Post Medical Job

Do you have a permanent (full-time or part-time) opening for a high-quality medical specialist? Click Here to post More »

Post Your Resume Here

Are you a healthcare professional working long 12 -14 hour days, too many weekends and holidays, or traveling too far from home? Are you not home for dinner usually or not able to spend enough quality time with your family More »

About US

NSI Healthcare Recruiters is one of the most trusted and reliable recruitment and placement services available to medical professionals in the USA. NSI has been in business for over 29 years and has assisted many healthcare providers in locating and hiring qualified medical professionals. More »

Contact Us

Candidates: Because our posted healthcare jobs are filled quickly we ask that you contact us for the latest updates. Employers: Please post your job here for affordable placement service. More »

Health-Care-Recruiter.com

We at Health-Care-Recruiter.com pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. More »

 

Daily Archives: December 21, 2015

Pharmacists Prescribing Birth Control And What It Means For Wider Access To The Pill

California and Oregon have passed law allowing women to bypass their doctors and get a birth control prescribed by a pharmacist. Many doctors say this is safe, but others argue that these measures don’t go far enough in ensuring women have access to these contraceptives and would prefer birth control pills be offered over the counter.

KHN’s Julie Rovner appeared on The Diane Rehm Show Monday to discuss the issue.

Listen to the conversation here.

This copyrighted story comes from WAMU’s The Diane Rehm Show. All rights reserved.

Other guests:

Frank Palumbo,executive director of the University of Maryland School of Pharmacy Center on Drugs and Public Policy

Dr. Nancy Stanwoodassociate professor of obstetrics and gynecology, Yale School of Medicine; board chairwoman, Physicians for Reproductive Health

  • Dr. Mark DeFrancescopresident, American Congress of Obstetricians and Gynecologists

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Health Plans’ Coverage Of Some Drugs Can Be A Source Of Consumer Confusion

Patients getting chemotherapy or other complex medications may have a sudden panic when shopping for health insurance: Their drugs often don’t appear to be covered.

“People think, ‘Jeez, what do I do now?’” said Anna Howard, policy principal at the American Cancer Society Cancer Action Network.

Despite advice to shop around before selecting a plan, consumers may find that getting answers about drug coverage can be an exercise in frustration, despite a federal health law requirement that insurers provide lists of the prescription medications included in their plans.

That’s because many treatments — particularly intravenous treatments like those used in cancer, hemophilia or multiple sclerosis — are covered under a separate part of an insurance plan, not the pharmacy benefit. And details of that medical-benefit drug coverage can be hard or impossible to find online. But the information is important to know because the drugs tend to be costly, so if they’re not covered, patients might have to pay out of pocket, switch to different treatments or appeal to the plan.

It’s fairly straightforward to check online formularies for pharmacy-covered medications, such as cholesterol treatments or blood pressure medications.

This KHN story also ran in USA Today. It can be republished for free (details).

But checking for medical-benefit drugs is much more complicated for consumers and can involve clicking through layers of websites. Even finding out if a drug is part of the medical benefit coverage instead of the pharmacy formulary isn’t easy.

“I haven’t been able to find that and I do this for a living,” said Katie Verb, associate director of policy and government relations at the Hemophilia Federation of America.

Medical-benefit drugs are mainly complex treatments that are infused or injected in a medical setting, such as a doctor’s office or chemotherapy clinic. In contrast, pharmacy-side drugs are generally pills or are self-administered injections.

In doing a search, consumers might need to know to which “therapeutic class” their drugs belong, or possibly their generic names. Even then, the information might not be available online. Insurers’ call lines don’t always have information about medical benefit drug coverage, either.

Insurers admit the difficulty in finding the information about intravenous drugs covered under the medical benefit.

“It requires legwork,” said Don Liss, a physician and vice president of clinical programs at Independence Blue Cross in Pennsylvania. “These calls get transferred to me on occasion.”

What kind of legwork?

