Long Term Care Pharmacy Alliance Concerned with Proposed CMS Rule; New Study Confirms LTCPA Position

/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.

A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.

"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.

The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.

In addition to the increased cost to payers, other key findings included:

* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.


In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.

In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.

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Good News for National Diabetes Month: People with Type 1 Diabetes Have Better Life Insurance, Long Term Care Insurance Options

(BUSINESS WIRE)--During National Diabetes Month, there is good news about insurance options for people living with type 1 diabetes. “Many people who in the past have been declined life insurance and long-term care insurance (LTC) solely on the basis of their type 1 diabetes diagnosis are now seeing some of the barriers come down,” said Danny Mensh, president of Mensh Insurance “Under certain circumstances, several major carriers are now willing to underwrite and issue both long-term care insurance and term life insurance policies.”

In the past, insurance carriers did not know how to price the risk on life insurance and long-term care insurance for people with type 1 diabetes and automatically declined their applications. However, within the last 24 to 36 months, the insurance industry has become more lenient on this chronic condition. “Due to improved medications, advancements in the manner in which they are distributed and more precise blood sugar level monitoring, underwriters are increasingly more comfortable with the longer life prospects and health maintenance of those with stable histories of type 1 diabetes,” Mensh said.

Some of the basic underwriting criteria for issuing policies to a person with type 1 diabetes include:

* Controlled A1c < 8
* < 60 units of insulin
* Controlled height and weight
* Average fasting blood sugar < 200
* Blood pressure, 140/90
* No transient ischemic attacks (TIAs) within past five years
* No smoking within last two years
* No cardiac complications or retinopathy associated with eye impairments
* No chronic steroid usage

“Many people with type 1 diabetes are very stable and can easily demonstrate via medical records that they should qualify for approval from major insurance carriers,” Mensh said. “It has been exciting to open up the options for future financial planning to people with this chronic condition.”

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CLASS Act Analysis Reveals America's Long-Term Care Future

/PRNewswire/ -- The Community Living Assistance Services and Supports (CLASS) Act -- a largely overlooked component of the 2010 Patient Protection and Affordable Care Act -- has the potential to transform long-term care financing in the United States from a welfare-based to an insurance-based system, according to the latest issue of Public Policy & Aging Report (PPAR).

With funding from The SCAN Foundation, this installment of PPAR features seven articles that recount the origins of the CLASS Act, analyze the legislation's key provisions, and explore potential hurdles of implementation.

"We consider this issue of PPAR to represent the best of what the publication has to offer," said PPAR Editor Robert Hudson, PhD, chair of the Department of Social Policy at the Boston University School of Social Work. "It is timely, informed, and cutting edge. It goes beyond the headlines and delivers detailed accounts of the emergence of the CLASS Act to a broad audience of policy and academic leaders."

The CLASS Act introduces a voluntary, federally administered insurance program designed to provide middle-class Americans the new choice to plan ahead for personal care and supportive service needs in the face of functional impairment. Enrolled individuals no longer will have to be demonstrably poor or spend themselves into poverty to receive long-term care protection.

According to the U.S. Department of Health and Human Services, at least 70 percent of Americans over the age of 65 will need long-term care services at some point in their lives.

"CLASS is about allowing working Americans to take personal responsibility for planning ahead so they can age with dignity and independence," said Bruce Chernof, MD, president and CEO of The SCAN Foundation. "CLASS enrollees will have the power to choose the services they want in the setting most appropriate to their needs."

The current issue of PPAR, published by the National Academy on an Aging Society, is available for purchase at www.agingsociety.org. The authors include Lisa Shugarman, PhD, of The SCAN Foundation; Joshua Wiener, PhD, of RTI International; Walter Dawson of Oxford University; Barbara Manard, PhD, of the American Association of Homes and Services for the Aging; Anne Tumlinson, MMHS, of Avalere Health; Rhonda Richards of AARP; and Kathryn Roberts, PhD, of Ecumen.

More information about the individual grantees and The SCAN Foundation can be found at www.thescanfoundation.org.

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How Local Governments Are Addressing Retiree Health Care Funding

/PRNewswire/ -- A new issue brief from the Center for State and Local Government Excellence finds that the economy has slowed the ability of local governments to address long-term funding of their retiree health care obligations.

The brief follows up on a 2009 survey in which 206 local governments indicated they were likely to adopt a long-term strategy to strengthen their retiree health care funding, including:

-- establishing a Section 115 trust (governmental); medical subaccount
[401(h)]; or Voluntary Employee Beneficiary Association (VEBA) trust
[501(c)(9)];
-- issuing OPEB bonds;
-- increasing the years of service for vesting for RHC;
-- increasing the age at which RHC is available;
-- terminating retiree health care for all new hires.


Since then, the economy, insufficient revenues, and competing budget priorities have posed the greatest impediment to their plans.

The new brief finds that many jurisdictions are making sweeping changes in their retiree health care plans:

-- 36 percent have increased or plan to increase the years of service
required to vest.
-- 11 percent have increased the retirement age.
-- 39 percent have eliminated or plan to eliminate retiree health
benefits for new hires.

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