HMOs Face Task of Having Brokers Follow Complex Drug Marketing Guidelines  - 10/11/05

In the brave new world of marketing Medicare prescription drug plans to millions of U.S. seniors, consultants say managed-care companies should make sure brokers with whom they have distribution partnerships follow the government's intricate maze of complex marketing guidelines.

"The feds are watching very carefully," said John Gorman, president and chief executive officer of Gorman Health Group, a Washington, D.C.-based managed care industry consultant. "Anytime you’ve got over 600 plans with a drug benefit hitting the market at exactly the same time, the biggest problem you are going to have is that beneficiaries get overwhelmed and confused. Full Story...

 

Many Insurers Set to Offer New Medicare Drug Plans - 10/11/05

Article from the New York Times Online


In a major step to cut drug costs for older Americans, the Bush administration announced on Friday that 10 companies would offer prescription drug coverage to Medicare beneficiaries in all parts of the country, while many other insurers would sell coverage in specific states, for premiums averaging $32 a month. Each company can offer several options, with different benefits and co-payments. Advocates for the elderly said the large number of choices could confuse beneficiaries. Under the new Medicare law, all 42 million beneficiaries will have access to drug coverage if they choose to sign up for it. Insurers can start marketing on Oct. 1, and people can sign up in the six-month period starting Nov. 15. Drug coverage becomes available on Jan. 1. People who are eligible now but delay signing up will be subject to financial penalties, in the form of higher premiums, for late enrollment. ##END##

Drug Firms Try to Fool Voters -  10/11/05

Article from the Los Angeles Times Online

The pharmaceutical industry's campaign to turn California's voter initiative process into its wholly owned subsidiary is moving into full gear. With the statewide appearance of two television ads financed by a war chest pegged at $60 million (and counting) and aimed at two ballot initiatives concerned with prescription drug prices, it's timely to consider what we're getting for the drug companies' money. The commercials attack Proposition 79, which was drafted by labor unions and consumer groups to force the industry to pony up discounts on drugs for California's poor, elderly and medically uninsured. As an alternative, the ads promote Proposition 78, the pharmaceutical industry's version of a discount program. As might be expected, these measures differ in their reach and enforceability...The California Medical Assn., which represents thousands of physicians in the state, hasn't yet taken a position on either initiative and may not do so. ##END##

Forcing a Look at Hospitals' Mission - 10/11/05
Adventist Facilities Accused of Price-Gouging, Denying Care to Uninsured Patients

Article from the Washington Post Online

ST. LOUIS -- Under a blistering sun here recently, armed with only bottled water, homemade signs and the plight of one deathly ill little boy, a dozen Latino immigrants came to shame leaders of the Seventh-day Adventist Church.

Their grievance: Hospitals operating in the name of the church overcharging and denying care to those least able to pay.

In the past year, lawyers for the poor have filed federal lawsuits in 22 states accusing nonprofit hospitals of failing to meet their tax-exempt obligations to provide indigent care. With those legal maneuvers unfolding at a glacial pace, one unlikely crusader is racing forward with a new line of attack, focusing on what he calls the un-Christian behavior of religiously affiliated hospitals. Full Story...

SUTTER HEALTH SLAPS UNINSURED WITH CLASS ACTION SUIT  - 10/11/05
Hospital Giant Counterclaims With Nation’s First Class Action Against Price-Gouged Uninsured Patients

SACRAMENTO, CA—Sutter Health, one of nation’s wealthiest not-for-profit hospital chains, filed the nation’s first class action lawsuit against price-gouged uninsured patients claiming breach of contract and seeking the difference between what the uninsured had already paid and what the hospital’s inflated list prices are. Full Story...
 

 
PHYSICIANS, PRUDENTIAL AND HEALTHNET ANNOUNCE COURT APPROVAL OF SETTLEMENT OF LANDMARK LITIGATION - 09/28/05

Miami, FL – Prudential, HealthNet and representatives of hundreds of thousands of  physicians, state and local medical societies announced that their settlement of the national class action lawsuit pending in the federal court for the Southern District of Florida before U.S. District Judge Federico Moreno has been approved.
 
Similar to earlier settlements with Aetna and Cigna, approval of this settlement provides a mechanism by which physicians can obtain compensation in connection with the claims brought in the lawsuits.  Full Story...

 

Employers Join to Push Drug Managers for Full Disclosure - 09/10/05

Article from the Wall Street Journal Online

Tired of rising drug prices, 52 large employers are using their combined clout to pressure pharmacy-benefit managers to change the way they administer employee drug purchases.

The group, including Caterpillar Inc., International Business Machines Corp., Starbucks Corp. and Verizon Communications Corp., collectively spends $3.7 billion a year on drugs. The companies plan to announce today that they are endorsing a new purchasing model that would require pharmacy-benefit managers, or PBMs, to disclose and pass on to their clients their acquisition costs for retail and mail-order prescriptions. Full Story...