This reporter tried to find the answer to a seemingly simple question posed by a friend: Is the chemotherapy drug she will soon need — Abraxane — covered by any of the insurance plans in her area?

Using directories available through the federal government marketplace, healthcare.gov, one could quickly locate in-network doctors, hospitals and labs for insurance plans in her area. Not so with Abraxane, approved in 2005 to treat metastatic breast cancer.

Typing it into the drug finder for one major insurer — CareFirst BlueCross Blue Shield in Virginia — yielded no information. Nor did it appear on an initial search for covered drugs in plans from Innovation Health, a partnership between Aetna and the Inova Health System. The link to the drug lists on healthcare.gov for plans offered by UnitedHealth Group didn’t work at all, showing only “no records found.”

Such broken links and missing information were noted in two recent studies by the Cancer Action Network, which concluded that simply relying on insurers’ websites or the online marketplace isn’t enough. The group, which studied health plans sold through federal and state exchanges in six states, also found that coverage for intravenous medications was unclear in most plans.

Verb and other advocates say information about medical-benefit drugs should also be posted, pointing to a few states, including West Virginia and Texas, with new laws requiring insurers to provide “information sufficient to determine whether a specific drug is covered when furnished by a physician or clinic.”

One difficulty with providing lists of medical benefit treatments on marketplace websites, insurers say, is that there are nuances with many treatments. It isn’t just a matter of yes or no.

Some oncology drugs, for example, are covered for certain types of cancer, but not others, Liss at Independence said.

He noted that on Independence’s website, consumers can reach a tab called “medical policies,” then type in a drug name to find coverage policies for various treatments under the medical benefit. Doing so for Abraxane shows it is a covered medication for metastatic breast cancer and some other cancers.

In addition to searching websites for “medical policies,” what are other steps consumers can take to find if their medications are covered?

Try searching by type of drug.

When an initial search of the “drug finder” function didn’t come up with Abraxane, the Innovation Health site suggested searching by “therapeutic class.” But there are many classes and subtypes, some with names like “hedgehog pathway inhibitors” or “nitrogen mustards.” Consumers may need to consult their physicians or the drug companies to find out.

Ask your doctor or billing office.

Oncologists generally know which drugs are covered by local insurers — and which are more problematic. Billing office managers are also familiar with coverage, so ask, and be specific about the insurer and the plan under consideration. Many insurers cover all treatments recommended by the National Comprehensive Cancer Network, a nonprofit alliance of 26 major cancer centers.

Check the generic name.

Some drugs are listed by generic name. Abraxane, for example, is the brand name for a type of paclitaxel. Entering that generic name on Innovation’s drug finder located it on the formulary. Still, that doesn’t work every time. CareFirst’s website didn’t list paclitaxel either.

Call the plan.

Have the exact name of the plan you are considering, as formularies and policies can vary, even within the same insurer. Federal regulations say information must be made available to prospective customers as well as existing ones. But sales reps may not have information about drugs covered under the medical benefit, rather than the pharmacy side.

CareFirst’s member services and sales staff found Abraxane was covered under the medical benefit on a 2015 formulary, but representatives said the 2016 list wasn’t available. Eventually, CareFirst’s public relations representative said the 2015 specialty list won’t change for 2016, so the drug is covered.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Regulators To Investigate Blood-Testing Startup Theranos

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Viewpoints: Health Law Faltering Despite GOP; The Case For A Switch In Iowa Medicaid

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

State Highlights: Colorado To Vote On Single-Payer In ’16; Demise Of Co-op Floods New York Marketplace

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

FTC Signals Its Plan To Block Merger Of Two Illinois Hospitals

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Hospitals In 15 States To Pay $28M To Settle Medicare Fraud Case

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Change In Kidney Transplant Rules Benefiting Hardest-To-Match Patients

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Practice Of Concurrent Surgeries Has Some Surgeons Under The Microscope

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Employers Feel The Pinch Of Rising Drug Costs

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS