Commentary

Connolly’s Attempts to Overhaul Health Programs Bad For Federal Employees

The Culpeper Times – July 6, 2010 - Now that Congress has rammed through health reform, several Members, including Congressman Gerry Connolly (D-VA), serving the 11th district,  have wasted no time identifying another program to “reform,” broken or not. Unfortunately, it seems that the Federal Employees Health Benefit’s Program (FEHBP) has landed in their crosshairs in the form of bill HR 4489. The goal of the bill is to completely overhaul, or, in the words of co-sponsor Congressman Stephen Lynch (D-MA), “blow up” FEHBP, and give Congress new powers to control pharmacy prices, evolving from its enormously popular current state, to a program more akin to Medicaid’s price.

The goal here, as with health care, is to consolidate government power, limit choice and competition and cater to liberal special interests. Their approach seems more focused on scoring ideological points than putting beneficiaries’ needs first, all but guaranteeing poorer health care for FEHBP enrollees who thought they were getting a good deal.

After years of government service, this isn’t what senior and retired folks were promised. And it’s certainly not what enrollees deserve. Read more.

Alabama: More Momentum for Cost-Plus

Drug Channels – July 15, 2010 – Tuesday’s post about South Carolina’ pharmacy profit boost connected me with Kelli D. Littlejohn, R.Ph., Pharm. D., Director, Pharmacy Services at the Alabama Medicaid Agency. Subject to approval by the Centers for Medicare and Medicaid Services (CMS), Alabama’s Medicaid program will soon implement a new pharmacy reimbursement program using Actual Acquisition Cost (AAC) instead of published benchmarks or Maximum Allowable Cost (MAC) lists. Does AAC sound familiar? Yup, it’s our old friend cost-plus pharmacy reimbursement. As far as I know, Alabama is the first state to move to a cost-plus model. Read the full post.

A Victory for Pharmacy Profits in South Carolina

Drug Channels - July 13, 2010 – Last month, I read a curious press release from NACDS titled Major Victory for Patients and Pharmacy in South Carolina. It describes the “monumental achievement” of switching the pharmacy’s ingredient cost reimbursement in the state’s Medicaid program from Average Wholesale Price (AWP) minus 10% to Wholesale Acquisition Cost (WAC) plus 12.5%

Don’t be fooled. This really is nothing more than a victory of politics over economics. Moving to WAC+12.5% means that South Carolina’s Medicaid program will now pay far more than other states for its drugs even though pharmacy costs are no higher. Read the full post.

Drug Company Payoffs

New York Times – July 7, 2010 – Before heading home for a weeklong recess, the House of Representatives passed a bill on July 1 that would crack down on a devious tactic used by some pharmaceutical companies. The tactic, known as “pay for delay,” involves business deals in which the makers of patented brand-name drugs pay generic competitors to delay the introduction of cheaper alternatives. Continue reading

Wal-Mart Whitepaper on Restricted Pharmacy Networks

Enabling Health Decisions Blog - June 28, 2010 – Of all the companies that might put out a restricted network whitepaper (PBMs, retail chains, consultants), I will admit that Wal-Mart is a surprise to me. It’s not that they haven’t been trying different strategies to increase market share – $4 generics, direct-to-employer contracting, but in general, I don’t see them doing a lot of marketing or selling in this space. They participate at one industry event, but their booth is very stark compared to other pharmacies. But, that being said, the whitepaper makes the key points that anyone would make (i.e., I agree with the framing of the opportunity) with a slight twist of focusing on member savings versus payer savings. Continue reading.

EXCLUSIVE: Wal-mart’s Pitch for Smaller Pharmacy Networks

Drug Channels – June 24, 2010 – I have a real treat for you today—an honest-to-goodness Drug Channels exclusive. Walmart contacted your friendly neighborhood blogger and offered to make Drug Channels the launch pad for a controversial Walmart-penned thought leadership piece called Access Based Network Design: A Walmart Low Price Network White Paper. (They obviously realize that you are the smartest and best-looking web audience out there.) Continue reading

Francis: “Where’s the Beef” in Claims That Employee Health Plans Overspend on Drugs?

Roll Call -March 2, 2010 – The House Oversight and Government Reform Subcommittee on Federal Workforce, Postal Service, and the District of Columbia held a hearing on the bill on Feb. 23. Chairman Stephen Lynch (D-Mass.) claimed that savings of as much as $1 billion a year would result from reform. David Balto wrote in Roll Call, it is estimated that the FEHBP costs 15 percent to 45 percent more than any other federal drug benefit program, an estimate asserting billions in waste. If these claims are accurate, there is indeed a serious problem. Continue reading

Why do pharmacy owners care about PBM transparency?

Drug Channels – February 25, 2010 – I have a legitimate, for-real, I’m-not-being-snarky question: Why do pharmacy owners care so much about PBM transparency? Continue reading

Statement from Walton Francis to The Honorable Stephen Lynch on FEHBP Prescription Drug Integrity, Transparency and Cost Savings Act

Author of Putting Medicare Consumers in Charge: Lessons from the FEHBP, February 9, 2010  Continue reading

Merritt: Congress Considering Risky Changes to Federal Employees’ Health Benefits

Roll Call – February 11, 2010 – Congress is considering risky changes to the popular Federal Employees Health Benefits Program that would disrupt prescription benefits for 8 million federal employees and retirees, reduce their choices and eliminate tools used by the program to save federal workers money. Continue reading

Drugstore Owners Look to Cash in on Health Care Reform

Huffington Post – January 28, 2010 – Now they’re finished with the postmortem of the Massachusetts Senate victory for Republican Scott Brown, Beltway elites are engaging in a new favorite parlor game: Who’s to blame for health care crashing? Continue reading

Medicare Part D Offers Template for Success

Managed Care Magazine – October 2009 – Working for an industry built on cutting health care costs gives Mark Merritt, president and CEO of the Pharmaceutical Care Management Association, a perspective valued by Washington DC policymakers Continue reading

Don’t Kill Competition for High-Tech Drugs

Roll Call – September 9, 2009 – The two of us have often been on opposite sides of important policy debates on technology and health care, but we are united today in viewing with alarm recent Congressional action involving biologic drugs and vaccines, derived from living organisms.Continue reading

Does Obama Take Health Costs Seriously?

National Review Online – September 1, 2009 – Revelations of an $80 billion bargain between the White House and PhRMA (Pharmaceutical Research and Manufacturers of America) are upsetting many Democrats.Continue reading

Democrats’ Bedfellows on Health Care Reform

Forbes – September 1, 2009 – Health care is big business, over one-sixth of the U.S. economy. Health care reform is big news this summer, as President Barack Obama’s reform agenda has hit the skids. Continue reading

Our View: Drugmakers Seek Excessive Monopolies on ‘Biologics’

USA Today - August 12, 2009 – Anyone whose own life, or that of a loved one, has been extended by one of the new “biologic” superdrugs should be deeply thankful for the risk-taking and ingenuity of the U.S. pharmaceutical industry. Continue reading

Biotech Bottleneck

Washington Post - July 28, 2009 – With a name like the Affordable Health Choices Act, you’d think the health-care reform bill that passed the Senate Health, Education, Labor and Pensions Committee this month would have made an effort to provide affordable health choices. Continue reading