TIME Crime

Prosecutors Charge 33 in Alleged Criminal Enterprise

The conspiracy spread across Ohio, Minnesota, California and Puerto Rico

(San Francisco) — Nearly three dozen people have been charged in California as part of a criminal network that illegally sold millions of dollars in prescription drugs and engaged in bank fraud, money laundering and racketeering, federal prosecutors announced Thursday.

Prosecutors alleged a widespread conspiracy that included numerous companies and activity in California, Minnesota, Ohio and Puerto Rico.

The group — some of them family members with ties to Southern California — got prescription drugs from unlicensed sources and resold them to unwitting customers, prosecutors said.

According to a grand jury indictment, David Miller, 50, ran a drug wholesale business called the Minnesota Independent Cooperative. The business bought about $157 million in drugs from Mihran Stepanyan, 29, and Artur Stepanyan, 38, even though Miller knew they were not licensed to sell drugs and obtained them illegally, the seven-count indictment says.

Ara Karapedyan, 45, another key figure in the enterprise, sold several hundred thousand dollars of drugs, including the antidepressants Cymbalta and Abilify and the cancer drug Gleevec, prosecutors said.

Karapedyan and the Stepanyans were among 32 people arrested Wednesday, according to the U.S. attorney’s office for the Northern District of California. Miller remains at large.

The U.S. attorney’s office said it did not know whether any of the defendants had attorneys who could comment on the allegations. Most of them appeared before federal judges Wednesday but did not enter pleas.

In addition to illegal prescription drug sales, the enterprise is accused of preparing fraudulent tax returns that relied on an unlicensed mailbox business for addresses. Karapedyan and his associates negotiated more than 500 fraudulent checks worth more than $5 million between 2012 and 2014, according to prosecutors.

Karapedyan and another defendant, Gevork Ter-Mkrtchyan, are also accused of paying $1,500 to have someone killed, though prosecutors said the hit was never carried out.

MONEY Health Care

How to Survive This Awful Allergy Season

pollen written on windshield covered in pollen
Joseph De Sciose—Getty Images/Aurora Creative

Lingering winter cold means pollen levels could rise quickly—and so could your medical costs.

Grab your tissue box. We’re in for a terrible spring allergy season. Experts say that the long winter may cause early-blooming trees to pollinate late this year, which means more trees pollinating at the same time.

About one in five Americans suffer from some kind of allergy, with seasonal allergies the most common, according to the Asthma and Allergy Foundation of America. While not as severe as food and insect allergies, hay fever can put a real damper on your life—seasonal allergies are responsible for some 4 million missed or lost workdays every year, the National Academy on an Aging Society estimates.

The upside is that if you take your allergies seriously this year, you might feel better and save money. True story: My entire childhood, I had “seasonal” allergies that lasted almost year-round. (For some reason, no one thought this was weird.) As an adult, I finally got tested. I was allergic to my cat. Part of me wishes I didn’t know that, but I don’t have to buy as much Claritin now.

Here’s what allergies could cost you—and how you can save.

Over-the-counter antihistamines: 10¢ to 67¢ a pill

With hay fever, you can burn money on boxes upon boxes of over-the-counter allergy relief like Claritin, Allegra, and Zyrtec. But you can save a ton if you just compare prices online, says Elizabeth Davis, editor-in-chief of GoodRx blog, a prescription savings blog.

“One thing that tends to be worthwhile is going for the non-name brand version,” Davis says. “It looks like you can get [generic Claritin] for as low as $10 for 100 tablets, but I’m generally seeing about $20 or so for a regular box of brand-name Claritin, which has 30 tablets.”

So shop online, save 85%.

Another medication to consider: nasal spray. Nasacort and Flonase were both recently approved for over-the-counter sale, where they cost between $17 and $25 a bottle, Davis says.

Prescription antihistamines: 50¢ to $1.60 a pill

Sometimes, over-the-counter medications won’t be enough to alleviate your symptoms. If you’re still suffering, or if you find yourself relying on Benadryl on a daily basis, it’s time to see an allergist.

