Washington, DC (Vocus) December 10, 2010 —

Voters would rather reduce Medicaid spending by better managing pharmacy benefits rather than cutting benefits for patients or payments to doctors and hospitals, according to a new poll commissioned by the Pharmaceutical Care Management Association (PCMA).

This poll comes on the heels of a new state-by-state economic analysis released by The Lewin Group showing that Medicaid uses fewer generic drugs and pays higher pharmacy costs than other programs. The report also finds that Medicaid pharmacy could save more than $ 30 billion over the next decade by transitioning from the current approach used by state Medicaid fee-for-service (FFS) programs to the more efficient approaches used by Medicare Part D plans, Medicaid managed care organizations (MCOs), and the commercial sector, including typical state employee plans.

“This poll shows Congress and the Governors how to reduce billions in Medicaid spending without harming patients or inciting a voter backlash. Voters don’t want Medicaid to pay pharmacies more and use fewer generics than other programs,” said PCMA President and CEO Mark Merritt.

Key Findings from the Ayres, McHenry & Associates, Inc. survey include:

    By an 80 to 15 percent margin, voters don’t want Medicaid to pay drugstores more for prescription drugs than private plans pay.

    Voters support reducing spending on Medicaid, provided benefits are not cut for patients in the program. Voters support reducing spending on Medicaid by a 63 to 25 percent margin “if it did not require cutting benefits for patients in the program.” A plurality of voters opposes reducing spending on Medicaid (49 to 36 percent) “if it meant reducing benefits for patients in the program or allowing fewer people to participate in the program.”

    Voters find approaches to cutting Medicaid costs acceptable when they involve reducing costs for prescription drugs, but find cutting payments to physicians and hospitals unacceptable. Voters find “requir(ing) Medicaid patients to use generic drugs unless their doctor objects” acceptable by an 85 to 12 percent margin, find “mak(ing) local drugstores compete with each other in order to be included in a Medicaid network, like they do for Medicare Part D and private sector plans” acceptable by a 74 to 16 percent margin, and find “mak(ing) sure that different pharmacies do not issue duplicate prescriptions to the same patient” acceptable by a 74 to 20 percent margin.

    Voters find cutting payments to physicians and hospitals who see Medicaid payments unacceptable by 64 to 29 percent and 61 to 31 percent margins, respectively.

    One likely reason for voters’ flexibility regarding Medicaid pharmacy is that the vast majority of voters have at least three pharmacies in their area. Eighty-five percent of voters have at least three pharmacies in their area, including 61 percent who have more than five pharmacies in their area.

Key Findings from The Lewin Group study:

Savings Opportunities Exist In Four Key Areas

While Medicaid FFS programs and costs vary greatly state-by-state, The Lewin Group identified four key areas where pharmacy benefit management could generally be improved:

    Generic Drug Dispensing: Medicaid FFS is less effective at encouraging the dispensing of generic drugs in place of brands. The generic dispensing rate in Medicaid FFS averages 68%, compared to an average 80% generic dispensing rate in Medicaid MCOs.

    Dispensing Fees: At $ 4.81 per prescription, the national average dispensing fee that Medicaid FFS programs pay to retail pharmacies per each prescription is more than double the average dispensing fees paid by Medicare Part D payers, Medicaid MCOs, or health plans in the commercial sector.

    Ingredient Costs: The rate at which retail pharmacies are reimbursed for the actual medication ingredients (pills, capsules, etc.) is also higher, on average, in Medicaid FFS programs than in Medicare Part D or the commercial sector.

    Drug Utilization: The number of prescriptions dispensed per person is typically higher in Medicaid FFS programs than in Medicaid MCOs due to less effective controls on polypharmacy, fraud, waste, abuse, and other factors in the FFS setting.

Estimated Federal and State Medicaid Savings

If all state Medicaid programs used a market-based approach such that dispensing fees, ingredient costs, drug utilization, and generic drug dispensing were brought in-line with norms for Medicaid MCOs, Medicare Part D, and commercial payers, Lewin estimates that:

    Combined federal and state savings to the Medicaid program would total $ 30.3 billion over the next decade.
    Medicaid FFS prescription costs could be reduced by 14.8%.
    Per member per month (PMPM) costs for Medicaid FFS pharmacy benefits could be reduced by $ 12 in 2011 under optimal management.

PCMA represents the nation’s pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 210-plus million Americans.

