Monday, October 11, 2004

Medicare Demonstration PPOs
A September GAO report to the House Finance Committeein Adobe Acrobat format - "Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare’s private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a total of 34 PPOs. GAO (1) described how CMS used its statutory authority to conduct the two demonstrations, (2) assessed the extent to which demonstration PPOs expanded access to Medicare health plans and attracted enrollees in 2003, (3) compared CMS’s estimates of out-of-pocket costs beneficiaries incurred in demonstration PPOs with those of other types of coverage, including fee-for-service (FFS) Medicare, M+C plans, and Medigap policies in 2003, and (4) determined the effects of demonstration PPOs on Medicare spending."  
  

Safe and Effective Approaches to Lowering State Prescription Drug Costs: Best Practices Among State Medicaid Drug Programs
A September CMS/HHS report in Adobe Acrobat format - "As a result of increasing prescription drug costs, State Medicaid programs have implemented a variety of cost-containment mechanisms in their drug programs over the past few years. These mechanisms have allowed states to reduce their pharmacy expenditures and maintain beneficiary access to a vital part of their overall healthcare. This paper describes some of these cost-containment mechanisms and highlights several states that have achieved reduced costs with each technique. In general, states have not yet taken advantage of all of these approaches. CMS can provide consultation and support to assist states in using these and other methods to lower their drug costs without compromising quality of care."  
  

Preferred lists for drugs such as Prozac? (Virginia)
October 7 Richmond Times-Dispatch story - "State Medicaid officials yesterday moved closer to making antidepressants such as Prozac and Zoloft subject to tighter prescribing procedures - but just how strict is yet to be determined. In an effort to control costs, the state agency has created lists of preferred drugs that doctors select from when prescribing drugs for Medicaid patients. That way, the state can negotiate better prices on the preferred drugs. At the urging of mental-health advocates, antidepressants and anti-anxiety drugs had been excluded from that process - until yesterday. Despite testimony from advocates that psychotropic drugs should be given special consideration, the Medicaid agency's Pharmacy and Therapeutics Committee yesterday voted to consider preferred drug lists in those categories..."