Thursday, May 04, 2006

GAO reports, you decide

Two reports recently issued by the Government Accountability Office (GAO) have made telling points about access to medications. One refers to Medicare Part D, and the other to AIDS Drug Assistance Programs (ADAPs).

GAO-06-654: MEDICARE: Communications to Beneficiaries on the Prescription Drug Benefit Could Be Improved. May 3, 2006. GAO investigators developed 5 questions, asked each of them 100 times at Medicare information call centers. The results were less than stellar: variable waits (some rather long), dropped calls, and, worst of all, inaccurate information.

SFGate.com writes (from AP):

The Government Accountability Office investigators said that about one-third of their calls resulted in faulty responses or no response at all because of disconnected calls. The accuracy rates varied a great deal based on the question, but when it came to one of the most important questions, operators provided the right answer only 41 percent of the time. That question concerned which drug plan cost the least for a beneficiary based on certain drug needs.


The GAO recommendation:


GAO is recommending that the CMS Administrator enhance the quality of its communications by taking actions to improve written materials, its 1-800-MEDICARE help line, and the Medicare Web site. CMS said that GAO’s findings did not present a complete and accurate picture of its activities. However, CMS said that it supports the goals of GAO’s recommendations and is already taking steps to implement them.

May 15 continues to loom as the "final" deadline for enrollment in the program. If you haven't made a choice but that date, there will be a "penalty" added to your premiums. The "penalty" is 1 percent of the premium's cost per month that you have not enrolled. (On a $50 premium, that's 50 cents added to the premium cost for each month that you delay enrollment.)

GAO-06-646: RYAN WHITE CARE ACT: Improved Oversight Needed to Ensure AIDS Drug Assistance Programs Obtain Best Prices for Drugs, April 26, 2006

From the abstract:

In order to make maximum use of the funding they receive, ADAPs are expected to secure the best price available for the drugs on their formularies. ADAPs may, but are not required to, purchase their drugs through the 340B federal drug pricing program, under which drug manufacturers provide discounts on certain drugs to covered entities. The Health Resources and Services Administration (HRSA) has identified the 340B prices as a measure of ADAPs' economical use of grant funds, but the Department of Health and Human Services does not disclose 340B prices to the ADAPs. GAO found that some ADAPs reported prices that were higher than the 340B prices for selected HIV/AIDS drugs. However, these reported prices may not have reflected any rebates ADAPs eventually received. While HRSA is responsible for monitoring whether ADAPs obtain the best prices available for drugs, it does not routinely compare the drug prices ADAPs report to 340B prices.

The Texas HIV Medication Program (THMP) purchases medications under the 340B program and gets rebates from some manufacturers. According to Dwayne Haught, Program Manager for THMP, the program gets its information about the 340B prices for medications from its supplier, not from manufacturers or HRSA.

The GAO's recommendation:


In its report, GAO recommends that HRSA require ADAPs to report the final prices they paid for drugs, net of any rebates, and that HRSA routinely determine whether these prices are at or below the 340B prices. In commenting on these recommendations, HRSA stated that these steps would be labor intensive and it lacks capacity to carry out such oversight.
So the Catch-22 is that HRSA won't (or can't) tell ADAPs what the 340B price is supposed to be, but it's too costly to keep track of the prices that ADAPs are paying to make sure that they are actually getting the 340B price. Huh? ADAP funds grow on trees, I guess.

Haught notes that the report erroneously characterizes the Texas program as requiring co-pays/cost sharing. THMP allows participating pharmacies to collect a $5 co-pay as a dispensing fee, but this fee is retained by the pharmacy and not sent to the program.

If I recall correctly, some pharmacies disregard the fee and dispense HIV meds for free.

Note to self: Which pharmacies are these? We should be celebrating their generosity.

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