While prescription allergy meds are usually more expensive—as low as $15 but as much as $40 or $50 for 30 tablets, Davis estimates—what you pay will depend on your health plan. Doctor visits, tests, and prescriptions are typically covered by health insurance, with a co-payment or co-insurance, after you meet your deductible.

The higher dosages in prescription meds might be what you need to kick your symptoms. A doctor might double, triple, or even quadruple your dose, or advise you to take a combination of antihistamines and decongestants, says Neil Kao, an allergist in Greenville-Spartanburg, S.C.

“When you go the doctor, you might say, ‘Well, I took Claritin, and it didn’t work,'” Kao says. “The doctor might say you need two—one in the morning, one at night. You might say, ‘The box says one.’ Well, that’s why I went to medical school!”

Also, while prescription generic Nasacort nasal spray costs more—typically $50 to $75 a bottle—and prescription generic Flonase costs less—usually $12 to $17—the prescription versions could be a better deal than over-the-counter versions if you have a low co-pay, Davis says. Talk to your doctor and check your plan.

Allergy testing: $30 to $275

Once you’ve spent serious money on allergy medicine, you may want to know if you’re on the right track, Kao says. Are you sneezing because there’s pollen in the air, or because you have a cold, or because your cat is shedding his winter coat? With a simple skin test, an allergist can determine what, if anything, you are allergic to.

According to HealthSparq, a health costs transparency firm, an office visit with an allergist typically runs $200 to $300 before insurance. Those estimates are based on insurer-negotiated prices on claims filed in Oregon, Washington, Utah, and Idaho.

From there, the cost of the allergy tests can vary from $30 to $275, and even as high as $4,000, depending on the type and number of tests given, according to HealthSparq. Pro tip: 77% of large employers offer a price transparency tool, according to Mercer, so you can get your own individualized price estimate.

Immunotherapy: $15 to $20 a session

After you know what you’re allergic to, allergy shots are another treatment option. Here’s how it works: Your allergist uses a skin test to decide which allergens to put in your shots, which slowly expose you to your allergens to get your immune tolerance back up to normal, Kao explains.

Kao recommends shots for sufferers with moderate to severe allergies who either do not get enough relief from medications or who do not want to take medications any longer. “Statistically, [shots] help about 90% of well-selected people,” Kao says.

HealthSparq estimates that it typically costs $15 to $20 a visit before insurance kicks in, but could be as high as $170 a visit, depending on your course of treatment.

However, Kao says that in the long term, allergy shots pay for themselves. Think of the money you won’t be spending on over-the-counter medications, prescriptions, antibiotics for sinus infections, and doctor’s visits. “That’s all money saved,” Kao says.

EpiPens: $450 to $500 for a two-pack

Pollen means something else for people with bee sting allergies: It’s time to carry an EpiPen again. EpiPens—or epipnephrine auto-injectors—provide immediate relief to anyone suffering from anaphylaxis, a potentially fatal allergic reaction. The pen is inserted into the middle of the thigh while a patient awaits professional medical attention.

Unfortunately, the price of EpiPens have increased significantly in the past several years. Davis of GoodRX Blog estimates a two-pack could run about $450 to $500 before insurance.

Coupons can help. At EpiPen.com you can apply for discounted epinephrine pens. Many patients with private health insurance can get the EpiPen two-pack for free, and everyone else can get $100 off, says Davis.

Alternately, you can get a generic epinephrine pen for $250 to $300, but you’ll need to ask your doctor to write a prescription specifically for the generic, Davis says.

Update: This article was updated to indicate the correct use of an EpiPen.

MONEY health

We’re Spending Much, Much More on Prescription Drugs

Americans spent nearly $374 billion on prescription drugs in 2014, thanks in part to some shockingly expensive new medicines.

MONEY Health Care

The Scariest Health Care Statistic of 2014

Express Scripts reports that spending on medicine surged by 13.1% in 2014.

Healthcare has no shortage of frightening statistics, but a recent review of U.S. spending on medicine last year by the pharmacy benefit manager Express Scripts EXPRESS SCRIPTS HOLDING COMPANY ESRX -1.87% contained a particularly scary revelation: Last year, Americans shelled out 13.1% more for medicine than they did in 2013. That surge in spending could put our healthcare system on a perilous path, especially given that healthcare utilization is climbing on the tailwind from aging baby boomers and healthcare reform.

