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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

A 30-month evaluation of the effects on the cost and utilization of proton pump inhibitors from adding omeprazole OTC to drug benefit coverage in a state employee health plan.

OBJECTIVE: On March 1, 2004, the state employee health plan began covering omeprazole OTC (over the counter) at a $5 copayment. Reimbursement to pharmacy providers for omeprazole OTC increased by $10.50 per claim, from $2.50 to a $13 dispensing fee. Initially, neither generic omeprazole prescription (Rx) nor brand omeprazole Rx was covered because omeprazole OTC was available in the same strength as the Rx products at a lower cost, but an omeprazole OTC shortage necessitated coverage of generic omeprazole Rx at a $10 copay. The objective of this study was to evaluate the long-term financial impact of a drug benefit policy change on a mid-size state employee health plan and its beneficiaries associated with the addition to coverage of omeprazole OTC. METHODS: The pharmacy claims database for the employee benefits division (EBD) was used to examine utilization and cost data for beneficiaries who received proton pump inhibitors (PPIs). Pharmacy claims for the 30-month period for dates of service from December 1, 2002, through May 31, 2005, were extracted from the database, yielding a preperiod of 15 months and a postpolicy change period of 15 months. RESULTS: In the 15-month postperiod, the number of PPI claims per member per month (PMPM) decreased by 3.9%, but the days of PPI therapy PMPM increased from 1.71 to 1.82 (6.4%). Price as measured by the allowed charge per day of drug therapy decreased from $4.25 to $2.74 (35.6%) despite an increase of $1.89 (76%) in the average dispensing paid per PPI claim to pharmacies, from $2.49 to $4.38. The average beneficiary copayment decreased by $0.50 (2.0%) per PPI claim, from $25.06 in the preperiod to $24.56 per claim in the postperiod. Therefore, the net heath plan cost for PPIs decreased by $2.20 PMPM (37.6%) during the 15-month postperiod, from $5.84 to $3.64 PMPM, producing savings of $4,207,350, or annualized savings of $3,365,880, in this employee benefit plan of 127,495 members. CONCLUSION: A change in policy to include coverage of omeprazole OTC and an increase in pharmacy reimbursement for omeprazole OTC resulted in 38% net savings to a state employee health plan. The large difference in drug acquisition cost between omeprazole OTC and the other Rx-only PPIs made it possible to implement a program intervention that provided financial benefit to pharmacists, beneficiaries, and the drug plan sponsor despite a 6% increase in PPI utilization.

Arkansas↗
PubMed1994

Health systems planning at a state level: New Jersey.

In 1991, New Jersey undertook a planning effort to eliminate the proliferation of high cost, redundant services, downsize or eliminate underutilized services, develop primary and preventive services, and consolidate regional services. The recommendation to reduce the number of accredited hospitals created serious opposition from a variety of interests and the legislature subsequently enacted legislation prohibiting enactment of rules to implement the plan. More recently, New Jersey undertook new legislation to reform health insurance to require community rating, availability of individual and small group policies, eliminate restriction on pre-existing conditions, and promote competition. Legislation also provided for hospital care of indigents to be funded by a change in the unemployment insurance system. The latter was to replace a funding mechanism which was initially invalidated by a Federal Court. In future years, some of these funds will be shifted to a subsidized insurance program. There is already evidence that these reforms have resulted in increased competition among insurance companies, hospitals, and providers. Hopefully, this will contain costs without a decrement to quality. It should also increase the number of people with health coverage, although this does not provide for universal coverage.

Health Care Reform↗
PubMed1978

Use of quantitative approaches in plan development.

Health Planning as mandated by P.L. 93-641 requires considerable emphasis on technical procedures, especially during the development of the 5 year Health Systems Plans (HSP) and the one year Annual Implementation Plans (AIP). In addition, the State Health Plans and the State Medical Facilities Plans, which are to be developed in part on the basis of HSPs and AIPs of the Health Systems Agencies (HSAs) in each state, are expected to have solid quantitative documentation. The gap between these expectations and the state of the art reality are reviewed in this article.

Evaluation Studies as Topic↗
PubMedDate not supplied

Effects on the cost and utilization of proton pump inhibitors from adding over-the counter omeprazole to drug benefit coverage in a state employee health plan.

OBJECTIVE: To evaluate the financial effects in a state employee health plan of a change in the drug coverage policy to include over-the-counter (OTC) omeprazole in a tier-copayment drug benefit design that favored the OTC drug. METHODS: The policy change in the Arkansas State Employee Benefit Division (EBD) involved 2 principal parts: OTC omeprazole placed in a new OTC copayment tier (5 dollars) and an increase in pharmacy reimbursement to a 13 dollars dispensing fee for each OTC omeprazole prescription. The prescription claims database was used to examine utilization and cost data for beneficiaries who received prescriptions for a proton pump inhibitor (PPI) during the 2-month period (January and February 2004) preceding the change in policy to cover OTC omeprazole compared with the 2-month period following the policy change (March and April 2004). RESULTS: During the first week of the new policy (March 1-7, 2004), OTC omeprazole accounted for 47% of all PPI claims. From the third week through the end of the 2-month study period, OTC omeprazole represented 60% of PPI claims. This shift to OTC omeprazole from prescription PPIs produced EBD average savings of 40.86 dollars (40.5%) per PPI claim in the first 2 months after implementation of coverage of OTC omeprazole compared with the immediate previous 2-month period. The average copayment savings for EBD beneficiaries were 4.20 dollars (16.5%) per PPI claim. The average increase in pharmacy reimbursement was 118% (6.27 dollars per claim in the postperiod versus 2.88 dollars per claim in the preperiod). Despite a 17.2% increase in utilization as measured by days of PPI therapy per member per month (1.91 PMPM) in the postperiod versus 1.63 in the preperiod, EBD savings were 2.11 dollars (38.9%) PMPM. Based upon PMPM savings of 2.56 dollars in the second month of coverage of OTC omeprazole, annual savings would be about 3,978,240 dollars for average eligible membership of 129,500 in this state employee health plan. CONCLUSION: This policy change to include coverage of OTC omeprazole in the state employee drug benefit plan produced savings to the state of as much as 50% of the total cost of PPI drugs despite an apparent small increase in utilization of PPIs and an increase in pharmacy reimbursement of more than 100%. Plan beneficiaries realized significant savings on average for PPI drugs and particularly for each OTC omeprazole prescription.

Anti-Ulcer Agents↗
PubMed1980

Migrant health revisited: a model for statewide health planning and services.

Since the migrant farmworker family is a marginal issue among competing priorities for public health services, the logical strategy ought to be the pooling of limited resources at the state and local level to provide maximum benefit for the dollar and the client. A program planning model in inter-agency migrant health services delivery has been developed in Colorado. The model includes tangible evidence of cooperation by front-line service agencies. A task force approach for joint agency programming was initiated at state and local levels, and a structure for accountability was established which was carried out with performance contracts.

Agriculture↗
PubMed1998

Health plans and state tort liability.

In 1997, Texas enacted legislation expanding state tort liability to health plans. The following article discusses major provisions of the Texas health plan liability law, as well as a recent lawsuit asserting that the statute is preempted by the Employee Retirement Income Security Act and the Federal Employees Health Benefits Act.

Liability, Legal↗