Page 19

40113 ChoiceRx ePub long (1)

INTRODUCTION Prescription drug benefits Health care costs are on the rise and this increase will affect employers, employees and taxpayers. A key part of the health care delivery system in the United States is the use of prescription drugs. According to a 2010 heath care tracking survey, two-thirds of all Americans—and nearly 90 percent of seniors—reported taking at least one prescription drug in the past year.1 These prescription drug benefits are often built into the underlying health insurance plans. Prescription drug programs can range from minimal and insignificant coverage to full coverage amounting to tens of thousands of dollars per year. The vast majority of health care plans fall somewhere in between and result in billions in healthcare spending per year. While prescription drug benefits only amount to ten percent of all heath care spending in the U.S., this spending can still have a large impact on the cost of health care.2 Any program of such a large scale can benefit from continued evaluation and cost-control measures. The cost for the American taxpayers, health insurance companies and government payers continues to be an issue of debate.  Stakeholders, including the patients and beneficiaries of public health programs, have an interest in how prescription plans are used and how money is spent. Furthermore, the drug industry’s profit margins are of additional concern especially when taxpayers are underwriting some of the costs. Pharmaceutical manufacturing was the most profitable industry in the U.S. from 1995 to 2002, and in 2008 it enjoyed profits after taxes of about 19 percent.3 TRICARE, Federal Employee Health Benefit Plan (FEHBP) and Medicare TRICARE, the Federal Employee Health Benefit Plan and Medicare are taxpayer-funded healthcare coverage programs for the United States Department of Defense Military Health System, federal employees and the elderly, respectively. Federally-funded prescription plans are an integral part of these. The delivery of prescriptions can occur essentially in two ways, by picking up medication at a local pharmacy or through a mail order program through a Pharmacy Benefits Manager (PBM). Federally-funded prescription programs are typically administered by a PBM, which traditionally acts as a middleman. PBMs have grown in scope and size in recent years and exercise an unusual amount of power over the prescriptions that patients use and the payments pharmacies receive. Congress has begun to exercise oversight of these massive healthcare companies, and we urge more oversight on behalf of the taxpayer-funded public health programs. Evidence points to serious concerns and potentially millions if not billions of dollars in waste created by these large middlemen. 1. Center for Studying Health System Change. Tracking Report No. 27. N.p., Dec. 2011. Web. 31 Jan. 2013. <//www.hschange.com/CONTENT/1264/> 2. Prescription Drug Costs: Issue Modules, Background Brief - KaiserEDU.org, Health Policy Education from the Henry J. Kaiser Family Foundation.” Prescription Drug Costs: Issue Modules, Background Brief - KaiserEDU.org, Health Policy Education from the Henry J. Kaiser Family Foundation. N.p., n.d. Web. 31 Jan. 2013. <http://www.kaiseredu.org/ Issue-Modules/Prescription-Drug-Costs/Background-Brief.aspx#footnote5> 3. Center for Studying Health System Change. Tracking Report No. 27. N.p., Dec. 2011. Web. 31 Jan. 2013. <//www.hschange.com/CONTENT/1264/> 19


40113 ChoiceRx ePub long (1)
To see the actual publication please follow the link above