Health Management

The Generic Purple Pill – How Nexium’s Expiring Patent Could Cut Your Medical Plan Costs by Thousands

The Generic Purple Pill – How Nexium’s Expiring Patent Could Cut Your Medical Plan Costs by Thousands

Nexium, the coveted “Purple Pill,” is losing its monopoly in a big manner come May 27. Nexium finished off 2013 with over $6 billion in sales, and was the second best-selling drug in the United States behind only Abilify. AstraZeneca, the pharmaceutical manufacturer of Nexium, has spent the past decade in legal battles over their exclusivity rights to the medication, effectively keeping other manufacturers from producing the same drug. Nexium is in a class of drugs called Proton-Pump Inhibitors, which treat ulcers and gastroesophageal reflux disease (GERD), by reducing the amount of acid in the stomach. While there are other medications that fall under the Proton-Pump Inhibitor classification, Nexium currently does not have a generic equivalent. That is slated to change, however, when AstraZeneca’s patent expires this May and other pharmaceutical companies can begin producing a generic version of the drug. The average retail price of a 30-day supply is a whopping $250, meaning that one employee taking Nexium costs the plan approximately $3000 per year just on this one prescription. But it’s not just one employee. Studies show that as much as 60 percent of American adults experience symptoms of GERD, such as heartburn and regurgitation. GERD essentially is

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What’s The Return On Investment Of Employee Wellness Programs?

What's The Return On Investment Of Employee Wellness Programs?

Have you ever wondered what the return on investment is for employee wellness programs?  You’re not the only one! The Department of Labor and Health and Human Services also wanted to look at the impact of employer sponsored wellness plans and those results created a stir in the wellness community. The first report was performed by the Rand Corporation and commissioned by the Department of Labor and Health and Human Services.  As more employers begin to implement wellness programs, the government entities wanted to determine the impact of employer wellness programs on the employee’s health and ultimately lowering health care cost.  This government sponsored study focused on the “lifestyle” (exercise, nutrition, stress, tobacco use) of employees.  Based on their results, the Rand study determined those employees that participated in employer wellness programs can reduce risk factors; however, the Rand Corporation did not see a cost reduction that was statistically significant. PepsiCo has since released a different study examining their wellness programs performed by the same Rand Corporation.  PepsiCo’s study had a different twist. In addition to “lifestyle management”, PepsiCo’s also reviewed the impact of their “disease management programs” (programs focused on chronic conditions).  Both the lifestyle and disease management programs

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Why Generic Drug Prices Are On The Rise

Why Generic Drug Prices Are On The Rise

After years of low cost generic drugs, the industry that manufactures these drugs is consolidating, causing the elimination of competition.  To further improve profits these generic manufacturers are eliminating lower-utilized less popular drugs causing shortages in these drugs – all of this against the backdrop of the FDA’s increased concern over the quality of drugs manufactured overseas. More than ever its important to educate employees on the variation in the price of drugs from one pharmacy to another and that employees are the best front line to controlling healthcare costs for themselves and your company. The People’s Pharmacy has published a great article on this subject.

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New Blood Pressure Guidelines Could Affect Your Health Wellness Program

New Blood Pressure Guidelines Could Affect Your Health Wellness Program

New guidelines released by the Eighth Joint National Committee (JNC 8) late last year reveal that evidence suggests the need for a shift in the long-standing blood pressure recommendations. The guidelines, which were published in the Journal of the American Medical Association on December 18, 2013, provide a higher cutoff for prescribing blood pressure medications in older populations. The previous set of guidelines – which established a blood pressure of 140 mm Hg over 90 mm Hg or above as hypertension, and set the desired blood pressure at or below 120 mm Hg over 80 mm Hg – were published over a decade ago. The new guidelines continue to recommend a systolic blood pressure below 140 mm Hg for adults under 60. However, the committee determined that for adults over the age of 60, this threshold can be loosened to 150 mm Hg before beginning medication. Additionally, patients with diabetes and renal disease are now being informed that instead of adhering to a stricter systolic blood pressure of 130 mm Hg, they can follow the 140 mm Hg guideline. This advice has already become a highly contested topic and the blood pressure guidelines have been criticized by many doctors and organizations,

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Narrow Network Health Plans: Can Directing Care Achieve Better Results And Cut Costs?

Intel Inc. announced that it had decided to contract directly with a single provider system rather than working with a national commercial health insurer for 5,400 employees at its manufacturing plant in Rio Rancho, N.M. This single provider system will administer Intel’s benefits for eight health plan options and better manage the firm’s healthcare costs, according to officials. The decision to implement this system garnered national attention since it showed that one of the largest employers in the United States believes narrow provider networks is one solution to controlling healthcare expenses. This trend is also growing in popularity among some employers in North Carolina. The theory is that by establishing access to a small network of top-line providers for certain scheduled healthcare procedures and operations, employers will be offering medical services at a lower cost to both themselves and their employees (the patients). Narrow networks have gained prominence in the wake of a recent government report detailing how even within the same region, hospital costs can vary more than $200,000 for same procedure. With narrow networks, employers and insurers can overcome such wide differences in expenses by directing employees to more affordable treatment options. Controlling these costs will keep employees

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Know What Regulations To Consider For Your Corporate Wellness Plan

