- San Francisco Chronicl Examines Gap In Medicare Drug Coverage
The San Francisco Chronicle on Tuesday examined how millions of Medicare beneficiaries "will have to find a way to survive Medicare's notorious doughnut hole." Under that provision of the Medicare prescription drug benefit, beneficiaries are responsible for 100% of prescription drug costs between $2,250 and $5,100. Medicare drug plans generally cover 75% of drug costs after a $250 deductible up to $2,250, and then 95% of prescription drug costs beyond $5,100. - Carolinas Try Contrasting Medicaid Experiments
HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, reports that North Carolina's last Medicaid HMO, Coventry-owned SouthCare, has gotten out of the Medicaid business as of August 1, meaning that the state will manage the entire Medicaid population through its own primary-care case-management (PCCM) program. - White House, Some Governors Disagree Over Planned Medicaid Cuts For Hospitals, Nursing Homes
The Bush administration faces "growing opposition" from state officials, members of Congress, hospitals and nursing homes over proposed rules that would reduce Medicaid reimbursements to public hospitals and nursing homes to save the federal government an estimated $12.2 billion over five years, the New York Times reports. The rules -- part of the fiscal year 2007 budget proposed by President Bush -- would reduce from 6% to 3% the allowable rate that states can tax hospitals and nursing homes. - Medication May Restore Bloodflow Following Stroke
A medication known as argatroban, when combined with another drug already used in the treatment of stroke patients, may help restore the flow of blood through blocked arteries, according to a preliminary study in the August issue of Archives of Neurology, one of the JAMA/Archives journals. - Care Improvement Plus Obtains Conditional CMS Approval To Expand Medicare Health Plan Into Southern
Care Improvement Plus has obtained conditional approval from the Centers for Medicare & Medicaid Services (CMS) to expand its Special Needs Plan into Maryland's Calvert, Charles and St. Mary's counties. In 2007, the Medicare Advantage plan intends to focus exclusively on the unique healthcare needs of chronically ill Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (ESRD). - Bob Dole's Podcast Assures Seniors 'They Will Have A Choice Of Plans' In Medicare Drug Coverage
Former Senator and health care advocate, Bob Dole, made available today the third episode in his podcast series, Ten Things Seniors Need to Know about Medicare's Drug Coverage. This episode, which can be downloaded at http://www.bobdoleonmedicare.com, as well as on iTunes and other podcast directories, focused on the fact that Medicare beneficiaries will have a choice of plans when enrolling in the 2007 Medicare drug benefit. - Groups, Lawmakers Respond To CMS Proposals On Medicare Payments, Specialty Hospitals
Lawmakers and hospital industry leaders have expressed mixed reactions to CMS proposals that would affect Medicare reimbursements for outpatient services and would require specialty hospitals to provide the government with information about physician investment and compensation, CQ HealthBeat reports (Reichard, CQ HealthBeat, 8/9). - Medicare Advantage Plans, Particularly Private FFS Plans, Experience Increased Enrollment
USA Today on Wednesday examined the effects of increasing enrollment in Medicare Advantage plans. According to data from CMS and the consulting firm Avalere Health, enrollment in MA plans increased 19% from Dec. 1, 2005, through July 1 to reach 7.3 million beneficiaries. USA Today reports that enrollment growth had been especially strong in a type of plan called private, fee-for-service Medicare plans, which generally have wider provider networks than conventional managed care plans. - Medicare Physician Payments To Drop 5.1%, Some Hospital Outpatient Care Rates To Increase In 2007
The Bush administration on Tuesday proposed a federal rule that would cut Medicare reimbursements for physician services by 5.1% for 2007, the New York Times reports. Administration officials said the cut is necessary to offset faster-than-expected increases in Medicare spending for physician services, the Times reports (Pear, New York Times, 8/9). - Companies With Ties To Former HHS Secretary Thompson Could Benefit From His Proposed Medicaid Change