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It is estimated that five out of ten people turning 67 will use a nursing home at some point in their lives and many will need home care and other related services as well About two-thirds of people in nursing homes have no living relatives. And about 70 percent of all nursing home patients are women. Nursing home costs are estimated to be ,000 in 2009, which would economically devastate most families. The federal government will not be helping either, unless you are without any assets, Medic

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Medicaid is the key source of health care coverage for low income families, disabled and poor, elderly South Carolinians. Yet few people really understand how the Medicaid program works or who and what it covers and doesnt cover. Listen to the stories of how Medicaid plays a critical part in the health of the states citizens and economy.
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www.esuremenow.com Welcome toPart 13 of 16 Long Term Care Insurance Videos from eSuremenow.com. In this video we shortly explain what Medicaid is. Does Medicaid pay for your Long Term Care expenses? You can find more answers to your Long Term Care Insurance Questions in our Long Term Care Insurance Guide at http and can also get your competitive Long Term Care Quotes from our experts at www.esuremenow.com Gurhan Gary Demirkan 703-763-4902 www.esuremenow.com Follow me on my other great sites www.esuremenowblog.com Facebook: www.facebook.com Quality Direct Mail Marketing Sites leadsquest.com www.facebook.com twitter.com

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Washington, DC (Vocus/PRWEB) February 03, 2011

With Medicaid spending growth almost doubling over the past year, a new document released today by Health and Human Services (HHS) Secretary Kathleen Sebelius to all 50 governors encourages the use of lower-cost drugs – including generics – to help reduce Medicaid spending. The next step is for state Medicaid programs to stop paying pharmacies more than Medicare and other programs, said the Pharmaceutical Care Management Association (PCMA).

“By managing pharmacy benefits like other, more successful programs, Governors can cut billions in Medicaid without cutting benefits to patients or payments to doctors and hospitals,” said PCMA President and CEO Mark Merritt.

According to a new study by The Lewin Group, Medicaid pharmacy could save more than $ 30 billion over the next decade by transitioning from the current approach used by state Medicaid fee-for-service (FFS) programs to the more efficient approaches used by Medicare Part D plans, Medicaid managed care organizations (MCOs), and the commercial sector.

Most state Medicaid programs use an old-school fee-for-service approach in which state officials arbitrarily decide how much Medicaid will pay pharmacies. This approach exposes state governments to political pressure from the independent drugstore lobby to set artificially high payment levels. On the other hand, most non-Medicaid drug benefits programs – like those offered by Medicare, employers and unions – use independent, third party pharmacy benefit experts to negotiate more competitive rates with pharmacies. These programs also use cutting-edge, market-proven strategies to increase the use of generics.

Recent polling finds voters would rather reduce Medicaid spending by better managing pharmacy benefits than cut benefits for patients or payments to doctors and hospitals.

PCMA represents the nation’s pharmacy benefit managers (PBMs), which improve affordability and

quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 210-plus million Americans.

Follow PCMA on Twitter

Contact:         

Charles Coté, 202-207-3605

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, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.

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In 1965, the United States government enacted legislation to provide low-income individuals with quality health care and related services. Initially viewed as the friendless stepchild of Medicare, Medicaid has grown exponentially since its inception, becoming a formidable force of its own. Funded jointly by the national government and each of the fifty states, the program is now the fourth most expensive item in the federal budget and the second largest category of spending for almost every stat

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Senior planning Services: Medicaid Made Simple

Howell, NJ (Vocus/PRWEB) February 01, 2011

Senior Planning Services, a social service firm based in Howell New Jersey, has effected positive change for seniors who are in need of Medicaid benefits in New Jersey.

Prior to the existence of Senior Planning Services, the burden of applying for Medicaid would fall squarely on the shoulders of seniors and their families. Due to the complexities involved in the application process, applying for Medicaid has often been met with failure and frustration.

Among other things, obtaining Medicaid eligibility requires the presentation of various documents. Some examples of documents that may be required by Medicaid include; birth certificate, proof of marital status and five years of all financial statements.

It is no wonder that the prospect of applying for Medicaid can be overwhelming to senior citizens and their families who may already struggling with the stress associated with caring for their loved one. The added anxiety associated with Medicaid has been a bane to contend with for seniors and their families.

When applying for Medicaid, there are often questions that seniors and their families need to have answered. Since every situation is unique, there are countless different Medicaid related scenarios that need to be handled correctly to ensure the best possible outcome. Medicaid expertise is required to navigate the intricate nuance that each scenario presents.

Senior Planning Services, a social service firm in Howell New Jersey has recognized and addressed all of the issues outlined above. They have pioneered their breakthrough Medicaid application program. Now, the entire undertaking associated with applying for Medicaid can be placed on Senior Planning Services shoulders. Their expert caseworkers will do all the work in place of the applicant. They will fill out the forms, they will gather all relevant documentation and they will travel to the Medicaid office for a face to face interview on behalf of their clients. Senior Planning Services will ensure that the Medicaid “spend down” is done correctly.

