Brand-name drugmakers cling to market share with costly copay coupons | Supreme Court allows ACA challenge to move forward | State Medicaid costs will rise regardless of expansion, study finds
November 27, 2012
PCMA SmartBrief
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Brand-name drugmakers cling to market share with costly copay coupons
More pharmaceutical companies are issuing copay coupons as patents on brand-name drugs expire with few blockbuster candidates in the pipeline. The coupons may seem like a bargain to consumers, but they keep health care costs high because insurers' share of the cost is much higher than if the patient were taking a generic drug. A study last year by the Pharmaceutical Care Management Association found brand-name-drug copay coupons could increase prescription drug spending by $32 billion over the next 10 years. The Atlanta Journal-Constitution (subscription required) (11/27)
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Legislative & Regulatory News
Supreme Court allows ACA challenge to move forward
The Supreme Court ruled that Liberty University's lawsuit challenging the Affordable Care Act may be reheard in a federal appellate court. The school says the law forces employers and the public to subsidize contraception and abortions in violation of First Amendment rights to religious freedom. The school might also claim that Congress exceeded its power in mandating that employers offer health insurance. Reuters (11/26)
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State Medicaid costs will rise regardless of expansion, study finds
State spending on Medicaid would rise by close to 3% through 2022 if all states were to expand Medicaid under the Affordable Care Act, according to the Kaiser Family Foundation. However, state Medicaid costs will rise regardless of whether eligibility is expanded because more people who previously qualified but did not sign up are expected to enroll after insurance marketplaces are set up. Kaiser Health News/Capsules blog (11/26), The Hill/Healthwatch blog (11/26)
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Budget negotiators consider raising Medicare eligibility age
Gradually increasing the eligibility age for Medicare from 65 to 67 would reduce federal spending by about $148 billion and might increase revenue as more people stay in the workforce, according to the Congressional Budget Office. Seniors would have an easier time getting private insurance once the Affordable Care Act is fully implemented, proponents of the idea say. However, research indicates costs would be transferred to employers and federal subsidies to buy private insurance would reduce overall savings. The Wall Street Journal (tiered subscription model) (11/26)
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N.J. considers bill to allow NPs to prescribe on their own
New Jersey state Sen. Joseph Vitale, D-Middlesex, has introduced a bill that would give advanced practice registered nurses the power to prescribe drugs independently, eliminating the need for a formal agreement with a consulting physician. Supporters said the bill would help address the shortage of primary care providers in the state, which is expected to get worse once the Affordable Care Act is fully implemented. (New Jersey) (11/26)
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Drug Industry Spotlight
Reminders increase statin adherence in study
Patients who received automated phone calls and follow-up letters were more likely to fill initial prescriptions for statins than those who did not receive reminders, according to a study of 5,216 patients who did not fill their new prescriptions within two weeks. Patients whose insurance plans included a drug benefit were more likely to fill prescriptions, the researchers found. MedPage Today (free registration) (11/26)
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Every path hath a puddle."
-- George Herbert,
Welsh-British poet, orator and priest
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 216 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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