Hearts or Minds

I have written about the hiring practices of Pharmaceutical Companies in A Picture is Worth 1000 words and Prilosec OTC, Wine & Cheese.

A Hat tip to Joe Padua at Managed Care Matters for providing details on a 21 year old pharmacy rep in South Florida without a degree yet but with the title of Miss FHM 2006 whose picture I have included here.

So now I have another image for use in enrollment meetings to illustrate how certain drugs come to be commonly prescribed and trust me the employees get the picture immediately as to what is really happening.
You really cannot make this stuff up.

The Big Lie

I ran across this explanation last week from the Kaiser Foundation on pharmacy trend and am reprinting it in full below to expose its true nature as pure cow dung.

Daily Health Policy Report

Prescription Drugs | Prescription Drug Spending Growth Rate Expected To Increase, Report Finds

[Apr 26, 2007]

Prescription drug costs increased at a slower rate in 2006 than in 2005, but the growth rate is projected to increase in 2008 and 2009 because of fewer generic drug releases and higher spending on specialty drugs, according to Express Scripts' annual drug trend report, the St. Louis Post-Dispatch reports. The report, released on Wednesday at the company's annual Outcomes Conference in St. Louis, examines data from its three million members to estimate national prescription drug costs. Express Scripts found that drug prices rose 8.2% in 2006, compared with 9% in 2005. The report projected that prescription drug spending would increase at higher rates in 2008 and beyond, according to the Post-Dispatch. Express Scripts attributes the future higher growth rates to fewer blockbuster drugs losing patent protection in 2008 and 2009. In 2006, several blockbuster drugs went off patent and lower drug spending resulted from patients switching to generics. In addition, because companies have launched aggressive campaigns to encourage patients to use generic drugs, much of the costs savings already have been realized, according to Tim Simpson, a principal at Mercer Human Resource Consulting. The report also found that certain drugs had higher levels of cost growth in 2006, including medications to treat diabetes, which experienced a 15.5% growth -- the second year of double-digit increases. Express Scripts expects the costs of diabetes medications to continue to grow at double-digit rates for the next four years, according to Julayna Meyer, vice president of trend management for the company. Spending on specialty medications -- high-cost, often injectable drugs -- is experiencing the fastest growth rate. Spending on those drugs is expected to reach $99 million by 2010, nearly double the $54 million spent in 2006. One in four dollars of prescription drug spending will go toward specialty drugs by 2010, Express Scripts predicts. Express Scripts CEO George Paz said employers could use the same cost-control measures on specialty drugs as are used on traditional drugs to limit spending (Feldstein, St. Louis Post-Dispatch, 4/26).

On the surface you get the distinct impression that there is absolutely nothing which can be done to mitigate rising drug costs and for corroboration we have evidence from Express Scripts' annual drug trend report as well as from Tim Simpson, a principal at Mercer Human Resource Consulting.

Since no big drugs are moving from brand to generic in 2007 we all just have to suck it up and take it. What is worse we are told is that by 2010 specialty drugs will account for $1 out of every $4 spent on prescription drugs. Well BOHICA! Think of employers across America struggling to manage their health care spend while standing up, because the pain when they sit is too great. What an utter load of excrement. There is quite a bit employers can do to whip this problem.

• The truth of the matter is that employers with a drug spend of at least $250,000 annually can adopt a plan design which encourages members to request the low cost in class generic because if they do the co-pay is zero.
  
• You need a PBM with a bullet-proof process to move your population into the low cost generic in therapeutic class.
  
• You need to negotiate the right to audit claims to make sure you are not subsidizing a huge generic mark-up like those I mentioned here.
• You need to understand plan design can change behavior which can reduce cost and higher admin fees for a truly transparent PBM are more than offset by lower claims costs as I wrote about in Lowering Rx Co-pays Produces Big Savings.
• You need to internalize that project driven consultants are transactionally oriented and in many cases may be using the same PBM RFP Template in Word and doing a find & replace all for your companies name and emailing it to CareMark, Express Scripts and MEDCO.
• If you let your PBM set your formulary you might not sit comfortably for some time.
• If your experience relative to pharmacy trend is reminiscent of Bill Murray's Groundhog's Day Movie you may need a new PBM or a new consultant or both.
  

The big lie IMHO is that some PBM's and Consultants enrich themselves while purportedly acting in the best interest of the employers which pay their bills. Unfortunately, the application of standardized project plans and workflows coupled with the insatiable quest for billable hours at transactionally driven consulting firms produces this behavior. Throw in overworked analysts skilled at data mining but lacking in specialized pharmacy experience familiarity or real world experience interacting with employees--you see consulting firms do not do enrollment meetings, they have call center and online web enrollment personnel for the transactional work that does not pay $500 per hour--and there you have it. Finally, if you ever really solved the prescription drug trend problem where would new revenue for PBM's or all the new projects for consultants come from?

At a deeper level, astute HR and Benefits personnel may want to ask whether you can ever obtain solutions to employee benefit cost problems from employees at a consulting firm. In the US market for professional services, the best professionals are principal owners not employees and this is true of attorneys, physicians, geologists, engineers, bankers and employee benefit consultants. As owners they can focus on working for their customers not on growing their departments fee revenue by 20% annually to meet Wall Street's earnings expectations.

