March 31st Affordable Care Enrollment Deadline

It was reported in an article February 24, 2014 by the Los Angeles Times that California’s enrollment website for Obamacare coverage was restored Monday after a five-day outage due to software problems.

The online troubles frustrated many consumers, enrollment counselors and insurance agents who wanted to use the Covered California website. The state had been signing up more than 7,000 people per day, on average, in February.

The online enrollment system went down late Wednesday and the state continued to work on it throughout the weekend.

In a statement, Covered California attributed the website problem “to a software malfunction that occurred during a planned maintenance update on Sunday, Feb. 16.”

Regardless of the online glitches, it was also reported that more than 1.7 million Californians have signed up for health coverage since Oct. 1, according to the state’s insurance exchange.

“This shows how strongly Californians are stepping up to take advantage of the Covered California opportunity,’ Peter Lee, the exchange’s executive director, said at a news conference Wednesday.
Another 877,000 Californians were determined to be likely eligible for coverage under the health care law’s expansion of Medi-Cal, the state’s health program for the poor.

Over the last month, the numbers of enrollees in private plans jumped by 203,072, while the number of Medi-Cal enrollees increased by 293,000.

“At least 626,210 of those who selected private plans are eligible for federal tax subsidies,” Lee said. “Covered California does not know how many of those who have signed up for plans were previously uninsured.”

With the March 31st open enrollment deadline rapidly approaching, it is important to contact Jeremy now at (310) 486-7620.

Press Release – Wall Street Journal

Read about us in the Wall Street Journal. To view the release, go to http://online.wsj.com/article/HUG1749346.html?dsk=y.
PRESS RELEASE
December 11, 2013, 2:41 p.m. ET

Jeremy Smith, President of Jordan Financial Network Insurance Services, Inc. has Recently been Certified by Covered California as an Active Agent in Supporting the Affordable Care Act (ACA).

Veteran insurance agent sees Obamacare changes to be the biggest he’s ever seen, but will open market to new customers.

Los Angeles, CA — Dec 11, 2013 / (http://www.myprgenie.com) — Jeremy Smith, President of Jordan Financial Network Insurance Services, Inc. has recently been certified by Covered California as an Active Agent in supporting the Affordable Care Act (ACA), frequently penned by many as “Obamacare.” Smith has been an Insurance Agent for 25 years and has seen the industry go through many changes. “But nothing like we are going to see over the next several months,” Smith added. “The recent changes will open doors to many people who previously were uninsurable and now will not only be able to obtain insurance, but can do so at an affordable cost.”
“Further,” Smith continued, “many Insurance professionals will also realize the vast ‘unexplored territory’ that will suddenly become available if that professional is willing to put the value of his client before his pocketbook.” In other words, Smith feels he will be able to increase his client base, while serving as a good source to help consumers to navigate through the haze of the complex healthcare market and get a better understanding of how this system will work.
Although Smith concedes the Government could have done a better job of educating the populace on the finer points of the ACA, he chooses not to dwell on the negative. “I have a choice. I can bemoan the fact that people are confused about what they should do regarding their health insurance or I can be proactive and become an expert on ‘Obamacare’ and be one of those folks who really knows his stuff and can truly help individuals and employers make the choices that will work the best for them regarding both benefits and costs. I choose to adopt the latter version,” Smith said.
Smith claimed that every person he knows has instantly become a potential client, or at least someone he can help to understand the process of the ACA. “Every person who filed a tax return for 2012 is a legitimate lead for me and this is exciting,” Smith says, “But it is way more exciting to be able to teach, consult, and be the ‘go to’ guy for people looking for answers to their healthcare insurance inquiries. Smith’s website, www.jeremycaliforniainsurance.com contains a plethora of information and blogs regarding ACA as well as opportunities for consumers to actually apply on his site for various insurance products outside the exchange. For those who will qualify inside the exchange, Smith can provide assistance in signing up with the Governmental program.
Smith’s Jordan Financial Network also offers insurance to both individuals and businesses in many other arenas, including Life, Workers Comp, Long Term Care, Disability, Medicare Supplements, etc.for people living in California and Arizona. Smith can be reached at 310-486-7625 or on his website.

