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Good
morning !
How to
Boil a Frog
Before
you call the ASPCA (http://www.aspca.org/site/PageServer)
, please read this through. No frogs will be harmed in this
Prattle and we will use only recycled electrons. Happy?
Cold
blooded animals experience temperature differently than warm
blooded creatures. Each will detect rapid changes in
temperatures and will move away from the noxious stimulus. . A
frog, for instance, would not take warmly to being dropped into
hot water if previously at room temperature. However, if you put
the frog into room temperature water and SLOWLY started to heat
the water, the frog would not detect the temperature difference
until it was too late.
The warm
blooded animals have their own “thermostat” to compare to the
external temperature. Too hot or too cold and homeostatic
mechanisms kick in (sweating, panting, shivering, etc).
Cold blooded animals don’t appear to notice.
“So, old
weird bald one, what does this have to do with drugs?” you might
say. Consider the members of employer or state sponsored
pharmaceutical benefit plans as frogs. Some are already in hot
water relative to their prescription drug benefits. Their
employer (plan sponsor) has already instituted mandatory
generic, prior authorizations, restrictive networks, and Spartan
formularies. Will they rebel if a mandatory mail order is
instituted for maintenance drugs or another drug is subject to
quantity limits? They probably will not like the change but
won’t quit.
Take another
group of frogs...those members who are at “room temperature”
(two tier- open formulary with no limits on quantity or any
prior authorization). How would they react to the aggressive plan mentioned
above? They would likely “scream bloody murder” when hit with
such a drastic change!
So how do
you get those comfortable frogs (members) to a pharmaceutical
benefit plan that employers/spnsors can afford? In other words “how do
you boil a frog?” The technique is the same as in the wild
kingdom…you turn up the heat slowly. You might start with a 3
tier benefit that asks members to pay more for the more
expensive drugs. Next you could add a provision where the member
pays the difference between generic drugs and brand drugs if
they choose to use the brand. Prior authorizations for more
drugs can be added (as they make sense) to assure the clinically
and fiscally responsible use of drugs. Increased flat copays or
coinsurance every year might at least keep pace with inflation.
Limiting the network could shave some costs without inciting a
riot. There are many tools that can be used to benefit the plan
sponsors and the members. Just don’t put them all in at once.
That said, you HAVE TO START using some of them or the plan
sponsors will be the ones in hot water along with their
shareholders/stakeholders/taxpayers.
Medicare
recipients (metaphorically the ‘old frogs’) are “already in hot
water” because they have been paying full price for their
medications. If the new Medicare Part D program does not
institute PBM practices to manage the costs from the very start
then those old frogs will find themselves in comfortably cool
water and much more resistant to effective management in the
future. I am not proposing to be mean but to be prudent. As a
country we can not afford to turn down the heat too much or the
entitlement mentality will only expand.
With
pharmaceutical expenses rising, inaction is a negative action.
Start now to use effective tools but prepare to hear some
croaking. It may be the only way to preserve the pond.
Steve
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ps. Best answer this week to
the question "How are you?" was
"Fantastic
and getting better!"
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