Better drugs equals pricier medicine

Thanks to innovative new therapies, people are living longer, but they’re doing so at a steep cost.

A decade ago, medicines were primarily small molecule drugs that were easy to manufacture and duplicate. As a result, these drugs were less costly to prescribe and were more quickly challenged by generic alternatives once their patent protection ended.

Today, medicines are increasingly complex biologics. These biologic drugs are medicines that are developed inside living systems such as plant or animal cells. Most biologics are complicated molecules or combination molecules that aren’t easily replicated. The complexity of biologics often translates into increased efficacy over prior generation drugs, but it also makes them much more expensive to develop and manufacture. It also makes it incredibly difficult for generic drugmakers to duplicate them once their patents expire.

The ongoing shift toward these increasingly complex — and correspondingly more expensive medicines — has resulted in them accounting for an increasingly larger share of our healthcare dollars.

According to Express Scripts, despite specialty drugs like biologics representing just 1% of all annual prescriptions, they accounted for a whopping 31.8% of drug spending last year.

Unsustainable spending?

Across the tens of millions of health insurance members covered by Express Scripts pharmacy plans, spending on the average member climbed to $668.75 per year for traditional drugs and $311.11 for specialty medicines.

As you can see in the following table, annual spending per member increased by 6.4% year over year for traditional drugs and by 30.9% for specialty drugs. In both instances, higher drug prices were overwhelmingly behind the increases.

If left unchecked, drug spending growth of this magnitude could be unsustainable. In 2013, IMS Health reported that U.S. spending on medicine clocked in at about $329 billion.

If spending increases by 13.1% per year over the next 20 years, the amount spent annually on prescription medicine would surpass $3.8 trillion (yes, with a “t”).

Taking matters into hand

Such a surge in drug spending would undeniably put patients at risk. Medical costs are the biggest reason for personal bankruptcy, particularly among patients with diseases like HIV and cancer.

In an attempt to blunt the risk to the system posed by runaway drug costs, pharmacy benefit managers, or PBMs, like Express Scripts and CVS Health CVS HEALTH CORPORATION CVS -0.79% — the two largest PBMs — are rethinking how they pay for drugs.

In December, Express Scripts negotiated a steep discount to AbbVie’s ABBVIE INC. ABBV -1.3% new hepatitis C drug Viekira Pak by offering exclusivity. In January, CVS Health similarly orchestrated a discount for Gilead Sciences’ GILEAD SCIENCES INC. GILD -0.53% competing hepatitis C drugs, also in exchange for exclusivity. Express Scripts estimates that its deal with AbbVie will save its clients $1 billion annually.

In addition to more aggressive price contracts with drugmakers, healthcare payers are also developing programs that can increase patient adherence to medicine to lower the risk of costly future healthcare events, as well as programs to increase the use of generic alternatives.

PBM programs that increase the use of lower cost generics could prove to be critical. Despite biologics’ difficult-to-copy nature, technology advances are helping generic drugmakers develop biosimilars. While not exact copies, these biosimilars deliver similar efficacy to their brand name counterparts. So far, biosimilars have been a bigger story in Europe than in the U.S.; however, the FDA approved its first biosimilar this month when it gave Novartis’ Sandoz unit the go-ahead to begin marketing its biosimilar of the top-selling cancer drug Neupogen. That approval is likely to be the first of many over the coming years.

Looking ahead

The financial stakes are high for patients and drugmakers. If prices are too low, it could force drug developers to focus only on diseases that offer the biggest payoff. That could derail advances in a range of orphan diseases. However, if prices for medicine continue to grow at this rate, it’s unlikely that the system will be able to afford it. Clearly, a middle ground is not only necessary, but in the best interest of everyone. Finding that middle ground, however, may remain difficult.

MONEY Health Care

Why You Could Have to Foot the Full Bill for a Weight-Loss Drug

The government has approved more drugs that suppress your appetite, but not all insurers will pick up the tab for the prescription.