Phone Lines Swamped

One of the best reasons to utilize the services of a qualified health insurance agent is illustrated in an article in the Ventura County Star by Tom Kisken,
January 15, 2014. He states that, “For many people, the hardest part of navigating the Covered California exchange and meeting a payment deadline that kicked in for some on Wednesday may be connecting with a live person.” The article goes on with example after example of people who spent hours calling Covered California’s toll-free number designed to connect people with help only to be told repeatedly by an automated voice that the high volume of calls meant that they should go to www.coveredca.com and find aid there. Callers who persisted and kept trying the line say they eventually end up on hold, waiting for as long as 97 minutes. They are often told at the end of the call they need to call the insurance company on lines also flooded with calls. Covered California officials said the automated disconnects are caused by a flood of phone calls that reached 75,995 for the week ending Jan. 11. People can enroll in plans through the exchange until March 31. The phone flood was pushed by payment deadlines. For the week ending Nov. 2, the average wait time for a call to Covered California was less than three minutes. The average wait for the week ending Jan. 11 was more than 49 minutes. 
”I found out I’m not even in (Blue Shield’s) system,” said Connie Kline of Simi Valley, who called the insurer and Covered California every day last week and was left without any proof she’s insured. “It’s not like I called once or twice. I called I don’t know how many times.”

Blue Shield was receiving 57,000 calls a day from people in the individual marketplace that includes Covered California plans. WellPoint, parent company of Anthem Blue Cross, received about 1 million calls the first two business days in January. “That’s more than we get in an average month,” said Anthem spokesman Darrel Ng. Hundreds of new people have been hired to work customer service and hundreds more have been shifted from other positions to help,” Ng said. Blue Shield said it ramped up its call center as well. Kaiser said they’re calling Covered California enrollees to help with any payment questions. 
Kennedy said, “Covered California is adding call center staff and considering expanding the number of phone lines, currently at 1,288.” He said people who can’t get through the lines can go to the Medi-Cal eligibility offices run by the Ventura County Human Service Agencies and trained to deal with Medi-Cal and Covered California. Or they can go to www.coveredca.com and use the “local help” button to find enrollment counselors and insurance agents.
Why not eliminate the headache of hours of your time being wasted and have a professionally trained Covered California certified agent spend the time to ensure that all your questions and concerns are being handled?
Call Jeremy Smith at (310) 486-7625 and let the professionals do the work at no cost to you.

Deadline for Signing Up – Obamacare

There is still time to sign up for coverage under the Covered California Insurance Plans. The deadline for open enrollment is March 31, 2014. At no cost to you Jeremy can walk you through the often confusing enrollment process. As always Jeremy is available to assist you with all your health and life insurance needs. Call for details – (310) 486-1720

OPEN ENROLLMENT DEADLINES

The deadline for open enrollment for Medicare is DECEMBER 7 2013. The deadline for enrolling in Covered California to ensure January 1 2014 effective date is DECEMBER 15th 2013. Open enrollment for Covered California (Obamacare) continues through March 31st 2014 but you are not assured of coverage as of January 1st. It is not too late to realize coverage January 1, 2014, do not delay – call Jeremy at (310) 486-7625 asap.

Medicare Part D Fraud Exposed

According to the South Bay Daily Breeze, Medicare is wasting hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available.
ProPublica analyzed the prescribing habits of 1.6 million practitioners nationwide and found that a tiny fraction of them are having an outsized impact on spending in Medicare’s massive drug program.
Just 913 internists, family medicine and general practice physicians cost taxpayers an extra $300 million in 2011 alone by disproportionately choosing name-brand drugs. These doctors each wrote at least 5,000 prescriptions that year, including refills, and ranked among the program’s most prolific prescribers.
Many of these physicians also have accepted thousands of dollars in promotional or consulting fees from drug companies, records show.
While lawmakers bitterly disagree about the Affordable Care Act, Medicare’s drug program has been held up as a success for government health care. It has come in below cost estimates while providing access to needed medicines for 36 million seniors and the disabled.
But this seeming fiscal success has hidden billions of dollars lost to unnecessarily expensive prescribing over the program’s eight-year history.
The waste is exacerbated by a well-meaning benefit written into the drug program, known as Part D: Low-income patients pay less than $7 per prescription regardless of a medication’s cost. The unintended consequence is that doctors can dole out name brands with little fear of pushback from patients about price.
Taxpayers spent $62 billion last year on Part D — more than a third of it on this low-income subsidy.