Former HHS Secretary Tommy Thompson's Medicaid overhaul proposal, announced last week, could benefit several companies that employ him, the Washington Post reports (Lee, Washington Post, 8/8). Thompson's proposal would shift responsibility for long-term care of elderly Medicaid beneficiaries from joint state and federal funding to the federal government and would have states focus on acute care for Medicaid beneficiaries younger than 65. - 2007 Medicare Physician Payment Rate To Be Released Soon; CMS Administrator McClellanSays Government
CMS Administrator Mark McClellan on Monday said his agency soon will issue new regulations to update Medicare reimbursement rates for physicians, the AP/Arizona Daily Star reports. Medicare reimbursements to physicians are scheduled to decrease 5% next year unless Congress acts to reverse the cut (AP/Arizona Daily Star, 8/8). - Care Improvement Plus Obtains Conditional CMS Approval For New Medicare Special Needs Plan
Care Improvement Plus has obtained conditional approval from the Centers for Medicare & Medicaid Services (CMS) to offer its new Regional PPO Special Needs Plan (RPPO SNP) to residents of South Carolina. A Medicare Advantage plan (MA-PD), Care Improvement Plus focuses exclusively on the unique healthcare needs of chronically ill Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (ESRD). - Care Improvement Plus Obtains Conditional CMS Approval For New Medicare Special Needs Plan
Care Improvement Plus has obtained conditional approval from the Centers for Medicare & Medicaid Services (CMS) to offer its new Regional PPO Special Needs Plan (RPPO SNP) to residents of Georgia. A Medicare Advantage plan (MA-PD), Care Improvement Plus focuses exclusively on the unique healthcare needs of chronically ill Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease, and/or end-stage renal disease (ESRD). - Sens. Rockefeller, Smith Introduce Bill To Delay Reductions In Payments For Medical Imaging Services
Sens. Jay Rockefeller (D-W.Va.) and Gordon Smith (R-Ore.) on Thursday introduced a bill (S 3795) that would delay $2.8 billion in Medicare cuts for medical imaging, CQ HealthBeat reports. President Bush in February signed a budget savings bill that includes the provision, which was "mandated in response to increases in imaging spending," CQ HealthBeat reports. - Care Improvement Plus Obtains Conditional CMS Approval For New Medicare Special Needs Plan In Texas
Care Improvement Plus has obtained conditional approval from the Centers for Medicare & Medicaid Services (CMS) to offer its new Regional PPO Special Needs Plan (RPPO SNP) to residents of Texas. A Medicare Advantage plan (MA-PD), Care Improvement Plus focuses exclusively on the unique healthcare needs of chronically ill Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease, and/or end-stage renal disease (ESRD). - Two Newspapers Look At Issues Related To Medicare Prescription Drug Benefit
Two newspapers on Friday featured stories on the Medicare drug benefit. Summaries appear below.
San Francisco Chronicle: The Medicare drug benefit has "been a boon for pharmaceutical companies and has swelled the membership ranks of health insurers. But it's uncertain whether this success will last," the Chronicle reports. - CMS Will Not Extend Moratorium On Approval Of New Specialty Hospitals
CMS will not extend a moratorium on approval of new specialty hospitals, despite a request for an extension last month by two senators because of concerns about information in a recent survey, agency spokesperson Peter Ashkenaz said on Thursday, CQ HealthBeat reports (CQ HealthBeat, 8/3). Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Max Baucus (D-Mont.) in a July 28 press release asked CMS to extend the moratorium until Oct. 8. - CMS Announces Payment, Policy Changes For Inpatient Rehabilitation Facilities In Fiscal Year 2007
Inpatient rehabilitation facilities (IRFs) are projected to receive approximately $7 billion in payments from the Medicare program in fiscal year (FY) 2007, under a final rule announced today by the Centers for Medicare & Medicaid Services (CMS). The rule updates payment rates and modifies payment policies for services furnished to Medicare beneficiaries for discharges occurring on or after October 1, 2006 through September 30, 2007. - Massachusetts Medicaid Managed Care Plans Developing New Offerings Under State's Health Insurance
