Citing health overhaul, AARP hikes employee costs

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Citing health overhaul, AARP hikes employee costs



By RICARDO ALONSO-ZALDIVAR, Associated Press – Thu Nov 4, 4:34 pm ET
WASHINGTON – AARP's endorsement helped secure passage of President Barack Obama's health care overhaul. Now the seniors' lobby is telling its employees their insurance costs will rise partly as a result of the law.
In an e-mail to employees, AARP says health care premiums will increase by 8 percent to 13 percent next year because of rapidly rising medical costs.
And AARP adds that it's changing copayments and deductibles to avoid a 40 percent tax on high-cost health plans that takes effect in 2018 under the law. Aerospace giant Boeing also has cited the tax in asking its workers to pay more. Shifting costs to employees lowers the value of a health care plan and acts like an escape hatch from the tax.
"Most plan co-pays and deductibles have been modified," Jennifer Hodges, AARP's director of compensation and benefits, wrote employees in an Oct. 25 e-mail. "Plan value changes were necessary not only from a cost management standpoint but also to ensure that AARP's plans fall below the threshold for high-cost group plans under health care reform."
AARP officials said medical inflation is the main reason employee costs will be going up. The health care law is "a small part," said David Certner, legislative affairs director.
Although the tax on so-called "Cadillac" health care plans doesn't take effect for years, employers are already beginning to assess their potential exposure because it is hefty: at 40 percent of the value above $10,200 for individual coverage and $27,500 for a family plan. The tax is intended as a savings measure, to prod employers and workers into more cost-efficient plans.
Certner said AARP's plans are currently under the threshold for the tax. "We intend to stay below those thresholds," he said. "It's not in anybody's interest to move above those thresholds, not the employees' nor the employer's."
AARP officials say the organization's public policy recommendations are made independently of other considerations, including its range of business ventures, from travel, to insurance, to publishing.
The 40 million-strong AARP represents people 50 and older, including retirees on Medicare and Social Security. Its endorsement of health care overhaul came at a critical time last year, days before a close vote on the House floor.
"The impact on AARP employees is not a factor at all in our policy making, which is directed at the impact on our membership and on all older Americans," said Certner.
About 4,500 people are covered by AARP's plans, including employees, dependents and retirees.
"We supported the (health care) package because it contained incredibly important protections for our younger members, who often have problems getting access to care," said spokesman Jim Dau. "And because it helps our older members in Medicare with important new benefits."
Starting in 2014, the overhaul law prohibits insurance companies from turning down people with medical problems, and limits what they can charge older customers. It gradually closes the coverage gap in the Medicare prescription benefit, and improves coverage for preventive care.
The Obama administration says changes required by the law so far have only had a minimal, single-digit impact on premiums. Many benefits experts agree with that assessment but point out that the increases come on top of untamed health care inflation.
AARP warned its employees that more cost-shifting could be in store. "AARP intends to make similar changes, as necessary, in the future to avoid the (health plan) tax," said Hodges' e-mail.
Current forecasts are that the overhaul will only have a small impact on job-based coverage, slightly reducing the number of people who would otherwise be covered by employer plans. Those workers would have access to taxpayer-subsidized coverage through new insurance markets.
 


<font size="3">aarp officials said <span style="background-color: #ffff00">medical inflation is the main reason</span> employee costs will be going up. <span style="background-color: #ffff00">the health care law is "a small part,"</span>


<font size="3">and aarp adds that it's chang[ed] copayments and deductibles to avoid a 40 percent tax on high-cost health plans . . . The tax on so-called "cadillac" health care plans . . . [which] is intended as a savings measure, to prod employers and workers into more cost-efficient plans.</font size>

<font size="3">"we supported the (health care) package because it contained incredibly important protections for our younger members, who often have problems getting access to care," said spokesman jim dau. "and because it helps our older members in medicare with important new benefits."

starting in 2014, the overhaul law prohibits insurance companies from turning down people with medical problems, and limits what they can charge older customers. It gradually closes the coverage gap in the medicare prescription benefit, and improves coverage for preventive care.</font size>

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<font size="3">Moral of the story: Read Beyond the Headlines

</font size>

 
http://www.nytimes.com/

Read the bill!

Children’s Hospitals Lose Some Drug Discounts


Children’s hospitals have been told by drug companies that they will no longer get discounts for medications, like the cancer drugs above, that are known as “orphan drugs.” The change is an unintended consequence of the new health law, and it is costing hospitals millions of dollars.
By ROBERT PEAR
Published: December 7, 2010


WASHINGTON — In an unintended consequence of the new health care law, drug companies have begun notifying children’s hospitals around the country that they no longer qualify for large discounts on drugs used to treat rare medical conditions.

As a result, prices are going up for these specialized “orphan drugs,” some of which are also used to treat more common conditions.