In order to facilitate maximum convenience, Senior Planning Services will even consult with applicants in their homes. In short Senior Planning Services has effectively changed the Medicaid application experience. What was once stressful can now be easy.

Senior Planning Services does free Medicaid consulting. They take pride in helping the community by answering all Medicaid questions that people may have. For help with your NJ Medicaid application, call Senior Planning Services at (732) 961 – 8430. Visit them online at http://www.Senior-Planning.com .

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, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.

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Washington, DC (Vocus) December 6, 2010

A new study from The Lewin Group finds that Medicaid pharmacy could save more than $ 30 billion over the next decade by transitioning from the current approach used by state Medicaid fee-for-service (FFS) programs to the more efficient approaches used by Medicare Part D plans, Medicaid managed care organizations (MCOs), and the commercial sector, including typical state employee plans.

The study notes that Medicaid FFS pharmacy programs use fewer generic drugs and pay pharmacies higher dispensing fees and ingredient costs than other programs. The findings from this groundbreaking report challenge the assumption that Medicaid pharmacy can only reduce costs by cutting benefits, limiting eligibility, demanding deeper manufacturer rebates, or paying drugstores higher dispensing fees in exchange for more pricing transparency.

“Medicaid is one of the few pharmacy benefit programs that still relies heavily upon a fee-for-service approach. By operating more like Medicare and commercial market plans, Medicaid could increase the use of generics and save billions without cutting benefits,” said Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt.

Currently, three-fourths of Medicaid pharmacy dollars are administered using a fee-for-service approach in which public officials play a role in determining how much to pay drugstores for each prescription filled (dispensing fees) and ingredient costs (the reimbursement for the cost of the actual drugs). The other one-fourth of Medicaid pharmacy is managed more like pharmacy benefits in the commercial sector, where third-parties use proven utilization management tools and negotiate pharmacy payments directly with chain drugstores and the drug wholesalers that represent independent pharmacies.

The Lewin study also finds that although state Medicaid programs pay widely varying Medicaid dispensing fees, these decisions seem largely unrelated to the level of ingredient cost reimbursements a state pays or the level of generic utilization a state achieves. For example, Texas pays the nation’s highest dispensing fees ($ 7.50) and New Hampshire pays the lowest ($ 1.75), but they both pay about the same for ingredient costs and generate similar rates of generic drug utilization.

Many Medicaid pharmacy discussions begin and end with the issue of the drug manufacturer rebates. However, the statutory and supplemental rebates paid to Medicaid by brand name drug manufacturers are determined separately from pharmacy dispensing fees and ingredient costs. This means that manufacturer rebates have no impact on the savings that more active management of dispensing fees and ingredient costs could achieve. Likewise, these savings also do not assume any additional cost sharing for Medicaid beneficiaries.

Key Findings

Savings Opportunities Exist In Four Key Areas

While Medicaid FFS programs and costs vary greatly state-by-state, The Lewin Group identified four key areas where pharmacy benefit management could generally be improved:

Generic Drug Dispensing: Medicaid FFS is less effective at encouraging the dispensing of generic drugs in place of brands. The generic dispensing rate in Medicaid FFS averages 68%, compared to an average 80% generic dispensing rate in Medicaid MCOs.

Dispensing Fees: At $ 4.81 per prescription, the national average dispensing fee that Medicaid FFS programs pay to retail pharmacies per each prescription is more than double the average dispensing fees paid by Medicare Part D payers, Medicaid MCOs, or health plans in the commercial sector.

Ingredient Costs: The rate at which retail pharmacies are reimbursed for the actual medication ingredients (pills, capsules, etc.) is also higher, on average, in Medicaid FFS programs than in Medicare Part D or the commercial sector.

Drug Utilization: The number of prescriptions dispensed per person is typically higher in Medicaid FFS programs than in Medicaid MCOs due to less effective controls on polypharmacy, fraud, waste, abuse, and other factors in the FFS setting.

Estimated Federal and State Medicaid Savings

If all state Medicaid programs used a market-based approach such that dispensing fees, ingredient costs, drug utilization, and generic drug dispensing were brought in-line with norms for Medicaid MCOs, Medicare Part D, and commercial payers, Lewin estimates that:

Combined federal and state savings to the Medicaid program would total $ 30.3 billion over the next decade.
Medicaid FFS prescription costs could be reduced by 14.8%.
Per member per month (PMPM) costs for Medicaid FFS pharmacy benefits could be reduced by $ 12 in 2011 under optimal management.

PCMA represents the nation’s pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 210-plus million Americans.

The full report can be obtained at no charge at http://www.lewin.com/content/publications/Medicaid_Pharmacy_Savings_Report.pdf .

Follow PCMA on Twitter

###

©Copyright 1997-

, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.

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