Some Massachusetts companies offering managed care coverage to state Medicaid beneficiaries are beginning to develop new coverage options in accordance with the state's new health care law, the Boston Globe reports. Under the new law, all residents must have health insurance and those who do not will face penalties (Krasner, Boston Globe, 8/2). - Former HHS Secretary Thompson Expected To Release Paper Suggesting Changes To Medicaid
Former HHS Secretary Tommy Thompson on Friday plans to release a "white paper" in which he recommends that the responsibility for long-term care of elderly Medicaid beneficiaries shift from joint state and federal funding to the federal government, the Washington Post reports. Thompson, who will speak to the National Governors Association on Saturday in Charleston, S.C., recommends that states focus on acute care for Medicaid beneficiaries younger than 65. - Former HHS Secretary Thompson Calls For Medicaid Shake Up - Plan Calls For Shifting Increased
Former Health & Human Services Secretary Tommy G. Thompson today released a comprehensive plan to revamp the nation's health insurance program for the poor, urging that the federal government take increased responsibility for planning, delivering and paying for services for the elderly -- especially long-term care services -- while the states take on greater responsibility for caring for those under 65. - Anthem Blue Cross And Blue Shield Selected For Indiana Medicaid Contract
The Indiana Family and Social Services Administration (FSSA) has selected Anthem Blue Cross and Blue Shield (Anthem) in Indiana for contract negotiations to provide health care benefits to enrollees in the Hoosier Healthwise Medicaid managed care program. FSSA solicited proposals earlier this year to re-procure Medicaid managed care contracts. - Medicare Should Pilot Test Patient-Centered Medical Home - American College Of Physicians President
Medicare should pilot test a patient-centered medical home, Lynne Kirk, MD, FACP, president of the American College of Physicians (ACP), today told a hearing of the House Energy and Commerce Subcommittee on Health. She urged Congress to direct Medicare to institute the new model of financing and delivering care. - U.S. Appeals Court Upholds Lipitor's Basic Patent With Exclusivity Maintained In U.S.
Pfizer Inc said today that a panel of the Court of Appeals for the Federal Circuit has upheld the exclusivity of the main patent covering atorvastatin, the active ingredient in Lipitor, maintaining patent protection for Lipitor in the U.S. until March 2010. - Smith And Rockefeller Introduce Bill To Protect Medicare Beneficiaries
The National Coalition for Quality Diagnostic Imaging Services (NCQDIS) applauds Senators Gordon Smith (R-OR) and John D. Rockefeller (D-WV) for introducing today bipartisan legislation that will prevent Section 5102 of the Deficit Reduction Act of 2005 (DRA) from going into effect on January 1, 2007. - Blue Shield Of California Introduces New Medication Therapy Management Program
Blue Shield of California has launched a Medication Therapy Management (MTM) program available to all qualified Blue Shield Medicare Part D members. The Blue Shield MTM program makes clinical pharmacists available to members at no additional cost for medication utilization reviews to assist with managing their medications and provides members educational materials through the mail. - S&P Equity Research Has Positive View On New Medicare Medical Device Reimbursement Rules
S&P Equity Research Services announced today its positive view on the new Medicare medical device reimbursement rules. Medicare released new rules governing reimbursements to hospitals for certain medical devices, under which no device category will experience a cut in excess of 5.4%. We think the decisions were particularly beneficial to makers of implantable cardioverter defibrillators and cardiac stents, where original proposals included cuts of up to 24% and 28%, respectively. - Newspapers Examine Medicare Beneficiaries' Experiences With Gap In Medicare Drug Coverage
Three newspapers on Sunday examined how some Medicare beneficiaries have reached the so-called "doughnut hole," or coverage gap in the Medicare prescription drug benefit. Under the doughnut hole, beneficiaries are responsible for 100% of drug costs between $2,250 and $5,100. Medicare covers 95% of prescription drug cost beyond $5,100 (Kaiser Daily Health Policy Report, 7/27). Summaries of the articles appear below. - Groups Representing Physicians Plan To Lobby Congress Over Medicare Payments
