Health Care is a dynamic part of our life and culture. It is a complex issue that touches everyone at some point in their life. Most Americans understand the value of their health and the value of having adequate health insurance protection. Unfortunately, many Americans do not understand that effective navigation of the health care system can often reduce expenditures, increase the quality of care, and enhance their health condition.

Individual and collective expectations are high pertaining to the delivery and quality of care, but the cost associated with new advances in medicine and pharmaceuticals comes at a high price. It is imperative that as the industry continues to evolve, so must our expectations. We must not only demand more of others, we must demand more of ourselves. We must access technology and information to enhance our ability to make educated decisions and establish realistic expectations. We must be more informed, inquisitive, accountable, and better consumers. We must understand the ramifications and consequences of our health care choices. The bottom line is, take control of your health care program or it will cost you physically and fiscally.

Like individuals, other industry stakeholders find themselves at a crisis point. The government, providers, health care facilities, employers, pharmaceutical companies, and insurance carriers need to be more responsible in controlling health care expenditures, educating the consumer, and controlling health care premiums.

As part of the education process, it is critical that consumers understand the relationship between the various other stakeholders. Effective interaction between these market forces will create an immediate impact.

As you seek information to help you optimize your health care coverage, ensure the quality of care, and enhance your overall health condition, let Healthy Outlook be one of your resources. It is our intent to provide information and expertise to help you effectively navigate the health care system and enhance your quality of life.

Paul is Chief Operating Officer of Benefit Specialists of NY. He can be reached at (315) 470-1887, or pmuoio@BenefitSpecialistsny.com

Legislation Affects Your Costs

During the last session, several pieces of health care legislation passed that will directly impact the cost of health care and the coverages provided. They include:

Extension Of Sole Proprietor Law S.6015-B (Seward)/A.9308-A (Morelle) Both the New York State Assembly and Senate have voted to extend the sole proprietor law to December 31, 2008. The original law sunset on December 31, 2005.

Another improvement in this version of the legislation is that the maximum rate cap that a sole proprietor can be charged above the community rated product (groups of 2-49 eligible employees) has been reduced from 120 percent to 115 percent. Since the law is not permanent, the issue will be revisited for future extensions.

This extension will continue to make health care more affordable and should help reduce the drop-out rate of sole proprietors purchasing health insurance. There will also be a positive impact on state subsidized programs such as Family/Child Health Plus and Healthy NY if sole proprietors continue to purchase health insurance and do not use state programs.

Public health care recipients to provide information about their employers - S.6682 (Maziarz)/A.10357-A (John)  Applicants using health care coverage under Child Health Plus, Family Health Plus, Medicaid, Healthy New York and any person requesting uncompensated care from a hospital must provide detailed information about their employer. Information gathered will document and track which employers are not providing coverage to all their employees and how much it is costing New York state to provide coverage.

Rx Savings - There For The Asking
by Mona Chitre, Pharm.D., CGP

Health care costs are on the rise and a contributing factor is the increasing cost of prescription drugs. According to the Centers for Medicare & Medicaid Services, personal spending on prescription drugs in New York state rose from $2.97 billion in 1990, to $9.83 billion in 2000.

That increase is not surprising since direct-to-consumer advertising by drug manufacturers increased at an unprecedented rate during that same time period.

A study released last November by the Kaiser Family Foundation revealed that in 2004, drug manufacturers spent nearly $12 billion on direct-to-consumer advertising, plus an additional $16 billion on free samples provided to doctors’ offices.

This marketing tsunami has created demand for costly name brand drugs and costly new treatments at the expense of more affordable and equally effective generic versions of medications, or equally effective treatments that offer a generic option.

While a remedy for the spiraling cost of prescription drugs may seem complex and elusive, it is actually quite simple and available to most everyone.

When your doctor has the prescription pad in hand or is reaching for the free samples of a drug you’ve seen advertised, or when you’re at the pharmacy counter to get a prescription filled or re-filled, simply ask if there is a generic alternative that’s right for you. Generics cost less than the name brands, and in most cases have a lower copay.

If you’re told that a generic alternative isn’t available, then ask if there is an effective alternative treatment that has a generic option. There are often several treatment options available for a given condition and the most time-tested of them usually has available a less costly generic.

If you think this is all too simplistic, check out these numbers. A recent study issued by Excellus BlueCross BlueShield revealed that Upstate New Yorkers could save more than $880 million a year if generic drugs, or effective alternative treatments that have a generic option, were used when available. The annual savings in just Central New York would exceed $289 million. Think about what that level of savings could do to control rising health care premiums, or the rising cost to taxpayers for programs like Medicaid and Medicare.

The study, “The Facts About Potential Savings from Generic Drugs in Upstate New York,” is available free for download, in the “Public Policy and Research” section of www.excellusbcbs.com.

With health care costs continuing to rise, driven in part by the increasing cost of prescription drugs, it is important that we all do what we can to make sure health care dollars are spent in the most medically effective and cost-effective manner. A proven way to do just that is to ask about generic alternatives to prescription medications, or proven alternative methods of treatment that offer a generic option. The savings is real, and it is there for the asking.

Check with your doctor to see if there’s a generic alternative that’s right for you.

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