Healthcare Town Hall

Atrial fibrillation is the most common form of cardiac arrhythmia, better known as an irregular heartbeat. The disorder has significant health and cost concerns for the Medicare population because of its association with an increased risk for stroke and all-cause mortality.

A study published in the May/June issue of American Health & Drug Benefits by Milliman’s Kate Fitch, Jonah Broulette, Bruce Pyenson, and Kosuke Iwasaki used Medicare Part D claims data to assess the use of the anticoagulant drug warfarin in the Medicare population.

Here is an excerpt highlighting key points from the study entitled “Utilization of Anticoagulation Therapy in Medicare Patients with Nonvalvular Atrial Fibrillation:”

• Patients with atrial fibrillation (AF) are at a significant, 5-fold increased risk for stroke and all cause mortality compared with those without AF.

• Oral anticoagulation therapy is recommended by national guidelines as the cornerstone for stroke prevention in patients with AF.

• Warfarin significantly reduces the risk for ischemic stroke; newer anticoagulant agents have shown even greater reduction of stroke risk compared to warfarin.

• Although AF risk increases with age, this present study shows that anticoagulation therapy is underutilized in Medicare beneficiaries who have nonvalvular AF (NVAF), resulting in an increase in ischemic strokes.

• These findings suggest the need to follow guideline-based anticoagulation recommendations in patients with NVAF to prevent strokes and the associated excess in healthcare costs, reduced quality of life, and even death.

• These findings also raise the need to investigate provider compliance with clinical guidelines regarding oral anticoagulation therapy for stroke prevention in older patients (aged >65 years) with NVAF.

A copy of the entire study can be read here.

Winghan Jacqueline Kwong, of Daiichi Sankyo Inc. also co-authored the study.

Medicare, Research anticoagulation, atrial fibrillation, Bruce Pyenson, Jonah Broulette, Kate Fitch, Kosuke Iwasaki, Medicare, Medicare Part D

Healthcare reform legislation has resulted in significant changes to prescription drug plan options under Medicare Part D. A new article by Troy Filipek and Greg Gysberg considers why plan sponsors should reexamine their existing approaches to prescription drug coverage and take advantage of the new opportunities available since passage of the new healthcare laws.

Medicare, Pharma Greg Gysberg, Medicare Part D, Troy Filipek

A new healthcare reform briefing paper by Brian Anderson and Troy Filipek looks at the reform provisions affecting Medicare Part D. The paper is available here.

Medicare, Reform Brian Anderson, Medicare Part D, Troy Filipek

Lots of reading to catch up on:

• Economist Jonathan Gruber’s WaPo article on the Cadillac tax as a way to fund healthcare reform
• The latest from the VA and DoD
• A NYT article on how different states are responding to the healthcare bill
• A WaPo piece on the Medicare Part D doughnut hole
• And finally more EHR news, including a look at why hospitals and doctors may look to move sooner on EHR

Electronic Health Records Cadillac plan, EHR, Medicare Part D, Veteran's Administration

Medicare Part D has not yet been the focus of much reform-related media attention, but as a program that serves millions of seniors, any changes bear watching. A new healthcare reform briefing paper by Troy Filipek looks at the reform concepts related to Part D that are currently on the table. These reforms include proposed price controls, efforts to fill the much-publicized donut hole, possible formulary changes, and various efforts at standardization and simplifiction.

Medicare, Pharma Medicare Part D, Troy Filipek

The latest issue of Health Affairs includes an article examining possible changes to the Medicare Part D prescription drug program that could reduce costs (note: subscription required). Milliman analysis on formulary design highlights one opportunity. Quoting from the article:

Formulary design is a widely used private-sector tool for controlling health plans’ drug costs. Medicare limited the freedom of Part D plans to control their formularies through rules such as the safe harbor guidelines established by the U.S. Pharmacopeia¹⁷ and MMA’s requirement that Part D plans cover at least two drugs per class.¹⁸

 

The CMS went beyond the statute, requiring at least one drug in each subclass as well. In addition, the CMS has given special protections to six classes of drugs, requiring that “all or substantially all drugs” in the classes be included in the formularies.¹⁸ This rule effectively eliminates Part D drug price negotiations over anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. In other classes, Part D plans routinely exclude some drugs as part of the normal commercial formulary process.¹⁹ The 110th Congress solidified and expanded the protected classes. The July 2008 physician payment update legislation gave the CMS clear statutory authority to expand the protected drug classes and created a cumbersome process that delays competition within the classes.²⁰

 

These rules limit the negotiating power of Part D plans and make drugs in those classes more expensive. A Milliman study found that these six protected classes accounted for 16.8-33.2 percent of Part D drug costs by Part D plan administrators. Reversing this one rule would decrease prices in these classes by 9-11 percent, for a projected Part D savings of $511 million per year.²¹ To ease the negative effect such restrictions can have on price negotiations, Congress could modify the Medicare Part D rules to give private drug plans more freedom to control their formularies. More-flexible formularies would permit more-aggressive negotiations by Part D plans, because the plans would have more maneuvering room to negotiate for deeper discounts, as they do with some of their non-Medicare plans.²²

Cost, Pharma Medicare Part D, Richard Kipp