The office of Dr. Hew Wah Quon in the Chinatown neighborhood of Los Angeles, Calif. Some doctors like Quon issue expensive name-brand drugs to Medicare patients. (Patrick T. Fallon for ProPublica)
Dr. Hew Wah Quon is one of Medicare’s top prescribers. From a worn office in Los Angeles’ bustling Chinatown, he churned out $27 million worth of prescriptions from 2009 to 2011, data show.
All of Quon’s patients in 2011 qualified for the low-income subsidy, sometimes called “Extra Help.” He mostly prescribed name brands, such as AstraZeneca’s Crestor, for high cholesterol. Crestor costs more than $6 a pill; the leading generic costs as little as 20 cents.
If Quon had prescribed the way other internists do in California, choosing drugs so that his average cost was similar to theirs, he alone could have saved Medicare $5 million in 2011, ProPublica’s analysis shows.
“Boy, this doctor is a walking economic disaster,” said Dr. Jerry Avorn, a Harvard medical professor who has written about the risks and benefits of prescription drugs.
When first contacted by ProPublica last year, Quon defended some of his choices but abruptly ended the interview and has since declined to comment. Others who prescribe similarly said they believe name-brand drugs work better.
Health programs run by the U.S. military and the Department of Veterans Affairs control costs by strictly limiting the name-brand drugs doctors can prescribe. Some of the nation’s leading private health insurance plans do as well.
But Medicare, which pays for one in every four prescriptions nationwide, hasn’t asked Congress for the authority to put similar checks in place.
The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers those programs, declined to make an official available for an interview and would not answer specific questions.
“By law, Medicare must cover items and services that are reasonable and necessary,” a CMS spokesperson said in an email. “Within those rules, doctors and their patients are free to make medical treatment decisions that are best for the patient.”
In the past, agency officials have said that while Part D is a government program, private insurers are responsible for running it. They normally decide how to manage their drug plans but cannot increase prices for the poor.
ProPublica’s analysis is part of a broader look at Part D oversight. An article in May found that Medicare has failed to take basic steps to investigate doctors who prescribe large quantities of dangerous, addictive or inappropriate medications.
Some, including the investigative arm of the Department of Health and Human Services, say CMS also needs to do more to stop waste — by investigating doctors who prescribe very differently than their peers. Others say it should establish penalties and bonuses to encourage more cost-effective habits.
“At some point, I think we have to hold prescribers accountable for their prescribing,” said Dr. Nancy Morden, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, which has studied Part D. “I just don’t see how that’s different from holding them accountable for the quality of care in the exam room or in the operating room.”
Numerous studies show that generics, which must meet rigid Food and Drug Administration standards, work as well as name brands for most patients. Although some medications do not have exact generic versions, there usually is a similar one in the same category.
Many of the 900-plus primary care doctors who favored name brands shared another trait: Financial ties to the companies whose pills they prescribe.
Since 2009, 48 percent of them have received at least $1,000 for speaking, consulting and other promotional purposes, according to data ProPublica compiled from company web sites. Eleven have accepted $100,000 or more, the data show. Quon has received more than $7,000 in speaking fees and meals.
Among a random sample of doctors who prescribed generics more frequently, only 15 percent accepted drug company money, and the amounts generally were less.
Dr. Jeffrey Grove, a Florida physician who chooses generics 90 percent of the time for his Medicare patients, said it’s irresponsible not to consider cost.
“I don’t care that the government pays for it,” said Grove, president of the American College of Osteopathic Family Physicians. Grove was at the 2003 ceremony when President George W. Bush signed Part D into law.
“How many people could we insure that are uninsured right now if those physicians were practicing responsibly as well?”
King of the Name Brands