The American Medical Association and other physician groups during the August congressional recess plan to launch a campaign to convince lawmakers to pass legislation that would prevent a reduction in Medicare physician reimbursement rates scheduled for next year, Roll Call reports. The campaign, called "House Calls," will have a budget of more than $1 million and will include lobbying, grass-roots advocacy, advertising and media outreach. - Groups Representing Physicians Plan To Lobby Congress Over Medicare Payments
The American Medical Association and other physician groups during the August congressional recess plan to launch a campaign to convince lawmakers to pass legislation that would prevent a reduction in Medicare physician reimbursement rates scheduled for next year, Roll Call reports. The campaign, called "House Calls," will have a budget of more than $1 million and will include lobbying, grass-roots advocacy, advertising and media outreach. - WellPoint Completes Acquisition Of QualChoice Health Plan's Medicaid Business
WellPoint, Inc. (NYSE: WLP) today announced the completion of its acquisition of QualChoice Select, Inc. the Medicaid plan from QualChoice Health Plan, Inc. (QualChoice), an Ohio- based managed care organization that was part of the University Hospitals Health System (UHHS). The transaction was announced April 26, 2006. - Arkansas Requests Additional $316M In Medicaid Funding For FY 2008-2009
The Arkansas Department of Health and Human Services in its proposed fiscal years 2008 and 2009 budget, submitted earlier this month, has requested an additional $316 million in state funding, most of which will fund the state's growing Medicaid program, the Arkansas Democrat-Gazette reports. The funding request represents a 20% increase in state contributions over the last two-year budget cycle. - Mental Health Advocates Oppose Preferred Drug List For Rhode Island Medicaid Beneficiaries
Mental health advocates in Rhode Island are concerned that plans to create a preferred drug list for Medicaid beneficiaries could "jeopardiz[e] the health of ... mentally ill residents," the Providence Journal reports. The state Department of Human Services has been authorized by the General Assembly to implement the preferred drug list, which would require Medicaid providers to prescribe generic drugs whenever they are available. - CMS Releases Final Prescription Drug Benefit Marketing Guidelines For 2007
CMS this week published final 2007 marketing guidelines for Medicare prescription drug plans, CQ HealthBeat reports. The final guidelines reflect feedback the agency received during a public comment period, including clarifications of certain policies and agency efforts to address potential problems or changes in policy (CQ HealthBeat, 7/27). In the draft guidelines, which were released in May, CMS said insurers sponsoring Medicare drug. - Most Beneficiaries Enrolled In Medicare Rx Benefit Satisfied With Drug Plan
More than eight in 10 seniors who are enrolled in Medicare drug plans are satisfied with their plans, while nearly two in 10 who have used their plans report experiencing a major problem with them, according to a tracking survey released on Thursday by the Kaiser Family Foundation, the AP/San Francisco Chronicle reports (Bridges, AP/San Francisco Chronicle, 7/28). - Medicare Should Pilot Test Patient-centered Medical Home: ACP Tells Congress
Medicare should pilot test a patient-centered medical home, Lynne Kirk, MD, FACP, president of the American College of Physicians (ACP), today told a hearing of the House Energy and Commerce Subcommittee on Health. She urged Congress to direct Medicare to institute the new model of financing and delivering care. - HHS To Award $1.7B In Grants To State To Encourage Home Care For Medicaid Beneficiaries
HHS on Wednesday announced plans to award $1.75 billion in grants to states under a five-year program to allow Medicaid beneficiaries to reside in their homes or in their communities, rather than in nursing homes, CQ HealthBeat reports. Under the program, states for one year will receive a higher rate of federal Medicaid matching funds -- between 75% and 90% -- for beneficiaries that states move from nursing homes into their homes or their communities. - Doughnut Hole In Medicare Rx Coverage Could Have Political Implications In Congressional Elections
