The Cost of Unhealthy Behavior: Got Wellness?

Here is an interview of Dr Steven Aldana conducted by WELCOA president Dr David Hunnicut.

Some of the key points are;

1. Sedentary Lifestyles account for 15% OF ALL HEALTHCARE COSTS and only 20-25% of the population achieves the recommended 30 minutes of daily physical activity
   
2. The total healthcare costs associated with a male 24 year old tobacco user are $220,000 which breaks down to a healthcare cost of $40 per pack of cigarettes of paid for by someone besides the smoker. 23% OF AMERICANS USE TOBACCO.
   
3. Obesity accounts for 12% of healthcare costs and 67% of the US population is either overweight or obese today.
4. Factoring in preventable health conditions aside from smoking you have an additional 40% of healthcare costs.
5. For those without an actuarial background we now have 70% of healthcare costs tied directly to lifestyle decisions. Physical Inactivity, Diet, Tobacco Use and preventable disease.
   
6. 70% OF deaths in America are attributable to strokes, heart attacks, diabetes and cancer which are all influenced very significantly by diet.

This week the media is reporting Consumer Driven Healthplans are getting a lukewarm reception from employees provided with alternative plans. What a shocker. Lets see, 80% do not get enough exercise, 23% smoke, 67% are overweight and or obese.

We have seen the enemy and its us.

Follow the Money at The FDA

Very interesting documentary about the FDA's funding sources in Pharma done by Gary Null of The Nutrition Institute of America is available here. The video is 90 minutes long and features very significant insights on the lack of institutional safety oversight the FDA provides.

video documentary features contributions of respectful professionals, such as FDA scientist Dr. David J. Graham, who addressed the prescription of Vioxx (a very dangerous drug presently withdrawn from the market) before the US Senate Finance Committee and firmly believes the FDA is "letting people down".

Here is more from the interview transcript available here

MANETTE: Dr. Graham, it's truly a pleasure to have the opportunity to interview you. Let me begin by asking you how long you've been with the FDA and what your current position is?

DR. GRAHAM: I've been with the FDA for 20 years. I'm currently the Associate Director for Science and Medicine in the Office of Drug Safety. That's my official job. But when I'm here today I'm speaking in my private capacity on my own time, and I do not represent the FDA. We can be pretty certain that the FDA would not agree with most of what I have to say. So with those disclaimers you know everything is okay.

MANETTE: On November 23, 2004 PBS Online News Hour Program you were quoted as making the following statement. “I would argue that the FDA as currently configured is incapable of protecting America against another Vioxx. Simply put, FDA and the Center for Drug Evaluation Research (CDER) are broken.” Since you've made that statement, has anything changed within the FDA to fix what's broken and, if not, how serious is the problem that we're dealing with here?

DR. GRAHAM: Since November, when I appeared before the Senate Finance Committee and announced to the world that the FDA was incapable of protecting America from unsafe drugs or from another Vioxx, very little has changed on the surface and substantively nothing has changed. The structural problems that exist within the FDA, where the people who approve the drugs are also the ones who oversee the post marketing regulation of the drug, remain unchanged. The people who approve a drug when they see that there is a safety problem with it are very reluctant to do anything about it because it will reflect badly on them. They continue to let the damage occur. America is just as at risk now, as it was in November, as it was two years ago, and as it was five years ago.

MANETTE: In that same PBS program, you were also quoted saying, “The organizational structure within the CDER is currently geared towards the review and approval of new drugs. When a serious safety issue arises at post marketing, the immediate reaction is almost always one of denial, rejection and heat. They approved the drugs, so there can't possibly be anything wrong with it. This is an inherent conflict of interest.” Based on what you're saying it appears that the FDA is responsible for protecting the interests of pharmaceutical companies and not the American people. Do you believe the FDA can protect the public from dangerous drugs?

DR. GRAHAM: As currently configured, the FDA is not able to adequately protect the American public. It's more interested in protecting the interests of industry. It views industry as its client, and the client is someone whose interest you represent. Unfortunately, that is the way the FDA is currently structured. Within the Center for Drug Evaluation and Research about 80 percent of the resources are geared towards the approval of new drugs and 20 percent is for everything else. Drug safety is about five percent. The “gorilla in the living room” is new drugs and approval. Congress has not only created that structure, they have also worsened that structure through the PDUFA, the Prescription Drug User Fee Act, by which drug companies pay money to the FDA so they will review and approve its drug. So you have that conflict as well.

Drug Pushers on Capitol Hill

By M. Asif Ismail
Data analysis by Helena Bengtsson

WASHINGTON, April 1, 2007 — Manufacturers of pharmaceuticals, medical devices and other health products spent nearly $182 million on federal lobbying from January 2005 through June 2006, a Center for Public Integrity study of disclosure records shows.

Interested observers will also want to consider what all this purchased based on the timeline prepared in conjunction with the study abovewhich is available here.

Here is but one sample of pure red meat in 2002;

2002

The Best Pharmaceuticals for Children Act is signed into law. It extends "pediatric exclusivity" provision of the FDA Modernization Act of 1997 that gives prescription drug makers an additional six months of patent protection during which generic drugs cannot be sold, in exchange for the manufacturer conducting studies of the drug's effects in children. The Congressional Budget Office estimates that, in the long run, prices for prescription drugs will increase as a result of the bill.

Trade Act of 2002 (H.R.3009) passed. The Act makes intellectual property rights and the elimination of regulatory practices (such as price controls) negotiating objectives in trade agreements.

Prescription Drug Users Fee Act renewed. Included in the legislation are industry requests to speed up product reviews and use third-party advisors recommended by the companies to assess products.

Greater Access to Affordable Pharmaceuticals Act is defeated. The Act would have weakened patent restrictions on pharmaceuticals, making way for more generic drugs.

Money Talks.

Interdependent Benefits Need An Integrated View

Aetna (NYSE:AET) today announced that employee assistance services will be a standard part of the servicing of fully insured health plans for all small group employers.


Here is a very useful study of Depression in the workplace--warning funded by Pharma--so make sure you have therapuetic infusion baked into your Rx & DM plan design.

Lowering Rx Co-pays Produces Big Savings

If your company has been increasing co-pays on prescription drugs in order to offset steadily rising pharmacy costs you may wish to consider how Blockbuster was successful in reducing pharmacy costs by over 33.5% by lowering co-pays and adopting a 4 tiered approach as noted here.

Lowering or eliminating co-pays for low cost or OTC generics while raising brand co-pays can produce dramatic results by raising your overall generic utilization rate while at the same time lowering your pharmacy trend to a negative number.

But do not allow your pharmacy claim data to languish on some PBM rep or pharmacy consultants hard drive. There is meaningful and compelling data there which can be mined to provide a prospective picture of your "at risk population to become a chronic "whose behavior needs further modification beyond just the pharmacy co-pay if your strategic objectives of controling benefit costs are to be achieved. You need analysis from someone with an understanding of your overall objectives in benefits as well as deep practical experience in arriving at proper plan design recommendations in your other benefit offerings--Medical, Dental, STD, LTD, Behavioral & EAP to allow the data from your pharmacy claims to impact all of your benefit offerings. You need an integrated view.

One of the observations on the health care space in the last 3-5 years I would make is that employers who have adopted consumer driven long term strategies have a much greater appreciation of the interdependence of their benefit offerings than many of the intermediaries who serve them. You see many intermediaries are transaction oriented, they are historically project or account acquisition driven. Essentially, at many consulting firms you have a partially extroverted actuary functioning as a relationship manager who trots out subject matter experts for absence management, disease management, disability management, behavioral & EAP and Pharmacy. The problem with such a business model is it does not lend itself to integrating thought leadership very well across product lines. No offense to actuaries but communication has never been what one could refer to as a group strength. If you take offense at that statement perhaps you should scan this proof statement (Its a letter from The American Academy of Actuaries on the lessons learned from the 1st year under Medicare Part D) and comment below on the salient points below. Do tell. There will be a prize for the best comment or barring that anyone who can finish and still talk.

The point is mining data will provide useful data. Putting that data together to arrive at appropriate plan design changes across multiple products requires the application of both plan design and cross- product expertise. Since most actuaries are so specialized-health, life, disability, pensions, good luck with that as the person with that skill set in America works for themself, especially if they are an actuary, because they can.

Retaining and Attracting Skilled Baby Boomers

The Dallas Morning News has reported The US is ill prepared with countermeasures to deal with a wave of retirement as baby boomers exit the workforce in droves over the next 5 years.

The oldest boomers will qualify for Social Security's early retirement benefits in less than a year, but a large part of corporate America isn't prepared for the tens of millions of employees who will quit their jobs or scale back their hours over the next decade.

"Most companies haven't seen their boomer employees retire yet, and if it's something not happening in this quarter, CEOs believe they have time to think about it," said Marcie Pitt-Catsouphes, co-director of Boston College's Center on Aging and Work.

The research center surveyed 578 businesses and found that only 12 percent have planned in-depth for the wave of boomer retirements that are projected to create a worker shortage. Twenty-six percent of the companies haven't planned at all.

Labor analysts predict the U.S. economy will face shortages of 6 million workers by 2012 and 35 million workers by 2030. Some industries will be hit harder than others, but the boomer brain drain is expected to ripple through the entire economy.

A Federal Reserve official recently told Congress that the nation's economic growth may slow to 2.2 percent annually by 2015 because of the surge in boomer retirements. That's a full percentage point below the average growth rate for the last 40 years.

