Analysis: Patients face more hurdles accessing drugs in exchange plans vs. employer coverage
WASHINGTON — A new analysis from Avalere Health released Monday found that consumers purchasing insurance through exchanges are twice as likely to face utilization management controls on prescription medications compared with people enrolled in employer-sponsored insurance plans. Utilization management controls, including prior authorization and step therapy, are administrative steps that patients and their physicians must complete to demonstrate appropriate use of the drugs. These tools are used by health plans to limit access to specific medications and, in some cases, reduce costs.
Branded mental health and oncology medications were extremely likely to be subject to step therapy or prior authorization, with more than 70% of covered drugs requiring utilization management in exchange plans. HIV/AIDS drugs had the lowest incidence of utilization management, with more than half of exchange plans providing open access to these medications.
“This is one more reminder that consumers shopping on the exchange need to look beyond premium costs when picking a plan,” stated Caroline Pearson, VP Avalere Health. “Patients may be better off selecting a plan that includes open access for drugs they use regularly, and they will need to work closely with their physicians to fulfill utilization management requirements where they exist.”
Health plans rely on utilization management tools to encourage use of lower-cost or generic drugs, as well as to ensure that the drugs prescribed are appropriate to a patient’s medical condition. However, those tools also may be a barrier to accessing needed medications, particularly for vulnerable populations like severely mentally ill patients. Utilization management for mental health drugs is more than four times more common for exchanges compared to employer coverage.
“Insurers offering exchange products are trying balance access and cost to ensure that consumers are getting value,” said Matt Eyles, EVP Avalere Health. “The utilization management tools we profiled are not as widely used in commercial insurance settings, so they need to be closely monitored for their effects on consumers and on the clinicians responsible for their administration.”
Rite Aid raises $6.8 million for Children’s Miracle Network Hospitals
CAMP HILL, Pa. — Rite Aid announced Monday that through its year-long fundraising efforts, the company raised $6.8 million for Children’s Miracle Network Hospitals in 2013, a record-breaking amount in the drug store chain’s 19 years of support for the charity. The money raised by Rite Aid funds care, research and equipment at 95 Children’s Miracle Network Hospitals in communities served by Rite Aid.
“To surpass our previous fundraising record by nearly $1 million, truly shows how committed Rite Aid associates are to supporting their local Children’s Miracle Network Hospitals,” said Ken Martindale, Rite Aid president, COO and president of the Rite Aid Foundation. “Thank you to all Rite Aid associates for another successful campaign and your continuous dedication towards delivering on our core value of being a caring neighbor.”
“Rite Aid amazed us once again with another record-breaking fundraising campaign in 2013, truly delivering on their core value of being a caring neighbor,” stated John Lauck, Children’s Miracle Network Hospitals president and CEO. “Thanks to the generosity of Rite Aid associates, customers and supplier partners, Children’s Miracle Network Hospitals is able to fulfill its mission of saving and improving the lives of as many children as possible. We are so thankful for our ongoing partnership with Rite Aid and all they do throughout the year to help sick and injured children in the communities they serve.”
The 2013 campaign kicked off last spring with its annual Miracle Balloon fundraiser. Additional funds were raised through community fundraisers, including annual events like a motorcycle ride organized by the company’s Dayville, Conn., distribution center, a Zumba-thon hosted by the Rite Aid in Prestonburg, Ky., a motorcycle ride organized by Rite Aid associates in Salem, Ohio, and countless car washes, bake sales and golf tournaments. And members of Rite Aid’s management team help raise funds by dedicating a day each summer to washing cars and competing in various activities at the company’s headquarters in Camp Hill, Pa.
Since becoming a sponsor in 1994, Rite Aid has raised more than $64 million for Children’s Miracle Network Hospitals.
OPI develops Coca-Cola-inspired nail polish
LOS ANGELES — OPI Products, a subsidiary of Coty, has collaborated with Coca-Cola to create a line of OPI nail lacquers inspired by several of the company’s most recognized brands, including Coca-Cola, Diet Coke, Coke Zero, Cherry Coke, Vanilla Coke, Sprite and Fanta.
The line of limited-edition nail lacquers will launch internationally in June.
“As the global leader in the professional nail industry, OPI is thrilled to partner with the world’s top beverage company, the Coca-Cola Co.,” stated Suzi Weiss-Fischmann, OPI co-founder and EVP. “These two iconic brands truly deliver happiness in a bottle — whether it’s a refreshing, invigorating sip of Coke, or a set of fingers and toes perfectly polished with OPI nail lacquer.”