Medicare beneficiaries with high drug costs "increasingly" are entering the gap in Medicare prescription drug coverage known as the doughnut hole, and experts say the issue could have political implications for the congressional elections in November, USA Today reports (Wolf, USA Today, 7/27). Under the doughnut hole provision of the Medicare prescription drug benefit, beneficiaries are responsible for 100% of total prescription drug costs between $2,250 and $5,100. - Community Mental Health System Reports $304 Million In Uncompensated Costs On Medicare Drug Benefit
Community mental health agencies across the country have spent an estimated $304 million of their operating funds to help persons with mental illnesses access the Medicare prescription drug benefit, according to a survey conducted by the National Council for Community Behavioral Healthcare. - Lawmakers Address Health Care Issues In Opinion Pieces In The Hill
The Hill on Wednesday published a series of opinion pieces from senators addressing health care issues. Summaries appear below. - Arkansas Discount Drug Program Expected To Begin In 2007
Arkansas Medicaid officials on Monday said they expect to launch a prescription drug discount program for low-income state residents in early 2007, the Arkansas Democrat-Gazette reports. The Arkansas Rx program will negotiate discounted prices with drug manufacturers and provide the drugs to individuals and families who have annual incomes lower than 350% of the federal poverty level and who do not have prescription drug coverage through Medicaid or private insurance. - Reversal Of Scheduled Medicare Physician Payment Cut Necessary To Ensure Access To Care
Lawmakers likely will take action to prevent a 5% reduction in Medicare physician reimbursements scheduled to take effect on Jan. 1, 2007, the AP/Seattle Post-Intelligencer reports (Bridges, AP/Seattle Post-Intelligencer, 7/26). At a hearing of the House Energy and Commerce Health Subcommittee, several House members on Tuesday called for an end to the Sustainable Growth Rate formula used to calculate Medicare physician reimbursements. - Care Improvement Plus Opens First Assessment Center For Medicare Beneficiaries With Chronic Illness
Care Improvement Plus, a unique disease management-focused Medicare Advantage plan for chronically ill Medicare beneficiaries living with diabetes, heart failure and/or end-stage renal disease (ESRD), recently opened its first assessment center at 5919A York Road in Baltimore. This will be the first of several centers throughout Maryland which will provide members with easy access to services that help them avoid dangerous complications and hospitalizations. - Medicare Prescription Drug Plans Paid For 12.4% Of U.S. Prescriptions In First Half Of 2006
Medicare prescription drug plans paid for 12.4%, or 194.3 million, of the 1.56 billion prescriptions filled in the U.S. from Jan. 1 to June 23, according to new data from IMS Health, the Boston Globe reports. In addition, the percentage of prescriptions for which beneficiaries paid cash decreased to 11.5% during the first half of the year from 12.2% in 2005, and the percentage of prescriptions for which Medicaid paid decreased to 9.1% during the first half of the year from 16.1% in 2005 - Lower Medicare Payments To Doctors Do Not Decrease Access To Care, GAO Finds
Reductions in Medicare payments to physicians have not resulted in a decrease in the number of providers accepting Medicare beneficiaries or made it difficult for beneficiaries to find providers, according to a Government Accountability Office report released on Friday, Reuters/Arizona Daily Star reports (Reuters/Arizona Daily Star, 7/22). - Colorado's Last Private Medicaid HMO To Exit Program Next Month
Colorado's only private Medicaid HMO has announced it will end its contract with the state in August, citing low reimbursement rates, the Denver Post reports. Colorado began offering HMOs to Medicaid beneficiaries in 1990 in an effort to control program costs. However, by 2004, four Medicaid HMOs had sued the state alleging underpayment. The state paid millions of dollars to settle the lawsuits, and the four HMOs left the program. - Complaints Over Medicare Rx Benefit Average 2.3 Per 1,000 Beneficiaries, CMS Says