In December, the Food and Drug Administration approved a new anti-obesity drug, Saxenda, the fourth prescription drug the agency has given the green light to fight obesity since 2012. But even though two-thirds of adults are overweight or obese—and many may need help sticking to New Year’s weight-loss resolutions—there’s a good chance their insurer won’t cover Saxenda or other anti-obesity drugs.

The health benefits of using anti-obesity drugs to lose weight—improvements in blood sugar and risk factors for heart disease, among other things—may not be immediately apparent. “For things that are preventive in the long term, it makes plan sponsors think about their strategy,” says Dr. Steve Miller, the chief medical officer at Express Scripts, which manages the prescription drug benefits for thousands of companies. Companies with high turnover, for example, are less likely to cover the drugs, he says.

“Most health plans will cover things that have an immediate impact in that plan year,” Miller says.

Miller estimates that about a third of companies don’t cover anti-obesity drugs at all, a third cover all FDA-approved weight-loss drugs, and a third cover approved drugs, but with restrictions to limit their use. The Medicare prescription drug program specifically excludes coverage of anti-obesity drugs.

Part of the reluctance by Medicare and private insurers to cover weight-loss drugs stems from serious safety problems with diet drugs in the past, including the withdrawal in 1997 of fenfluramine, part of the fen-phen diet drug combination that was found to damage heart valves.

Back then, weight-loss drugs were often dismissed as cosmetic treatments. But as the link between obesity and increased risk for type 2 diabetes, heart disease, cancer and other serious medical problems has become clearer, prescription drugs are seen as having a role to play in addressing the obesity epidemic. Obesity accounts for 21% of annual medical costs in the United States, or $190 billion, according to a 2012 study published in the Journal of Health Economics.

The new approved drugs—Belviq, Qsymia, Contrave and Saxenda—work by suppressing appetite, among other things. Saxenda is a subcutaneous injection, the other three drugs are in pill form. They’re generally safer and have fewer side effects than older drugs. In conjunction with diet and exercise, people typically lose between 5% and 10% of their body weight, research shows, modest weight loss but sufficient to meaningfully improve health.

The drugs are generally recommended for people with a body mass index of 30 or higher, the threshold for obesity. They may also be appropriate for overweight people with BMIs in the high 20s if they have heart disease, diabetes or other conditions.

In 2013, the American Medical Association officially recognized obesity as a disease.

Nevertheless, “people still assume that obesity is simply a matter of bad choices,” says Ted Kyle, advocacy adviser for the Obesity Society, a research and education organization. “At least half of the risk of obesity is inherited,” he says.

Many people who take an anti-obesity drug will remain on it for the rest of their lives. That gives insurers pause, says Miller.

The potential cost to insurers could be enormous, he says.

Susan Pisano, a spokesperson for America’s Health Insurance Plans, a trade group, says the variability of insurer coverage of anti-obesity drugs “relates to issues of evidence of effectiveness and evidence of safety.”

In 2012, the U.S Preventive Services Task Force, a non-partisan group of medical experts who make recommendations about preventive care, declined to recommend prescription drugs for weight loss, noting a lack of long-term safety data, among other things. But its analysis was based on the older drugs orlistat, which is sold over the counter as Alli or in prescription form as Xenical, and metformin, a diabetes drug that has not been approved for weight loss but is sometimes prescribed for that by doctors.

The task force did recommend obesity screening for all adults and children over age 6, however, and recommended patients be referred to intensive diet and behavioral modification interventions.

Under the health law, nearly all health plans must cover preventive care recommended by the task force without cost sharing by patients. Implementation of the obesity screening and counseling recommendations remains a work in progress, say experts.

Dr. Caroline Apovian, director of the Nutrition and Weight Management Research Center at Boston University, says many of the patients she treats can’t afford to pay up to $200 a month out of pocket for anti-obesity drugs.

“Coverage has to happen in order for the obesity problem to be taken care of,” says Apovian. “Insurance companies need to realize it’s not a matter of willpower, it’s a disease.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why a Serious Medical Condition Could Cost You Even More Next Year

Pill container spilling out money
Last Resort—Getty Images

Health insurance plans are hitting you with higher out-of-pocket costs for the specialty drugs you may need, a new study finds.

