate use.
The problem with e-tracking systems — which the industry has agreed to shoulder the cost of implementation of for the states — is that they uncover meth labs. How is that a problem? That means that local law-enforcement agencies, many of which are battling budgetary pressures of their own, have to spend money to go out and bust the labs. Switching to Rx-only just forces meth labs further underground and makes them much harder to identify.
So how does that help battle the problem with meth? Good question. It doesn’t. And, at best, it drives up healthcare costs, as consumers now need a doctor’s visit to treat the common cold or a simple allergy. If they don’t go to the doctor, the additional costs show up in lost productivity due to absenteeism/presenteeism as sick people either stay home or go to work sick and infect others.
The simple fact is that Rx-to-OTC switch drives down health costs for patients and payers, and improves access to important medications for the insured and uninsured alike. According to a Northwestern University study, using OTCs, when appropriate, to treat certain upper respiratory infections saves up to $4.75 billion a year.
Near-term potential switches include Protonix (Pfizer Consumer) and Aciphex (Eisai). Beyond allergy and proton-pump inhibitors, such other switches as statins may require more complicated educational pieces and distribution agreements going forward, according to Laura Mahecha, Kline Group industry manager of healthcare practice. Statins are one class of drugs that pharmaceutical companies for many years have looked to switch from Rx to OTC — every time unsuccessfully. But that could change.
“A lot of the [future switches] will be driven by the economics,” Mahecha said, a factor that could drive the creation of a new behind-the-counter status for certain drugs, much the way Plan B is sold now.
A new BTC class of drugs could open the door for other new classes of OTCs — erectile dysfunction, Pfizer is rumored to have an OTC version of Viagra in development for the European market; benign prostatic hypertrophy; or even incontinence.
Success rates improve two-fold when quit attempts combine the use of an OTC smoking-cessation product and counseling. And that improves healthcare — both costs and outcomes — immeasurably.
According to the latest figures from the Centers for Disease Control and Prevention, more than 43 million American adults smoke. Smoking-related diseases claim an estimated 443,000 lives each year, including those affected indirectly. According to the American Lung Association, smoking costs the United States more than $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct healthcare expenditures, or an average of $4,446 per adult smoker.
Want to chip away at those costs? Incentivize smokers to quit by offsetting the cost of smoking-cessation products by whatever means possible. That means more coupons, more patient-assistance programs and co-pays for nicotine-replacement therapy. Also, extend the indication for use beyond the current recommended 12 weeks for nicotine-replacement products. According to a Wall Street Journal article published earlier this month, the Food and Drug Administration currently is considering extending recommended use of NRT therapies beyond 12 weeks. In the United Kingdom, for example, NRT products are recommended for use from six to 12 months.
It’s time for America to start applying some of the lessons learned by the private sector. Take a company like Wegman’s, for instance, which first introduced its “Eat Well, Live Well” employee health-and-wellness program in 2003 and has had increased success every year. Last year, some 11,500 Wegmans employees participated, and according to a poll conducted at the end of the program, nearly 7% lost weight, 200 employees lowered their blood pressure, 219 lowered their cholesterol and 39 quit smoking. Such OTC products as diet aids and meal-replacement products, blood-pressure monitors, smoking-cessation products, etc., are the tools that drive those types of results.
The newest OTC category to fall into this preventive care/wellness bucket is breast-feeding pumps and related products. U.S. surgeon general Regina Benjamin in January issued a “Call to Action to Support Breast-feeding,” which outlined steps that should be taken to remove obstacles faced by women who want to breast-feed their babies. This came on the heels of a recommendation by the American Academy of Pediatrics that new mothers breast-feed their children through the end of the first year of life. Last month, the IRS, acting on one of Benjamin’s proposed steps, reclassified pumps and related feeding products as a legitimate medical expense.
According to a study published last year in the journal Pediatrics, the United States could save $13 billion a year in healthcare and related costs if 90% of U.S. babies were breast-fed exclusively for six months.