Quon’s office, right outside downtown Los Angeles, is wedged between a bank and a budget hotel. His name is half-peeled off the front window. On the waiting room walls, smudges mark where legions of patients leaned their heads.
Yet in 2011, nearly 80,000 prescriptions flowed through this unassuming space and his other office in Monterey Park, a largely Asian city nearby.
Quon, 62, was the nation’s top prescriber that year for a dozen brand-name drugs and second-highest for another 13.
High on his list was Crestor, the most potent of a class of cholesterol-lowering drugs known as statins. Quon prescribed it 5,250 times — more than twice as many as any other doctor in Medicare. About 70 percent of his 948 Medicare patients filled a prescription for it.
Doctors typically find that generics such as simvastatin, the most-prescribed drug in Part D, work well to treat the risks from artery-clogging cholesterol. Crestor is usually reserved for stubborn cases because it costs 30 times as much.
Quon also liked Lovaza, purified and concentrated fish oil. It is marketed by GlaxoSmithKline to help reduce very high triglycerides, a fat in the blood linked to heart disease. At more than $90 per prescription in 2011, Lovaza’s price dwarfed that of over-the-counter fish oil supplements sold for a few dollars per bottle. Quon prescribed it 4,700 times, tops in the country.
Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said that while high triglycerides are a risk factor for heart attack and stroke, there is no scientific evidence that Lovaza lowers the odds of either event. Even GlaxoSmithKline says on the drug’s website that, “It is not known if Lovaza prevents you from having a heart attack or stroke.”
Nissen said it is “absolutely inconceivable” to treat so many patients “with a drug approved only to treat a relatively rare disorder.”
Another Quon favorite is Forest Laboratories’ Bystolic, which treats high blood pressure. He prescribed it 2,225 times, second-highest among Medicare doctors. Several drugs in the class, known as beta blockers, are generics and cost less than $10 per month. Each of his Bystolic orders cost $58.
The FDA has said Bystolic had no proven advantage over generic beta blockers. In 2008, it warned Forest Labs that its ads overstated the drug’s benefits.
Quon’s prescriptions for Crestor, Lovaza and Bystolic alone cost Medicare $1.3 million in 2011. Overall, his patients received name brands 75 percent of the time, compared to 23 percent for all California internal medicine specialists, including Quon. The average cost of Quon’s prescriptions was $129; the group’s was $65.
Medicare data show a consistent pattern for Quon since at least 2007.
“He is a big brand user. That’s his style,” said David Wong, whose C.T. Pharmacy is down the block. “He’s famous.”
The prescribing habits of Quon and other primary care doctors with similar devotion to name brands collectively cost Medicare more than $1 billion in 2011. Nearly a third of that could have been saved if their prescribing had the same average cost as their peers.
Other specialties showed comparable patterns, but ProPublica’s analysis focused on primary care doctors because they treat a variety of illnesses and prescribe a range of medications that have generic alternatives.
In June, the HHS inspector general issued a report on potential waste and abuse in Part D. Among a group of “very extreme outliers,” the report cited one doctor with an “unusually large number” of Lovaza prescriptions whose costs in 2009 were 151 times more than average.
The inspector general did not name the doctor, but by matching statistics in the report to Medicare data, ProPublica was able to identify the doctor as Quon. No other physician met the criteria.
For the Poor, Priciest Pills