As more companies add wellness programs to keep healthcare claim costs down, they should consider what compliance regulations need to be followed for successful program implementation. Otherwise, workplace wellness plan savings can vanish due to penalties resulting from a failure to follow the rules. There are a few key rules to remember when setting up and monitoring a corporate wellness plan that can reduce the likelihood of violations for employers. Here is an overview of what to factor into an employee wellness program. Americans with Disabilities Act (ADA) The ADA prohibits employment discrimination against disabled individuals and limits the circumstances in which an employer may require physical examinations or answers to medical inquiries. For wellness plans to comply with ADA guidelines, voluntary medical exams and inquiries are permitted if: Participation in the program is voluntary; Information obtained is according to the confidentiality requirements of the ADA; and Information obtained is not used to discriminate against an employee The gray area here is determining exactly how “voluntary” is defined, as the Equal Employment Opportunity Commission (EEOC), which oversees ADA complaints, has not issued formal guidance. However, if the wellness program requires an employee to complete a health risks assessment to become eligible for

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Keep Your Health and Wellness Initiative On Track

Keep Your Health and Wellness Initiative On Track

While employers may consider a variety of options to help save money on medical plans, improving the health of employees is really the best way to reduce healthcare costs and produce positive long-term results. For example, 66 percent of companies with highly effective health and productivity programs report they perform better than their top competitors, versus 50 percent of companies with ineffective programs. While wellness initiatives are growing in popularity and being adopted by more companies, their effectiveness is limited if these programs fail to precipitate ongoing involvement by employees. It takes much more engagement than simply introducing employees to a new health initiative. Benchmarks of Success For the past 28 years, the Wellness Council of America (WELCOA) has been dedicated to studying the efforts of America’s healthiest companies and promoting its patented Well Workplace process. Through the Well Workplace model, WELCOA has identified seven key benchmarks of success that are inherent in companies adopting results-oriented workplace wellness programs: Capture CEO level support – management must be personally involved. Create a cohesive wellness committee/team that represents all levels of the organization, includes employees from all stages of wellness, meets regularly, and has an agenda and action items. Collect data, including health risk assessments

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Discounts & Total Health Immersion Program As Part of Your Wellness Program?

Discounts & Total Health Immersion Program As Part of Your Wellness Program?

When it comes to promoting wellness initiatives, one of the leading companies nationwide in this movement is Whole Foods Market. John Mackey, the company’s co-creator and co-CEO, recently discussed Whole Foods’ innovations in employee healthcare programs and mentioned two distinctive factors that he believes are cutting costs – a healthy discount incentive and total health immersion. The Healthy Discount Incentive Program Based on each team member’s degree of wellness, this program offers employees additional discounts at Whole Foods’ stores beyond the standard 20 percent that all of them receive. The extra discount is based on meeting certain biometric criteria for cholesterol levels, body mass index, height-to-waist ratio and blood pressure, along with being nicotine free. There are four additional levels of discounts based on the team member’s score. Total Health Immersion Program Whole Foods team members who are most at risk for getting ill or considered high-risk individuals — those who are obese, have heart disease or diabetes, or have very high cholesterol or blood pressure — have the opportunity to attend this innovative program. At the company’s expense, these team members can go to a medically-supervised program where they receive intensive training in healthy eating and living. While Mackey did not

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What Do the Final Regulations Addressing Employee Wellness Programs Mean?

What Do the Final Regulations Addressing Employee Wellness Programs Mean?

The IRS, DOL, and HHS (the Departments) have jointly issued final regulations addressing employee wellness programs under the Affordable Care Act (ACA).  These final regulations modify the proposed wellness regulations that were issued in November 2012.  The final regulations apply to insured and self-insured group health plans (both grandfathered and non-grandfathered) effective for plan years beginning on or after January 1, 2014. Most of the proposed regulations remained unchanged, including an increase in the maximum permissible reward under a health-contingent wellness program from 20 to 30% of the cost of individual coverage under the group health plan, and up to 50% for programs designed  to prevent or reduce tobacco use.  The final regulations contain clarifications as to what constitutes a reasonable design for health-contingent wellness programs (distinct from participatory wellness programs), and the reasonable alternatives that must be offered in order to avoid prohibited discrimination. The final regulations also rearrange the five health-contingent wellness program requirements, to clarify differences between “activity-only” wellness programs (requiring that  an individual perform or complete an activity related to a health factor, such as dieting or exercising, in order to obtain a reward) and “outcome-based” wellness programs (requiring an individual to attain or maintain a specific health outcome,  such

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The Eat Smart, Move More NC Campaign Against Obesity And Your Role In It

The Eat Smart, Move More NC Campaign Against Obesity And Your Role In It

In the wake of a recent report that 29.1 percent of adults in North Carolina are obese (more than the median number for the United States overall), the state has taken action to address this problem with a new initiative. The Eat Smart, Move More campaign is dedicated to helping residents of the state make healthy food choices which will in turn promote healthy communities. Laying out a plan for the next seven years (2013-2020), the campaign clearly states the stark facts about the healthcare burden North Carolina faces under present conditions, including: Excess weight in adults costs North Carolina more than $17.6 billion annually (medical costs plus lost productivity). Per capita healthcare spending for an obese person is roughly 42 percent higher than for someone of normal weight. Medicaid and Medicare pay approximately half of the medical costs associated with obesity. To reverse the trend in increasing obesity and the rise in healthcare costs associated with it, the Eat Smart, Move More campaign proposes the following core behaviors: Increase physical activity – Adults should do at least 150 minutes of moderate-intensity aerobic activity per week and muscle-strengthening activities that involve all major muscle groups for at least two days a week. Increase consumption of

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