Foundation for HealthSmart Consumers: New OTC reimbursement rule will be costly
WASHINGTON A panel of healthcare thought leaders has concluded that a recent IRS rule change requiring a written prescription so that over-the-counter medicines can be eligible for reimbursement under flexible spending accounts will demand retail system challenges that are operationally impossible to overcome in the time frame required.
“We see this as a threat to consumer access and choice at a time when we need our citizens to be more engaged in managing their health and the cost of care,” stated Jon Comola, executive director of the Foundation for HealthSmart Consumers. Because of the new rule change, Comola said, “some consumers are likely to seek prescriptions for OTCs or alternative [prescription] drugs in order to comply with the new tax requirement.”
According to Foundation researchers, the resulting costs could reach $2.5 billion annually if office visits and lab tests are incurred by even 10% of the insured population; potential new pharmacy costs could reach $3 billion annually.
“We are concerned about the negative impact on people who are using OTCs to address health issues like smoking cessation, weight control, arthritis and allergies because of the increased tax on higher cost products,” said Jim Parker, fellow for The Foundation. “This may result in increased physician visits and potentially the prescribing of more expensive prescription drugs.”
The number of consumers who take advantage of health spending accounts is not insignificant, the Foundation added. “More than 50 million of the 195 million commercially insured consumers have healthcare accounts and will be directly affected by this new rule,” noted Roy Ramthun, president HSA Consulting.
As of Jan. 1, consumers will no longer be able to pay for most OTC medicines with funds from their flexible spending accounts and other health accounts (including HSAs and HRAs) unless the OTCs are “prescribed.” Retailers already are taking steps to warn shoppers of the new restrictions on purchases of OTC medicines using funds from their healthcare accounts.
This rule change, enacted as part of the Patient Protection and Affordable Care Act, is intended to help fund increases in healthcare spending in other parts of the bill.
Express Scripts looks to curb nonadherence among patients
ST. LOUIS Pharmacy benefit manager Express Scripts said it has created a way to accurately predict which patients were most at risk of not adhering to their medications.
The PBM announced Monday that it had created a computer model that could predict whether a patient would fail to take medications as prescribed up to a year in advance, allowing early intervention to improve adherence. The company said patent protection for the model is pending. According to Express Scripts’ 2009 Drug Trend Report, nonadherence results in $106 billion being wasted on increased medical costs every year.
“The problem of nonadherence isn’t new — it’s easy to walk through a hospital and identify people who would not be there if they had simply taken their medications,” Express Scripts chief medical officer Steven Miller said. “But our new predictive models allow us to do something that wasn’t possible before: better identify those patients before they run into trouble and tailor practical, patient-centric solutions that target the specific factors that put them at risk for nonadherence.”
Alcon introduces new lubricant eye drops
HUENENBERG, Switzerland Alcon on Monday announced the launch of Systane Balance lubricant eye drops, formulated with HP Guar, borate, sorbitol, propylene glycol and Alcon’s exclusive LipiTech System — an emulsion technology of mineral oil and an anionic phospholipid. The new eye drop is designed to restore the lipid layer and the natural tear film to allow for relief of dry-eye symptoms.
“We are dedicated to applying scientific rigor to discover treatments for chronic conditions, such as dry eye,” stated Sabri Markabi, Alcon chief medical officer and SVP research and development. “[For example], meibomian gland dysfunction is a significant cause of dry eye symptoms, and now patients who suffer from dry eye associated with MGD can use Systane Balance to restore their lipid layer, re-establish their natural tear film and maintain their tear film stability.”
MGD is the most common cause of evaporative dry eye, with an estimated 50% of dry-eye patients experiencing MGD. Physicians observed an association between the use of Systane Balance and better tear film stabilization, as well as an improvement in the thickening of the lipid layer, which are desirable characteristics in treating dry eye. Unlike some other drops where blurring may be a concern, patients reported minimal blur after instilling drops of Systane Balance, the company stated.