HEALTH

In study, insurer shows cost benefits of smarter health decisions by patients

BY Jim Frederick

BLOOMFIELD, Conn. Americans can lower their total medical costs significantly by taking simple steps to prevent or manage disease and by switching to generic drugs whenever possible, new research from health insurance giant Cigna confirmed.

A new, multiyear study compared the healthcare claims of 897,000 Cigna customers enrolled in consumer-driven health plans, preferred provider organizations and health maintenance organizations. Based on its findings, Cigna asserted that beneficiaries covered by its Cigna Choice Fund CDH plans “improve their costs without compromising care by becoming more engaged in improving their health and by becoming informed healthcare consumers,” according to a company report.

“When Americans engage in health-smart habits, such as participating in health coaching and disease management programs, substituting generic medications for brand-name drugs and avoiding unnecessary trips to the emergency room, their total medical costs went down 15%,” the report noted. That resulted in an average savings of $358 per person in the first year, Cigna noted.

Behind the cost reductions, according to the insurer, were higher-than-industry-average rates of participation by Cigna CDH plan members in health coaching and disease management programs, as well as higher generic drug substitution rates. “Cigna CDH plan participants who also have Cigna Pharmacy Management benefits choose generic equivalent drugs 70% of the time,” the company noted.

Avoiding unnecessary emergency room visits also is key to health cost savings, the report noted. “CDH plan enrollees use the emergency room at a 13% lower rate than individuals who have HMO and PPO plans,” the company asserted. “When Cigna Choice Fund customers visited an urgent care facility, their doctor’s office or convenience clinic instead of the ER, they saved an average of $800.”

 

“The evidence is clear,” the report’s authors asserted. “Given the right incentives, the right health improvement programs, useful cost and quality information, and easy-to-understand correspondence, individuals are making rational, wise and successful healthcare decisions.”

 

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HEALTH

NACDS to IRS: Delay health debit card changes

BY Michael Johnsen

ALEXANDRIA, Va. The National Association of Chain Drug Stores on Tuesday released a letter addressed to the Internal Revenue Service requesting clarifications of provisions regarding over-the-counter and prescription medications in the Patient Protection and Affordable Care Act.

First and foremost, NACDS is concerned that current IRS guidance would prohibit the use of debit cards in the purchase of not only any prescribed OTC medicine, but also any prescription-only therapy.

“Currently, there is no robust interaction between pharmacy dispensing systems and [inventory information approval systems; the systems used to substantiate purchases for flexible spending accounts]; an IIAS cannot distinguish between a medication for which a prescription is required and an OTC that has been prescribed,” NACDS explained. “As a result, a prohibition on using debit cards for prescribed OTC medications could have the practical effect of prohibiting the use of debit cards for all prescribed medications. … IRS’ prohibition on using debit cards for prescribed OTC medications greatly diminishes the value of the IIAS infrastructure unless pharmacies invest even more capital to modify the IIAS infrastructure to comply with the new guidance.”

There is significant capital at stake, NACDS argued, as the IIAS modifications to distinguish prescription-only and OTC across all stakeholders could take as long as two years to implement. NACDS requested IRS allow the use of debit cards to purchase prescribed OTCs; otherwise, the association requested that the two-week delay the IRS has allowed for implementation be extended by two years.

For a full copy of the letter, click here.

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American Diabetes Association continues to raise awareness as celebratory month nears

BY Allison Cerra

ALEXANDRIA, Va. American Diabetes Month will be celebrated this November, and the group leading the fight to end the disease is encouraging others to join the movement.

 

Shortly after announcing that "Celebrity Apprentice" winner and Poison frontman Bret Michaels joined its "Stop Diabetes" movement, the American Diabetes Association has launched the "Share Your Vision to Stop Diabetes" video contest, and has asked Americans to:

  • Become advocates for the cause;
  • Learn how to survive the holidays;
  • Give their time and passion; or
  • Donate funds to support diabetes research, information and advocacy programs.

 

With nearly 24 million children and adults afflicted with the disease in the United States — and an additional 57 million at risk for Type 2 diabetes — diabetes has reached epidemic proportions, the association said.

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