News in brief - Sept. 25, 2006

Public health contractors' security breaches - Perspectives on Medicare Part D - Medicare coverage of cancer drugs - Cancer drug case settled

Public health contractors' security breaches

Medicare Advantage plans and state Medicaid agencies should be required to report to the government any security breaches involving beneficiaries' private health records, an oversight agency said in a recent report.

An investigation by the Government Accountability Office found that more than 40% of Medicare managed care plans and Medicaid agencies said that they experienced a recent privacy breach involving confidential health records. Most of these entities outsource services to third-party vendors, making privacy protections of paramount importance, GAO said.

Federal contractors who provide services for Medicare or TRICARE already are required to inform the Centers for Medicare & Medicaid Services within 30 days if they detect security lapses involving patient data.

Perspectives on Medicare Part D

While roughly 70% of physicians believe that the new Medicare prescription drug benefit is helping beneficiaries save money on their medications, more than 90% believe that the program is too complicated, according to a pair of recent studies by the nonpartisan Kaiser Family Foundation.

"We have surveyed seniors many times, and now pharmacists and doctors, and the story is remarkably consistent," said Drew E. Altman, PhD, the foundation's president and CEO. "The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many."

Nearly six in 10 physicians reported having patients who experienced problems getting the drugs they needed, and one in 10 said such issues resulted in a serious medical problem for at least one of their patients.

Doctors have some complexity to deal with themselves. Nearly 70% of surveyed physicians said they had limited knowledge of Medicare drug plans' approved medication lists, and most never check the formularies before prescribing specific drugs.

Medicare coverage of cancer drugs

The implementation of the Medicare drug benefit has expanded access to potentially lifesaving cancer treatments, according to a report by the Washington, D.C., consulting firm Avalere Health.

Medicare drug plans cover 70% of brand-name cancer drugs and 99% of generics, according to the study, which appears in the journal Health Affairs. The median co-payments that the plans charge seniors for the drugs range from $5 to $40.

But such coverage does not necessarily connote full access to needed drugs. Techniques aimed at controlling volume and costs, such as prior authorization, step therapy and quantity limits, also must be considered, the authors said. "Formulary presence is not the only indicator of beneficiaries' access," they state. "The application of utilization management controls must also be considered."

Cancer drug case settled

On Aug. 29, the Schering-Plough Corp. agreed to pay $435 million and plead guilty to criminal conspiracy charges to settle federal allegations that the company illegally marketed its cancer drugs Temodar (temozolomide) and Intron A (interferon alfa-2b, recombinant).

The Justice Dept. accused the drugmaker of improperly promoting the cancer treatments for uses not approved by the Food and Drug Administration. The department also alleged that Schering paid kickbacks to physicians in the form of advisory board positions, entertainment and clinical trial placements to induce doctors to prescribe the cancer drugs.

The settlement with the U.S. attorney for the District of Massachusetts also resolves civil Medicaid fraud claims involving allergy and stomach medications made by Schering.

The drugmaker admitted to no wrongdoing in the agreement, which remains subject to court approval.