Part D was created amid a partisan fight over who should run the program — the government or private industry. But it was accepted that no matter who was in charge, poor Medicare enrollees would need extra help paying their drug bills.
Today, this special subsidy has ballooned into the program’s biggest cost, hitting $22.8 billion in 2012, according to the Medicare Payment Advisory Commission (MedPAC), a group that reports to Congress on Medicare. That’s up 35 percent since 2007.
The growth has been fueled in part by the meager co-pays set by Congress.
For the more than 11 million who get the subsidy, generics cost no more than $2.65. Even the most expensive drugs cost the patients $6.60 or less.
Medicare reimburses drug plans for the difference between these amounts and what other enrollees pay.
With little incentive to be cost conscious, these patients and their doctors often use name brands when generics are readily available, studies show.
For others in Part D, typical co-pays for brand-name drugs — $40 to $85 — deliver a strong push towards generics, which generally cost less than $5.
A MedPAC analysis found that if low-income patients were prescribed generic drugs in the same proportion as other Medicare enrollees, the program could save $1.3 billion a year in just seven drug categories. A separate study this year by the Bipartisan Policy Center, a Washington think tank, says savings could be greater across the program, perhaps as high as $44 billion in a decade.
“I really think that you need both the carrot of lower cost for the generic side as well as the potential stick of higher costs on the brand side,” Bruce Stuart, then a MedPAC member, said at a meeting last year. Stuart heads the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy.
Experts say that if patients had to pay higher co-pays for name brands, they would likely ask for something cheaper.There’s no sign that the rules for Part D’s low-income subsidy will change anytime soon, however. Last year, MedPAC urged Congress to modify the co-pays to spur greater use of generics. President Obama proposed raising brand co-pays and reducing generic ones in his 2014 budget, but Congress hasn’t acted on it — and likely won’t.
Former CMS administrator Mark McClellan said encouraging greater use of generics makes sense. But faced with angering either the powerful pharmaceutical lobby or advocates for the poor, he said, lawmakers may see no political benefit in pushing a change.
The drug industry’s leading trade group, the Pharmaceutical Research and Manufacturers of America, opposes higher brand co-pays for the poor. And the group has a history of batting away proposals that might cut into the billions of dollars of profits drug makers earn from high-margin products in Part D.
When Congress debated Part D in 2003, the group lobbied to kill a Democratic proposal to let the government negotiate volume discounts on drugs. In 2010, it helped squelch efforts to allow imports of cheaper drugs from abroad as part of the Affordable Care Act’s expansion of Part D.
Matt Bennett, a senior vice president with the group, called Part D a “success for both beneficiaries and taxpayers.” In a statement, he said, “Improved access to medicines in Part D not only leads to better health outcomes for patients, but it also lowers other Medicare spending.”
It’s illegal to pay to doctors to prescribe, but the money drug makers give doctors to speak or consult on their behalf appears to be a good investment. In June, ProPublica reported that 17 of the top 20 prescribers of Bystolic, including Quon, received speaking fees in 2012 from the manufacturer, Forest Laboratories.
The pattern extends to Part D’s top name-brand prescribers. Two doctors, in Kentucky and New Jersey, have each received more than $225,000 in promotional payments from drug makers since 2009. A large chunk came from AstraZeneca, maker of Crestor, the doctors’ most-prescribed drug.
AstraZeneca spokeswoman Michele Meixell said the company doesn’t choose its speakers based on prescribing but on “expertise in a therapeutic area, experience and qualifications.”
Part D’s Ethnic Hot Spots

Along one mile-and-a-half stretch of Los Angeles’ Koreatown, seven primary care doctors have some of

