Got an interesting flyer from Humana today. Effective May 1, they’re changing how they cover certain medications. Based on previous experience, I expect other carriers to follow suit shortly.
The letter starts out auspiciously enough:
“Humana is launching a new program designed to help employees who take certain high-cost drugs save money each month on their prescriptions. And when employees choose less expensive drugs, overall pharmacy costs should decrease.”
The program targets specific medications that have “lower-cost alternatives,” presumably generic equivalents. For now, Humana is focusing on meds for heartburn, pain, allergy and high cholesterol. Left unsaid, but certainly easily inferred, look for blood pressure and anti-depressant meds to follow.
The program is set up so that, at the next refill (or, for first-time use, the initial scrip), insured’s will need to talk with their doc about their new options:
- Switch to lower-cost alternative (i.e. generic),
- Stay on current med, but absorb a greater share of the cost, or
- Obtain authorization to continue with their current prescription
This is really not all that new, and I’m not convinced that it’s necessarily a bad idea. In recent years, a disproportionate percentage of health costs – and renewal increases --has been attributable to meds. And many carriers have implemented a “formulary-based” protocol; that is, if you’re med isn’t on their “preferred” list, you pay more (sometimes a LOT more) for it.
This move is also consistent with Humana’s increasing push for Consumer Driven Health Care. The idea is that patients should be taking a more pro-active role in their own care. We see this in the widespread publicity (if not actual purchase) of High Deductible Health Plans and HSA’s, and the disappearance of the lower end of the deductible scale (when was the last time you saw a $250 deductible?).
I actually applaud this move, because it encourages us to take a more active role in our care, and in how we access and use the healthcare system. The funny thing is, I don’t currently have any groups with Humana (that’s another post), but I think that this move is a positive step in the evolution of how we pay for healthcare.
Thx for posting this, and also for sending the Humana info!
ReplyDeleteWhen your email arrived I was having one of "those" days when putting out fires was a top priority. I briefly glanced at the attachments and your email. Making a mental note of the subject MYB Act, my initial thought was this is some crazy government scheme telling carriers (or insureds, or both) to Mind Your Business.
Upon reading further I have to agree and say "this is a good thing". There are too many insureds (particularly those in corporate plans) who participate in Zombie medicine practices.
In other words, they see an ad for a new med and, since it only costs THEM $15, they immediately pressure their physician to put them on this latest miracle drug. Docs are all to happy to comply for a number of reasons, not the least of which is defensive medicine . . . but that should be left for another post.
Of course the "hidden" cost is much more than $15, probably more like $100+. So the patient pays $15 and is now convinced this new drug will cure what ails them and maybe even bring about world peace. In the meanwhile the carrier coughs up the additional $85 and then factors that in to next years renewal rate increase.
I try to be sensitive to the public in their cries for lower premiums and more affordable health care . . . but without accountability (on the part of the insured) their pleas fall on deaf ears.
I liken these Zombie insureds to folks on a meal plan, pretty much like in college. You (more precisely the parents of the students) pre-pay for a semester of meals. This entitles the bearer of the ID card to unlimited meals, and unlimited portions, anytime during the semester.
Some on the meal plan will not change their eating habits and will only eat when necessary and in controlled portions. Others will use the plan as an excuse to eat as much as they want any time they want.
When consumers know the actual cost of an item, and have to bear some of the direct cost of those items, their buying habits change.
If auto insurance premiums included the cost of gasoline, oil changes, tires and wiper blades people would SCREAM about the high price of car insurance.
With (too many) health insurance plans covering routine maintenance, and doing so at low copays that bear no relationship to the actual cost, it is no wonder we have Zombies asking for the newest (and most expensive) meds to fix their problems.
Bob Vineyard, CLU