JAMA: Low-income families with high cost-share levels most likely to forego a child’s asthma treatment
CHICAGO — According to a report published Monday by JAMA Pediatrics, cost-related barriers to care among children with asthma are concentrated among low-income families with higher cost-sharing levels. And while the Affordable Care Act’s low-income subsidies may reduce these barriers for many families, millions of dependents for whom employer-sponsored family coverage is unaffordable could remain at risk for cost-related problems because of ACA subsidy eligibility rules, the report concluded.
Overall, 15.6% of parents borrowed money or cut back on necessities to pay for their children’s asthma care, the report noted.
After adjustment, parents at or below 250% of the federal poverty level with lower vs. higher cost-sharing levels were less likely to delay or avoid taking their children to a physician’s office visit (3.8% vs 31.6%) and the emergency department (1.2% vs 19.4%) because of cost. Higher-income parents and those whose children were receiving public subsidies (e.g., Medicaid, CHIP) also were less likely to forego their children’s care than parents at or below 250% of the FPL with higher cost-sharing levels.
"We found that delaying and avoiding health care because of costs was concentrated among commercially insured children with higher levels of cost sharing and household incomes at or less than 250% of the FPL," researchers noted. "The ACA will expand cost-sharing subsidies to families with incomes at or below 250% of the FPL, which could reduce cost-related barriers to care, especially for families with children with chronic conditions like asthma and living in states with lower income eligibility limits for CHIP. For families at 200% to 250% of the FPL, however, these cost-sharing subsidies will be modest," they added. "Moreover, because of a family glitch, these subsidies will not be available to millions of dependents for whom employer-sponsored family coverage could be unaffordable. Work is needed to evaluate the effects of the ACA and potential unintended gaps in subsidy access to inform ongoing policy refinements."
Studies examining the effects of expanding subsidized coverage to poor children, such as through Medicaid or CHIP, have found improvements in access to care. According to the researchers, one recent study of commercially insured children with asthma found that higher cost-sharing for drugs was associated with modest reductions in the use of medication and increases in asthma-related hospitalizations for older children. However, limited evidence exists on responses to cost sharing for care other than drugs and on variations across income levels to inform low-income subsidies mandated by the ACA.
Former P&G vice chairman Dimitri Panayotopoulos joins Boston Consulting Group
BOSTON — The Boston Consulting Group has tapped former Procter & Gamble vice chairman Dimitri Panayotopoulos to serve as a senior adviser in its consumer practice.
In his 37 years at P&G, Panayotopoulos was a cornerstone of the company’s global success and earned a reputation for relentlessly pushing boundaries. As vice chair of global business units and, more recently, the adviser to the chairman and CEO, Panayotopoulos helped the company focus on breakthrough ideas, speed to market and large-scale transformation across all businesses.
"We are extremely excited to bring Dimitri on board as a senior adviser," said Tom Lutz, a BCG senior partner and global leader of the firm’s consumer practice. "His experience in driving revenue and profit growth in an array of businesses and in building brand leadership around the world will be a tremendous asset to our clients."
Panayotopoulos began his career at P&G in the company’s sales organization in the United Kingdom. He continued to build experience across the advertising and marketing groups before moving on to various country manager positions. In his eight years in China, Panayotopoulos built the company’s business from disjointed franchises into a market leadership position in beauty products. He then managed P&G’s 110-country market-development organization in Central Eastern Europe, the Middle East and Africa, and spearheaded the creation of a unified approach to brands and businesses in those markets. After being named group president of Global Fabric Care in 2004, Panayotopoulos helped build Downy, Lenor and Gain into billion-dollar brands.
Panayotopoulos will be based in Amsterdam, but will support BCG case teams globally by sharing his expertise in innovation and go-to-market strategies. He also will lend his expertise on China, Africa and other emerging markets.
NACDS supports Senate letter to HHS urging more time to implement Medicaid reimbursement
ARLINGTON, Va. — Citing the need for a one-year transition period for states to implement the July average manufacturer price-based federal upper limits, or FULs, nine Senators are urging Department of Health and Human Services Secretary Kathleen Sebelius to consider the challenges that states will face when the final Medicaid AMP-based FULs are published. The National Association of Chain Drug Stores has expressed its support for sending the letter.
In July, CMS will publish the final Medicaid AMP-based FULs. The agency has indicated that it expects the new FULs to be effective immediately.
“We believe that such a rapid implementation will pose problems for under-reimbursement of Medicaid prescriptions at the state level, which may pose problems for beneficiaries,” the Senators wrote to Sebelius. “We encourage CMS to establish a one-year transition period for state implementation of the FULs, as well as for implementing any necessary dispensing fee changes by the states once the new FULs have been published along with any corresponding and necessary regulatory guidance.”
“Most states face numerous obstacles to immediate implementation, including current year legislative sessions that do not allow for Medicaid reimbursement changes, the need for legislative or regulatory changes to achieve compliance, the need for cost-of-dispensing-fee studies for calculating fair pharmacy reimbursement and/or the need to file a State Plan Amendment to implement the new reimbursement approach,” the Senators stated in the letter.
The letter also cites the support for a one-year transition period by the National Association of Medicaid Directors. In a letter to CMS in September 2013, NAMD also recognized the above-mentioned obstacles for states, and requested from CMS the creation of a transition period up to one year for implementation.
NACDS president and CEO Steve Anderson expressed appreciation to the Senators for sending this letter, “The bottom line is that patient access to pharmacy care should not be compromised. Implementation of these AMP-based FULs poses great concern for pharmacy patient care, and we appreciate the leadership of Senators Mark Warner, D-Va., Johnny Isakson, R-Ga., and the support of their colleagues in recognizing how this immediate reimbursement change could impact access to pharmacy services for low-income Americans.”