Over the last 18 years, Congress has required drug manufacturers to provide discounts to a variety of health care providers, including community health centers, AIDS clinics and hospitals that care for large numbers of low-income people.

Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States.

The reason behind the change is murky, though some drug makers had opposed expansion of the drug discount program. The discounts typically range from 30 percent to 50 percent, and children’s hospitals say the change is costing them hundreds of millions of dollars.

Under the new law, hundreds of rural hospitals became eligible for discounts for the first time, but the discounts are not available on orphan drugs, which account for a surprisingly large share of their outpatient pharmacy costs. At the same time, children’s hospitals lost access to discounts on the drugs.

In a typical letter to a children’s hospital, one company, Genentech, said that, because of the new law, it would not offer discounts on certain cancer medicines like Avastin, Herceptin, Rituxan and Tarceva, or on Activase, which is used to dissolve blood clots in heart attack and stroke patients.

Another drug maker, Allergan, cited the new law as a reason for denying discounts on Botox, which, besides removing wrinkles from the face, is used to reduce spasticity in patients with cerebral palsy and other neurological disorders.

Joshua D. Greenberg, vice president of Children’s Hospital Boston, said that loss of the discounts “jeopardizes our ability to care for some of the sickest children with the most complex health care needs.”

Robert A. Nordin, the pharmacy manager at Gillette Children’s Specialty Healthcare in St. Paul, said his hospital was losing hundreds of thousands of dollars’ worth of discounts on drugs like Botox and Rituxan.

Christina M. Barnes, the pharmacy director at Galion Community Hospital in rural Galion, Ohio, said she was excited when her hospital qualified for the discount program earlier his year. But, she said, she was dismayed to learn that many drugs would be excluded.

“We were given an advantage with one hand, and it was taken away with the other hand,” Ms. Barnes said.

William A. Sarraille, a lawyer at Sidley Austin in Washington who represents drug makers, said, “The discounts are huge and can have a very significant, very negative impact on the ability of manufacturers to develop new, better products that meet patients’ needs.”

The Food and Drug Administration classifies more than 350 medicines as orphan drug products. Manufacturers said they could not recover the costs of developing such drugs if they were required to sell them at deeply discounted prices.

A House Democrat who worked on the health care law said the situation had resulted from “an honest mistake in drafting,” and he added, “No one intended to take away any of the drug discounts that children’s hospitals already had.”:hmm:

The discount program is widely known as the 340B program, after the relevant section of the Public Health Service Act.

Mary K. Wakefield, the administrator of the Health Resources and Services Administration, the federal agency that manages the program, said she shared the concerns of children’s hospitals. “We support a technical correction by Congress that will preserve access to discounted medications for more vulnerable Americans,” Ms. Wakefield said.

The House has voted to restore discounts for children’s hospitals. Similar legislation has been bottled up in the Senate, despite support from Republicans like Senator Scott P. Brown of Massachusetts and Democrats like Senator Sherrod Brown of Ohio. A version of the proposal was included in bipartisan health care legislation unveiled Tuesday by Senate leaders.

When Congress created the drug discount program in 1992, it said the purpose was to enable clinics and hospitals to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”

In a last-minute change sought by some drug manufacturers, Congress stipulated in the new health care law that rural hospitals, children’s hospitals and certain free-standing cancer centers could not get discounts on orphan drugs through the 340B program. Ms. Barnes, at Galion Hospital in Ohio, said: “The list of orphan drugs is small, but it involves big dollars. Many, perhaps most, of our cancer patients receive at least one orphan drug during their treatment.”

Leonard M. Gulino of Cape Elizabeth, Me., said the discount program had substantially reduced the cost of Botox treatments for his son, Gregory, who has had multiple strokes and severe tightening of leg muscles because of a rare disease.

Elimination of the discounts for orphan drugs at children’s hospitals came as a surprise to federal health officials who work on the program. They said they learned of it only after President Obama signed the legislation in March.

Terence J. Hurley, a spokesman for Genentech, said the company was waiting for guidance from federal officials because “there remains significant lack of clarity regarding the orphan drug provisions” of the new law. Allergan and the Biotechnology Industry Organization, whose members produce many orphan drugs, declined to comment.

Drug companies said that the discount program was intended to help hospitals care for the uninsured, and that this need would diminish as millions of the uninsured gained coverage under Mr. Obama’s health care overhaul.

But Ted Slafsky, the executive director of Safety Net Hospitals for Pharmaceutical Access, a nonprofit group, said, “The exemption for orphan drugs undermines the mission and purpose of the drug discount program.”
 
http://www.nytimes.com/

Read the bill!

Children’s Hospitals Lose Some Drug Discounts


Children’s hospitals have been told by drug companies that they will no longer get discounts for medications, like the cancer drugs above, that are known as “orphan drugs.” The change is an unintended consequence of the new health law, and it is costing hospitals millions of dollars.
By ROBERT PEAR
Published: December 7, 2010


WASHINGTON — In an unintended consequence of the new health care law, drug companies have begun notifying children’s hospitals around the country that they no longer qualify for large discounts on drugs used to treat rare medical conditions.