Price Swings for Generic & OTC Drugs

Yesterday driving to an enrollment meetings I notice the Claritin advertised for $17.99 for a 30 day supply at Walgreens. A Froogle search after stopping shows a 600 day supply is available for $32.70 with shipping included.

The WSJ Health Blog recently pointed out the wide swings on the generic version of Ambien.

A Rite Aid spokesman tells Health Blog that generic Ambien will be available chain-wide today. A 30-pill supply of both the 5 milligram and 10 milligram doses will retail for $124.99. That’s a hefty markup over the wholesale prices–ranging from $9.74 to $25.01 for 100 tablets–that Health Blog found Tuesday. The margins on generics make them among pharmacies’ most-profitable lines of business.

Drugstore.com will be offering the generic sleeping pills as early as next week. The Web site partners with Rite Aid and handles the pharmacy chain’s online prescriptions. Prices are likely to be in line with store prices, the Rite Aid spokesman says.

For those not too exhausted to hunt for a bargain, online pharmacy RxUSA.com is offering a 30-day generic supply of the 5 mg dose for $15; the 10 mg dose is $19.50.

Obviously it pays not to be too exhausted to search for lower costs.

It's The Thought That Counts

In a "largely symbolic" move The City of Houston has decreed a pay or play health plan for contractors doing business with the city as detailed here in The Houston Comical;

In an effort to encourage more employers to provide health insurance, Mayor Bill White proposed a plan Tuesday that would require about half the city's contractors to offer health benefits to employees or contribute to a fund that would help cover the costs of medical care for the uninsured.

The proposal, expected to be considered by the City Council today, is largely a symbolic move since most city contractors already provide workers with insurance. But it sets an example, White said, that he hopes other public and private employers will follow.

"If enough employers did this, we would create a fund that could be used to make health care more accessible to the residents of Houston and to defray some of those costs that we are currently encountering in our emergency rooms because of the uninsured," he said.

I must give credit to the comical for at least inferring that many contractors will simply;

1. Stop bidding on City contracts and stick with private sector jobs ;
2. Build the cost into their contracts on a cost plus basis;

Yet one would have to be obtuse to miss those points, no?

The good news is Harris County collected $22M from Big tobacco so hopefully the new smoking ban will not inhibit future health care for all in the Bayou City.

HIPAA ,ADA, Cho Seung-Hui & Unintended Consequences

Walter Olson has written a lucid account of the role privacy laws like HIPAA and others contributed in preventing VA Tech authorities from acting to avoid the recent shooting. It is worth two minutes of your life to read it here.

Walter Olson edits two fine blogs Overlawyered.com and PointOfLaw.com and is a senior fellow at the Manhattan Institute

File this one under unintended consequences.

In a way it is akin to all the employers trying to engage their workforce in a serious good faith wellness effort who are hindered by ADA & HIPAA and bad thoughts of the EEOC in your workplace asking "What were you thinking?" So you water down the effort to keep the lawyers and Fed's out of the benefit department. Yet the whole time you must ask whether the intent of the ADA & HIPAA was to prevent making a member conscious of what they are at risk for absent an intervention? I mean a disability is imminent from a cursory scan of a lot of pharmacy records in many cases not to mention the Health Risk Assessment right? How Ironic. The Americans With Disabilities Act actually results in more disabilities. Unintended Consequences.

I can almost picture Ronald Reagan whispering, "I Told Ya."

Dealing with a Pain In The Butt

Life is short. I refuse to handle customers who are abusive or rude. I just fired a prospect who was both in every interaction to date. I feel much better now thank you.

Depression Untreated Got EAP?

On the heels of the VT shootings Houston has seen murder suicides at Johnson Space Center last Friday as well as another murder suicide at an upscale apartment complex yesterday.

On a personal note my own 6 year old niece was spending Sunday evening with her nanny when the nanny's spouse attempted suicide. He had been depressed recently.

60 Minutes ran a very interesting piece Sunday night highlighting similarity between school shooters and presidential assassins.

As 60 Minutes noted;

"With the school attackers that we studied there’s no profile, there’s no set of demographics that they share. But there are certain behaviors that they undertake," Georgeann Rooney, a threat assessment specialist at the Secret Service, tells 60 Minutes.

Behaviors that, she says, are like those of assassins. "This isn’t an individual who just snaps and wakes up and decides they are going to attack their school. There’s a planning process," Rooney says. "This planning, a lot of times, if you know what to look for it can be detectable."

And one theme they detected was bullying: two-thirds of the school shooters were victims of bullies. "They'd call you gay, call you stupid or fat or whatever. Kids would sometimes throw rocks at me and push me and kick me and hit me and stuff like that," Luke Woodham [school shooter]told researchers.

The Secret Service research reads like a road map to the mind of Virginia Tech killer Seung-Hui Cho; he mentioned suicide to others, and he planned for months, buying one of his guns nearly three months before the attack.

HR & Benefit managers are frequently challenged to justify the ROI associated with EAP programs. Yet after every tragic event we are faced with evidence friends, families and co-workers were often aware of a problem manifested in behavior.

Murder is the Number One cause of on-the-job death for women in the workplace and 20% of those women, on average, are murdered by their partner at the workplace (Bureau of Labor Statistics, 1993). Here are some tips for managers and supervisors to make your workforce safer