A man walks by the office of Dr. Hew Wah Quon in the Chinatown neighborhood of Los Angeles, Calif. Some doctors like Quon issue expensive name-brand drugs to Medicare patients. (Patrick T. Fallon for ProPublica)
the highest rates of name-brand prescribing in the country. Nearly 3,000 miles away in Brooklyn, N.Y., a single building in a Russian community houses six such doctors.
By mapping doctors who favor name brands, ProPublica found unexpected clusters in ethnic neighborhoods in and around the biggest cities. The average cost of a Part D prescription in these enclaves can be more than 50 percent higher than that of surrounding areas, the analysis showed.
Researchers have previously noted regional differences in the way doctors prescribe drugs. But ProPublica’s analysis aimed to unravel which individual doctors drive name-brand prescribing and what, if anything, they had in common.
Many worked solo or in small groups. Often they received their medical training outside the United States, records show.
Doctors’ drug choices can be influenced by many things — their peers, patient requests, a chat with a sales rep or studies in medical journals. In recent years, concern about undue influence has prompted many academic medical centers and large group practices to ban sales reps and to refuse free samples.
But many physicians in ethnic communities continue to embrace these relationships. When reporters visited offices in such neighborhoods of New York City and Southern California, drug reps crowded the reception counters as they unloaded rolling suitcases full of samples or waited to speak to the doctors.
Chinatown is one of the most densely populated parts of Manhattan. Outdoor fish markets crowd next to storefronts selling counterfeit handbags and pirated DVDs. Every block seems to have at least one pharmacy, and hundreds of medical offices are stacked above and around them. More than 90 percent of Part D prescriptions written in 2011 by these doctors were for the poor, Medicare data show.
The neighborhood is home to 20 high-prescribing primary care doctors who disproportionately favor name brands.
One of them, internist George Liu, is a founder and longtime leader of a prominent Chinese-American physicians’ association. In 2011, Liu wrote more than 9,000 prescriptions — 47 percent for name brands. By comparison, all internists in New York used name brands, on average, only 27 percent of the time.
Liu, who specializes in diabetes, said he does his own research on drugs and doesn’t depend on sales reps. A “new drug has a reason why it’s on the market,” he said.
Liu has given lectures for the makers of his favored drugs, he said. Three of his top 10 drugs are made by Eli Lilly, which has paid him $123,000 since 2010. One Lilly osteoporosis treatment, Forteo, cost Medicare $1,140 for a month’s supply.
Liu said scrutinizing how doctors use name brands is an “incorrect way of looking at medical care.” He and his peers are saving Medicare money, Liu said, by staying open long hours and keeping patients from costly emergency room visits.
In an office nearby, Dr. Henry Chen praised Part D for making it easy for poor patients to get name brands. He said it’s wrong that state Medicaid programs for the poor and some private insurers force doctors to get prior approval before prescribing them.
Chen wrote more than 50,000 prescriptions in 2011, placing him among the top 100 prescribers nationally in Part D. Forty-five percent of his prescriptions were for name brands. He said picking a drug is like choosing how to get from New York to Washington.
“You could drive a Mercedes-Benz. You could drive a Rolls-Royce. Then you can drive a horse,” he said. All three would get you there, he said, “but the speed and the quality is different.”
Chen, who also has an office in Brooklyn, was paid $11,400 to deliver promotional talks for Eli Lilly and Merck last year. In 2011, he received more than $2,500 in meals from Lilly alone. Two of the drugs in his top 10 are made by Lilly and another by Merck.
Dartmouth researcher Morden said doctors in these areas are shifting the excess costs to others. “The other person one neighborhood over who’s getting a generic product is subsidizing the brand products for that whole neighborhood,” she said.
Not everyone in Chinatown defends such prescribing.
Dr. Perry Pong, chief medical officer of a local health center, was dismayed to hear that his colleagues stood out for pricey drug choices: “That’s bad. I’m ashamed of that.”
Pong said his center tells doctors to use generics first. But Medicare’s figures show some haven’t done so, and Pong said he couldn’t explain it.
‘The Light Bulb Goes Off’

Pharmacist Mark Greg mimics the time-tested tactics of drug company sales reps. Like them, he studies doctors’ prescribing records, arms himself with medical studies and even provides lunch.
The difference: Greg is pushing generics.
He works for Advocate Physician Partners, part of a Chicago-area hospital chain that gives doctors bonuses for meeting performance measures that include generic use.
Greg, the group’s manager of clinical programs, asks doctors to see things from the patient’s point of view.
“Would you want to pay $10 a day for the same benefit as you would get for paying 10 cents a day?” he said. “In many cases the light bulb goes off.”
At one Advocate clinic in Chicago, 11 primary care physicians prescribed at least 80 percent generics in 2011. One of them, Dr. Tony Hampton, had an average prescription cost in 2011 of $41 — versus $89 among the 900-plus high name-brand prescribers in ProPublica’s analysis.
Hampton wrote more than 14,800 prescriptions in Part D, 13 percent of them for name brands. He said he gets very little resistance: “It’s just a few patients who need that little extra push.”
Across the country, private practices and government agencies have tackled the high cost of prescribing and determined that they can trim spending without sacrificing patient care. Some tightly control the drugs doctors can prescribe; others ramp up the co-pays on costly drugs.
Some with the lowest name-brand use have close ties to insurance companies, such as Kaiser Permanente and Southwest Medical Associates in Las Vegas, which is owned by UnitedHealth Group.
At both Southwest and Advocate, patients taking generics have met or exceeded national success rates for lowering cholesterol and controlling diabetes.
“You can be cost-effective and have high quality,” said Dr. Linda Johnson, medical director for primary care at Southwest. Johnson and others said only a small percentage of patients react negatively to slight fluctuations in their medications and require a name-brand drug.
Mitra Behroozi, executive director of the 1199SEIU Benefit and Pension Funds in New York, said her union’s health plan offers its 400,000 enrollees at least one option in each drug class, usually a generic, that is free. Members who want a name brand must spring for the difference, which can top $100 in some cases.
“We don’t pay for the latest, greatest if it’s not more efficacious,” she said.
The VA is likewise strict, often requiring prior approval for brands when generics are available. More than 80 percent of the 140 million prescriptions written annually by its doctors are for generics, said Mike Valentino, the agency’s pharmacy chief.
“We take out of the equation the marketing and advertising that drives so much of the prescription drug utilization in this country,” Valentino said.
The push has had a massive payoff.
Researchers have compared the VA’s prescribing to Part D’s. In a study that examined diabetes, cholesterol and blood pressure-lowering drugs, they found name-brand use under Part D in 2008 was two to three times higher than in the VA.
Medicare could have saved $1.4 billion if prescription choices mirrored those in the VA, according to the study, published in June by the Annals of Internal Medicine.
Lead author Dr. Walid Gellad, an assistant professor of medicine at the University of Pittsburgh, said that Medicare needs to follow the VA or create a system that tracks doctors and rewards or punishes them for their choices.
“There’s this big narrative that Part D has been this huge success because it’s come in under budget,” Gellad said. “My personal opinion is that we could have done a lot better.”

