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Report: Appellate court strikes down insurance mandate in health law

BY Alaric DeArment

NEW YORK—The healthcare-reform law took a hit Friday when a federal court in Atlanta ruled one of its key provisions unconstitutional, according to published reports.

The Wall Street Journal reported that in a 2-1 ruling, the U.S. Court of Appeals for the 11th Circuit found the law’s mandate for individuals to buy health insurance or face penalties to violate the Constitution because it represented a "wholly novel and potentially unbounded assertion of congressional authority." Judges Frank Hull, a Clinton administration appointee, and Joel Dubina, appointed by George H.W. Bush, wrote the 207-page opinion.

Twenty-six mostly Republican governors and attorneys general, the National Federation of Independent Businesses and two individuals had filed the suit. The appeals court upheld the portion of an earlier ruling by U.S. district judge Roger Vinson of Florida that overturned the insurance mandate, but kept the rest of law. Vinson had ruled the entire law unconstitutional.

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Study examines impact of voluntary, mandatory mail on medication adherence

BY Antoinette Alexander

NEW YORK — Mandatory mail seems to cause some patients to prematurely discontinue therapy, especially among those patients without previous mail-service pharmacy experience. At least, that’s what a recent study on mandatory mail suggested.

The CVS Caremark-funded study, “Adherence to Medication Under Mandatory and Voluntary Mail Benefit Designs,” recently was published in the American Journal of Managed Care.

It is no secret that a challenge in designing pharmacy benefits is to find the ideal balance between access to essential medications and cost management. It is a balancing act that is becoming increasingly difficult and, in an effort to help curb costs, employers increasingly are offering a mail-service option. According to the study, in 2010, nearly 96% of all employers offered mail pharmacy services to their employees. The majority of plan sponsors offer voluntary mail, while nearly 19% of employers implemented mandatory mail.

However, the impact on adherence rates under voluntary and mandatory mail benefit designs remains murky. The study — which focused on adherence rates in the first year of therapy — aimed to help clear the waters.

The study examined seven therapeutic classes for either anti-diabetic or cardiovascular therapies. The data came from employer-sponsored pharmacy insurance plans that offered either mandatory or voluntary mail pharmacy benefits managed by CVS Caremark between July 1, 2008, and March 31, 2010.

“Participants with a mandatory mail pharmacy benefit design were less likely to remain persistent during the first year of therapy. Most impacted were those who had no previous mail use and thus were most likely to have been unfamiliar with the requirements of mandatory mail,” the authors wrote. Some of the authors are current or former employees of CVS Caremark.
 
According to the results, persistence rates were similar through the first 60 days of therapy; however, the mandatory mail cohort experienced a “notable” drop in persistence by the 90th day of therapy.

“The lower persistence in the mandatory mail cohort beginning between days 60 and 90 indicates potential barriers to access during the period of time when the prescription must be transferred from a retail pharmacy to a mail-service pharmacy,” the authors wrote. “The substantial drop in adherence occurring at this transition point suggests an important target for improved processes at mail-service and retail pharmacies to facilitate transitions between distribution channels — a transition that can require several steps.”

Several key takeaway points:

  • By restricting pharmacy choice and access, mandatory mail appeared to cause some members to prematurely discontinue therapy;

  • When members chose to discontinue, rather than switch pharmacy channels, the unintended consequence was a reduction in medication adherence and the potential for increased medical expenses; and

  • Individuals without previous use of mail-service pharmacy are particularly sensitive to this plan design and are an important population to target for interventions to support adherence.

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Study: Need for diabetes educators likely to rise

BY Alaric DeArment

CHICAGO — The need for diabetes educators will rise sharply between now and 2025 as the diabetes epidemic worsens, according to a new study by the American Association of Diabetes Educators.

The study, conducted by Dobson DaVanzo & Associates, found that the need would increase by at least 60% over the next 14 years, with new career opportunities likely to emerge as private insurers and Medicare recognize the role the educators play.

As this happens, the range of work settings for diabetes educators will expand and include retail clinics, home health and long-term care centers and others in addition to hospital outpatient and physician office positions.

"The research confirms that diabetes education is a growing and vitally important healthcare specialty," AADE CEO Lana Vukovljak said. "Diabetes education, in addition to being a public health benefit, is a proven way to reduce healthcare costs."

In addition, payers are likely to view diabetes education more favorably, thanks to the growing body of literature supporting its cost effectiveness and the trend toward greater integration in health care.

The study included literature review, a search of employment websites to find job postings for diabetes educators, a claims analysis using Medicare claims from 2006-2009 and the development of a quantitative workforce model of the supply and demand for educators through 2025.

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L.JANDAYAN says:
Jul-23-2012 07:18 am

As this happens, the range of work settings for diabetes educators will expand and include retail clinics, home health and long-term care centers and others in addition to hospital outpatient and physician office positions.-James Stuckey

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