Generation X is only three-fourths as large as the boomer generation it follows. Analysts predict that some businesses will be hard-pressed to find replacements for the senior managers, technicians and other employees approaching retirement

So if only 12% of Business has planned for expected retirements that leaves 88% vulnerable. One of the first areas impacted unfortunately will be an employers Short and Long Term Disability plan. In the absence of a flexible work schedule which permits the boomers desire to cut-back their schedule to spend time with grandchildren in another state or with a spouse who has retired, some boomers will notice peers going out on disability and ask; Why ot me? Since some Americans over 55 work everyday with physical problems which are disabling for many will choose disability especially where there is pain involved. Dr Scott Haig wrote on this in Time recently in an article focused on pain;

As an orthopedist who has seen a lot of tough older men with painless, yet arthritic joints, I'm suspicious of there being a peripheral pain blockade that sometimes occurs around joints that are simply not given a chance to rest when they hurt. These are the ones who when asked "Don't you have any pain? say something like "not really but what does it matter, I still have to work to put the food on the table."

The population between 55-64 will grow by 48% over the next 5 years. Incidence rates for disability explode exponentially over 55. When employees realize they can go on disability for many the concern about putting food on the table is suddenly removed. These are some of cultural factors cited by employers in my march 28, 2007 post The Black Hole In Your Benefits Plan.

To see how just a small percentage of the disabled population can drive costs up exponentially in a disability plan see my 3/30/2007 post Surveillance exposes Disability Fraud-Black Hole II

Most people in business would readily acknowledge its considerable less expensive to keep the customers you have than to acquire new ones. This is also true of employees. So while employers should look to be senior friendly in hiring they should also consider return-to-work plans and job accommodation as critical retention tools for talent with a very high ROI. Employers should consider engaging a consultant with significant expertise at evaluating plan loss experience data and formulating recommendations for return-to-work plans as well as plan design for short and long term disability to achieve the optimal ROI outcome.

Can't you smell that smell? Follow The Money

60 Minutes ran its episode today titled Under the Influence about the incestuous and corrupt influence of the Pharmaceutical Lobby and the full text and video are here.

The episode has been well covered at Pharmalot.

I have never been a big fan of 60 Minutes but have to admit they got this story right.

Prepare yourself for non-stop media coverage of all things pharmacy and PBM related through the 2008 elections. Have no delusions this attention will leap the firebreak into employer sponsored plans and be a featured part of The Healthcare Debate, as well it should. Employers should not have any illusions they fare any better via their formulary/rebate driven PBMS. Psst, they are doing it to you as well. Quick somebody find me a Physician on the Board at Express Scripts, MEDCO, or CVS CareMark.

Spring is here and 12 months from the 2008 primaries we have 60 Minutes airing a story that will be whipping Seniors into righteous indignation. It is interesting how 60 minutes waited 3.5 years after the vote to run the story though--just had to wait for the 1st candidate to promise free health care. Imagine what was talked about in retirement communities all over Florida tonight? I bet it had to do with this;

"You push this bill through that produces a windfall for the drug companies. And then a short time later, you go to work for the drug lobby at a salary of $2 million. That doesn't look good," says Kroft.

"There was nothing I could've done in my life after leaving Congress that wouldn't have had — I didn't have some impact on in 25 years in Congress … If that looks bad to you, have at it," Tauzin says. "That's the truth."

In fairness to Tauzin and former Medicare chief Tom Scully, they weren't the only public officials involved with the prescription drug bill who later went to work for the pharmaceutical industry.

Just before the vote, Tauzin cited the people who had been most helpful in getting it passed. Among them:

John McManus, the staff director of the Ways and Means subcommittee on Health. Within a few months, he left Congress and started his own lobbying firm. Among his new clients was PhRMA, Pfizer, Eli Lilly and Merck.

Linda Fishman, from the majority side of the Finance Committee, left to become a lobbyist with the drug manufacturer Amgen.

Pat Morrisey, chief of staff of the Energy and Commerce Committee, took a job lobbying for drug companies Novartis and Hoffman-La Roche.

Jeremy Allen went to Johnson and Johnson.

Kathleen Weldon went to lobby for Biogen, a Bio-tech company.

Jim Barnette left to lobby for Hoffman-La Roche.

In all, at least 15 congressional staffers, congressmen and federal officials left to go to work for the pharmaceutical industry, whose profits were increased by several billion dollars.

"I mean, they — they have unlimited resources. Unlimited," Burton says. "And when they push real hard to get something accomplished in the Congress of the United States, they can get it done."

As this story gets legs, and it will, quite a few HR/Benefits People may be answering questions about how they know with certainty they are getting the best deals on Drugs from their PBM? Prudent employers should be prepared with data for the phone call. It is time to get ahead of the snowball before it becomes an avalanche.