As a result, prices are going up for these specialized “orphan drugs,” some of which are also used to treat more common conditions.

Over the last 18 years, Congress has required drug manufacturers to provide discounts to a variety of health care providers, including community health centers, AIDS clinics and hospitals that care for large numbers of low-income people.

Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States.

The reason behind the change is murky, though some drug makers had opposed expansion of the drug discount program. The discounts typically range from 30 percent to 50 percent, and children’s hospitals say the change is costing them hundreds of millions of dollars.

Under the new law, hundreds of rural hospitals became eligible for discounts for the first time, but the discounts are not available on orphan drugs, which account for a surprisingly large share of their outpatient pharmacy costs. At the same time, children’s hospitals lost access to discounts on the drugs.

In a typical letter to a children’s hospital, one company, Genentech, said that, because of the new law, it would not offer discounts on certain cancer medicines like Avastin, Herceptin, Rituxan and Tarceva, or on Activase, which is used to dissolve blood clots in heart attack and stroke patients.

Another drug maker, Allergan, cited the new law as a reason for denying discounts on Botox, which, besides removing wrinkles from the face, is used to reduce spasticity in patients with cerebral palsy and other neurological disorders.

Joshua D. Greenberg, vice president of Children’s Hospital Boston, said that loss of the discounts “jeopardizes our ability to care for some of the sickest children with the most complex health care needs.”

Robert A. Nordin, the pharmacy manager at Gillette Children’s Specialty Healthcare in St. Paul, said his hospital was losing hundreds of thousands of dollars’ worth of discounts on drugs like Botox and Rituxan.

Christina M. Barnes, the pharmacy director at Galion Community Hospital in rural Galion, Ohio, said she was excited when her hospital qualified for the discount program earlier his year. But, she said, she was dismayed to learn that many drugs would be excluded.

“We were given an advantage with one hand, and it was taken away with the other hand,” Ms. Barnes said.

William A. Sarraille, a lawyer at Sidley Austin in Washington who represents drug makers, said, “The discounts are huge and can have a very significant, very negative impact on the ability of manufacturers to develop new, better products that meet patients’ needs.”

The Food and Drug Administration classifies more than 350 medicines as orphan drug products. Manufacturers said they could not recover the costs of developing such drugs if they were required to sell them at deeply discounted prices.

A House Democrat who worked on the health care law said the situation had resulted from “an honest mistake in drafting,” and he added, “No one intended to take away any of the drug discounts that children’s hospitals already had.”:hmm:

The discount program is widely known as the 340B program, after the relevant section of the Public Health Service Act.

Mary K. Wakefield, the administrator of the Health Resources and Services Administration, the federal agency that manages the program, said she shared the concerns of children’s hospitals. “We support a technical correction by Congress that will preserve access to discounted medications for more vulnerable Americans,” Ms. Wakefield said.

The House has voted to restore discounts for children’s hospitals. Similar legislation has been bottled up in the Senate, despite support from Republicans like Senator Scott P. Brown of Massachusetts and Democrats like Senator Sherrod Brown of Ohio. A version of the proposal was included in bipartisan health care legislation unveiled Tuesday by Senate leaders.

When Congress created the drug discount program in 1992, it said the purpose was to enable clinics and hospitals to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”

In a last-minute change sought by some drug manufacturers, Congress stipulated in the new health care law that rural hospitals, children’s hospitals and certain free-standing cancer centers could not get discounts on orphan drugs through the 340B program. Ms. Barnes, at Galion Hospital in Ohio, said: “The list of orphan drugs is small, but it involves big dollars. Many, perhaps most, of our cancer patients receive at least one orphan drug during their treatment.”

Leonard M. Gulino of Cape Elizabeth, Me., said the discount program had substantially reduced the cost of Botox treatments for his son, Gregory, who has had multiple strokes and severe tightening of leg muscles because of a rare disease.

Elimination of the discounts for orphan drugs at children’s hospitals came as a surprise to federal health officials who work on the program. They said they learned of it only after President Obama signed the legislation in March.

Terence J. Hurley, a spokesman for Genentech, said the company was waiting for guidance from federal officials because “there remains significant lack of clarity regarding the orphan drug provisions” of the new law. Allergan and the Biotechnology Industry Organization, whose members produce many orphan drugs, declined to comment.

Drug companies said that the discount program was intended to help hospitals care for the uninsured, and that this need would diminish as millions of the uninsured gained coverage under Mr. Obama’s health care overhaul.

But Ted Slafsky, the executive director of Safety Net Hospitals for Pharmaceutical Access, a nonprofit group, said, “The exemption for orphan drugs undermines the mission and purpose of the drug discount program.”
 
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