HEALTHCARE LAW UPDATE

WASHINGTON November 13, 2013– Top congressional Democrats on Sunday stood by President Obama and the flawed rollout of the government’s healthcare website, expressing confidence the problems would be fixed and the issue would not drag down the party in next year’s mid-term elections.
“I don’t think you can tell what will happen next year, but I will tell you this — Democrats stand tall in support of the Affordable Care Act,” House Minority Leader Nancy Pelosi (D-San Francisco) said on NBC’s “Meet the Press.”
Pelosi downplayed the defection of 39 House Democrats on Friday who voted to help pass a Republican bill, opposed by the White House, to address the millions of people facing cancellation of their health insurance policies. The bill, which passed 261-157, would allow insurers to continue selling individual policies that do not meet new federal standards under the law.
The number of Democrats who defied President Obama and House Democratic leaders on the vote was about the same as those who have joined with Republicans on other bills to alter the healthcare law, Pelosi said. On one such vote in July, to delay the employer mandate in the law, 35 Democrats joined with Republicans.
“No matter how much Congresswoman Pelosi tries to spin this, this is a mess,” Sen. Kelly Ayotte (R-N.H.) said on “Meet the Press.” “My constituents are very unhappy with the notices they’re receiving and higher premiums.”
Obama tried to address the problem of policy cancellations last week even as administration officials scrambled to try to get the healthcare.gov website running correctly by the end of the month. On Thursday, Obama gave insurance companies permission to renew policies that were to be canceled for not meeting the law’s new standards that require, for example, coverage for prescription drugs, hospitalization and maternity care.
But companies do not have to renew the policies and would need permission from state regulators to do so.
“Keep in mind, it is a suggestion. It is not a ruling, and it certainly is not a law,” Ben Nelson, chief executive of the National Assn. of Insurance Commissioners, said on “Fox News Sunday.” A former Democratic senator, Nelson said insurance commissioners are concerned Obama’s proposal could disrupt the healthcare market and lead to higher premiums.
Insurance industry officials have the same concerns. They met with Obama at the White House on Friday and are working with the administration to try to address the issue of policy cancellations, said Karen Ignagni, president of America’s Health Insurance Plans, an industry trade group.
“We have the same goals. We’re going to work together to try to get people into affordable coverage,” she said on “Fox News Sunday.” “We have work to do, there is no question. But we have an interest in doing it together and working together on that.”