CMS in June received about 2.3 complaints related to the Medicare prescription drug benefit for every 1,000 beneficiaries enrolled in Medicare drug plans, according to data released by the agency on Wednesday, CQ HealthBeat reports. The agency received about 2.6 complaints per 1,000 beneficiaries enrolled in stand-alone prescription drug plans and about 1.4 complaints per 1,000 beneficiaries enrolled in Medicare Advantage plans, the data show. - Domestic Manufacturing Of A Modified Version Of The Anti-Influenza Drug Tamiflu® Dry Syrup 3%
Japan - Chugai Pharmaceutical Co., Ltd. ("Chugai") [Head Office: Chuo-ku, Tokyo. President: Osamu Nagayama] announced today that the company has decided to manufacture a modified version of "Tamiflu® Dry Syrup 3%" in Japan. Tamiflu® Dry Syrup is a dry syrup formulation of the anti-influenza drug "oseltamivir" that Chugai imports from F. Hoffmann-La Roche Ltd. ("Roche") [Head Office: Basel, Switzerland. CEO: Franz B. Humer] for production and marketing in Japan. - Abbott To Preview M2000™ Real-time PCR Diagnostics System Designed To Provide Fast
Abbott Molecular will preview its new automated molecular diagnostics system, the m2000™, at the annual meeting of the American Association for Clinical Chemistry (AACC) in Chicago (July 23-27). The m2000 is based on real-time polymerase chain reaction (PCR) technology for detecting and monitoring infectious diseases and is designed to provide clinical laboratories a unique system that fully automates all of the complex and heavily manual steps often associated with molecular diagnostics. - SunTrust Returns As Sponsor For The Kyle Petty Charity Ride In 2006
SunTrust Bank announced today its sponsorship of the 2006 Kyle Petty Charity Ride in an ongoing commitment to support and bring awareness to the racing community's charitable causes. - Researchers At Columbia University Discover On-off Switch For Chronic Pain
Chronic pain affects approximately 48 million people in the U.S. and current medications are either largely ineffective or have serious side effects. But researchers from Columbia University Medical Center have discovered a protein in nerve cells that acts as a switch for chronic pain, and have applied for a patent to develop a new class of drugs that will block chronic pain by turning this switch off. - Center For Medicare Advocacy Releases Medicare Part D Progress Report, USA
The Center for Medicare Advocacy, the nation's oldest and leading Medicare advocacy group, is releasing a progress report with policy solutions to improve the Medicare prescription drug benefit. - Pseudomonas Needs Neuraminidase For Pulmonary Infection
Therapeutics targeting a surface-bound enzyme encoded by the influenza virus neuraminidase are highly effective antiviral treatments. Although many bacterial pathogens, including the opportunistic pathogen Pseudomonas aeruginosa, also encode neuraminidases, whether these enzymes are important for bacterial pathogenesis such that they would be appropriate antibacterial targets has not been clear, until now. - Pain From Circumcision Being Treated More Seriously By Doctors
One of the first things most little boys in the U.S. experience is something they'll never remember - circumcision - but that doesn't mean it isn't a painful experience. The debate over whether infants feel pain has ended, and the positive conclusion is catching up with obstetrical, pediatric and family physician training programs, 97 percent of which now learn effective pain relief techniques for circumcision. - Public Attitude Shifts In Favor Of Employer Incentives To Change Employee Health Behavior
A new study shows that public sentiment is shifting towards acceptance of higher health insurance rates for people with unhealthy lifestyles, giving human resources executives new ammunition to introduce employee health plan designs with incentives to pursue healthier habits. - Amnesia-inducing Drug Has Shed Light On How We Form New Memories
A study conducted by researchers at Carnegie Mellon University and the University of Pittsburgh involving an amnesia-inducing drug has shed light on how we form new memories. - Medicare Physician Reimbursement Reductions Might Limit Acceptance Of New Patients
Forty-five percent of physicians in the American Medical Association plan to decrease or stop the acceptance of new Medicare beneficiaries and TRICARE members if Congress does not act to stop a 5% decrease in Medicare physician payments that is scheduled to take effect in 2007, AMA President Jeremy Lazarus said on Tuesday, the AP/South Florida Sun-Sentinel reports.
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