APA continues to lobby for the strongest possible parity legislation capable of passing both the House and Senate and being signed into law by the President. With lead Republican sponsors Senator Pete Domenici (R-NM) and - possibly - Representative Jim Ramstad (R-MN) retiring at the end of this Congress, it is imperative that we continue to push for prompt enactment of a mental health "parity" law this year.
While the House bill offers stronger protections in certain areas, APA recognizes the significant, delicate compromise reflected in the Senate bill and supports both measures. The Senate bill represents a landmark compromise between healthcare organizations and the business and insurance communities that overcame the traditional opposition to parity that has kept prior bills from passing in the Senate. With recent House passage of the Paul Wellstone Mental Health and Addiction Equity Act, Senate leaders have offered a compromise proposal to House leadership for consideration. Key players have yet to discuss specific details of the proposal, but the compromise appears to draw the House bill closer to the Senate bill in coverage determinations, in particular dropping the requirement to cover all disorders included in the DSM, and draws the Senate bill closer to the House bill in out-of-network coverage requirements. Though the situation remains in play, sponsors in both chambers have expressed optimism about reaching an agreeable compromise. Despite complications along the way, it appears that the House and Senate continue toward significant legislative action on mental health parity by the end of this year.
CMS Final Rule Establishes New E-Prescribing Standards
The Centers for Medicare and Medicaid Services (CMS) issued a final rule that establishes new electronic prescribing standards under Medicare Part D, which will take effect on April 1, 2009.
The rule sets standards for four types of information: formulary and benefits, medication history, fill-status notification (a standard will allow providers to receive an e-mail notice from a pharmacy or other dispenser telling them that a patient's prescription has been picked up, not picked up, or has been partially filled), and identification of individual healthcare providers.
The CMS anticipates that the conversion from the paper-based system to the e-prescribing system will help reduce the estimated 530,000 per-year adverse drug events for Medicare beneficiaries.
The standards will apply to freestanding Medicare Prescription Drug Plan sponsors, Medicare Advantage Prescription Drug Plans and other Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription-related information about Part D covered drugs.
CMS Issues Report on Medicare Changes
The Henry J. Kaiser Family Foundation issued a report based on data from the CMS, summarizing Medicare prescription drug plans (PDPs) in 2008 and key changes since 2006. The report generates findings from several Medicare Part D 2008 Drug Spotlights and highlights the scope of drug coverage available to Medicare beneficiaries under Part D plans, and changes in drug coverage and costs since 2006.
Key findings in the report include:
- Plan Availability: The number of stand-alone prescription drug plans available in 2008 is 1,824. About a quarter of all PDPs in 2008 are "benchmark" plans for the low-income subsidy (LIS); that is, they qualify to enroll beneficiaries receiving the full LIS with no monthly premium payment required.
- Premiums: Monthly PDP premiums vary widely in 2008, as in previous years, and are substantially higher for plans offering some gap coverage. On average, enrollees who stayed with the same drug plan between 2007 and 2008 faced higher premiums in 2008.
- Coverage Gap: In 2008, a majority of Part D plans have a gap in drug coverage in which enrollees pay 100 percent of total drug costs before catastrophic coverage begins. Only a relatively small share of Part D enrollees are enrolled in plans that offer gap coverage.
- Benefit Design and Cost Sharing: Most stand-alone plans do not offer the defined standard benefit, and more PDPs have shifted to a tiered cost-sharing structure. Cost sharing for brand-name drugs has increased since 2006, particularly for non-preferred brand-name drugs.
- Specialty Tiers: Most national stand-alone drug plans use a specialty tier for high-cost medications in 2008, and more plans are opting to charge a higher coinsurance rate for their specialty tier drugs.
- Formularies and Utilization Management: The scope of formulary coverage continues to vary widely across PDPs in 2008, with the greatest differences relating to the treatment of brand-name drugs. Based on an analysis of coverage of a sample of 169 drugs, PDPs have increased the use of utilization management restrictions for on-formulary brand-name drugs.
To read the entire report please click here.