Blue Shield of CA extends Policies

According to the LA Times, November 5, 2013, California Insurance Commissioner Dave Jones says the state health exchange “made a bad decision” by requiring its participating insurers to cancel coverage by Dec. 31 for hundreds of thousands of consumers.
“I don’t think it was necessary,” Jones said in an interview. “I think people should be given the opportunity to stay in their current plans for another year.”
On Tuesday, Jones discussed a settlement with Blue Shield of California that will buy some more time for about 80,000 policyholders whose policies are being terminated.
Blue Shield of California agreed to let those policyholders extend their current coverage until March 31 to resolve regulators’ claims it didn’t give customers ample warning about the changes.
“This is important because it will allow people with current plans more time to shop and it resolves a defect we discovered,” Jones said.
But Blue Shield said “the changing deadlines may confuse customers and lead some people to pay a deductible twice in one year after they enroll in a new plan for 2014.”
In recent weeks, insurance companies across the country have notified policyholders that their existing coverage will expire because it doesn’t meet all the standards of the Affordable Care Act.
Consumers are guaranteed new health insurance next year regardless of their medical history and many will see rates drop thanks to federal premium subsidies.
But some people will pay more, have fewer health plan options and possibly lose access to their regular doctors and hospitals as medical networks shrink.
“I’m not convinced it would have been fatal to the risk pool,” said Jones, a Democrat who has strongly backed the implementation of the healthcare law. “The Dec. 31 cutoff for individual policies in California didn’t have to happen.”

Business Insurance Solutions in 2014

CaliforniaChoice announced on October 22, 2013 the introduction of a small-group “Business Solutions Suite” designed to provide small businesses and their employees with a host of additional products and services at no additional cost. CaliforniaChoice is one of the nations most successful small-group private health insurance exchanges.

“When it comes to purchasing health insurance, employers today are choosing between a government option, a single carrier or a private exchange,” said Ron Goldstein, president and CEO of CHOICE Administrators, which operates CaliforniaChoice. “Our new Business Solutions Suite includes products and services employers want and need; and we’re able to offer them at absolutely no additional cost to the employer, which enhances the overall value of our program.”
CaliforniaChoice’s Business Solutions Suite will be available January 1, 2014.

The Business Solutions Suite is comprised of three levels, based on the number of employees in a small business. Each level includes discount dental, voluntary vision, discount hearing programs, a pharmacy prescription card, a premium-only plan, access to an online human resources support center, Cal Perks employee discount programs, payroll discounts, and Cal-COBRA billing support. Businesses with more than 15 employees also have access to a flexible spending account, and those with 20 or more employees receive federal COBRA billing support.

CaliforniaChoice offers a wide selection of benefit plans – ranging from platinum metal tier benefits (the richest benefits) to gold, silver and bronze – through Aetna, Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan and Western Health Advantage. CaliforniaChoice also offers both full and limited provider networks within each metal tier of benefits, which gives employees more flexibility when it comes to selecting the right coverage. The program also includes a host of optional benefits including dental, vision, chiropractic, life and payroll services.

For more information, call Jeremy at (310) 486-7625 to discuss the most effective options for your small business.

Successful Applications on Covered California

In an article by Chad Terhune October 9, 2013, the LA Times reported that 29,000 people had successfully applied for coverage with Covered California the preceding week.
Covered California released the data earlier than planned to counter “misinformation” and reports about widespread glitches preventing people from signing up.
“This continued drumbeat of doubters and misinformation made us say, ‘Let’s put this out,'” Lee said. Pointing to persistent Republican efforts in Washington to defund or delay Obamacare as a federal government shutdown drags on, Lee said that “you can’t derail something when it has already left the station. We are going very strong.”
California’s enrollment efforts are significant because of its size and strong political backing for the Affordable Care Act. California is one of 14 states running their own insurance exchange; the federal government is operating the marketplace in the 36 other states.
“This is a good start, but the pace of enrollment will have to accelerate for California to meet its goals,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I hope they have eliminated the glitches.”
In California, 16,311 households had completed the application process through Saturday the 5th, representing 28,699 people. Consumers had started an additional 27,305 applications that are still pending while they consider their options and keep shopping.
“This blew the socks off anything we expected,” Lee said.
Lee acknowledged that the state website has been slow and “clunky” in the first week, but he said computer upgrades are making it “faster every day.” He also said service-center employees were answering calls within five minutes by the end of last week, down from 30 minutes beforehand.
Experts say the real test for California and other exchanges will come in November and early December when websites, call centers and enrollment counselors come under even greater pressure. Enrollment in exchanges nationwide runs through March 31. But consumers must sign up by Dec. 15 if they want coverage in effect by Jan. 1.