Americans with health coverage–including those who buy it through government insurance exchanges and Medicare beneficiaries–are likely to pay more out-of-pocket next year for so-called “specialty drugs,” which treat complex conditions, according to two studies from consulting firm Avalere Health.

More than half of the “bronze” plans now being sold to individuals through federal and state marketplaces for coverage that begins in January, for example, require payments of 30% or more of the cost of such drugs, Avalere said in a report out Tuesday. That’s up from 38% of bronze plans this year.

In “silver” level plans, the most commonly purchased exchange plans, 41% will require payments of 30% or more for specialty drugs, up from 27% in 2014.

As the cost of prescription medications rise, insurers are responding by requiring patients to pay a percentage of specialty drug costs, rather than a flat dollar amount, which is often far less. Insurers say the move helps slow premium increases.

But “in some cases this could make it difficult for patients to afford and stay on medications,” Avalere CEO Dan Mendelson said in a written statement.

While there is no standard definition of such drugs outside of the Medicare program, they are often expensive medications used to treat serious, chronic illnesses, such as multiple sclerosis, rheumatoid arthritis, hemophilia, some cancers and hepatitis C. While lists of specialty drugs can differ by insurer and by policy type, drugs can include arthritis treatments Enbrel and Humira, cancer drugs Gleevec and Tarceva, hepatitis C treatment Sovaldi, and MS drugs, Betaseron and Copaxone.

While they add up to only about 1% of all prescriptions written, specialty drugs account for 25% of spending on all drugs—an amount expected to rise rapidly, according to various studies.

An earlier Avalere analysis found that for the first time since Medicare’s drug program began in 2006, all of the stand-alone drug insurance plans place some drugs into specialty “tiers.” Two thirds of those plans require patients to pay a percentage of the costs of drugs in those tiers, rather than a flat dollar payment. Medicare plans can place a product into a specialty category only if the price negotiated with the drugmaker exceeds $600 a month.

Increasingly, health plans –including those offered to people with job-based coverage – require hefty payments, sometimes 20% to 40% or more of the total cost of medications that insurers classify as specialty drugs. That’s a change from the flat dollar payments of $10 to $30 or $50 that many patients have become accustomed to for other types of drugs.

Source: Avalere

There is a limit to how much patients must pay, but it’s often high: Most policies have an annual out of pocket maximum, which is often several thousand dollars.

The new Avalere study looked at plans sold in the federal exchange and in New York and California, which run their own marketplaces.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation.

MONEY Health Care

6 Questions to Ask Before You Sign Up for a Health Plan This Year

tweezers and pill
Geir Pettersen—Getty Images

Employers are changing your health insurance options more than ever. Rushing through your open enrollment paperwork could cost you.

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans—where most working-age folks get coverage—are changing too.

Rising costs, a looming tax on rich benefit packages, and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015.

“If there’s any year employees should pay attention to their annual enrollment material, this is probably the year,” says Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don’t blow off the human resources seminars. Ask these questions.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”

Insurers publish directories, but the surest way to see if docs or hospitals take your plan is to call and ask.

“People tend to find out the hard way how their health plan works,” says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “Don’t take for granted that everything will be the same as last year.” (Kaiser Health News is an editorially independent program of the foundation.)

2. Is my employer changing where I get labs and medications?

For expensive treatments—for diseases such as cancer or multiple sclerosis—some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3. How will my out-of-pocket costs go up?

It’s probably not a question of if. Shifting medical expense to workers benefits employers because it means they absorb less of a plan’s overall cost increases. By lowering the value of the insurance, it also shields companies from the “Cadillac tax” on high-end coverage that begins in 2018.

Having consumers pay more is also supposed to nudge them to buy thoughtfully—to consider whether procedures are necessary and to find good prices.

“It gets them more engaged in making decisions,” says Dave Osterndorf, a benefits consultant with Towers Watson.

How well this will control total costs is very unclear.

Your company is probably raising deductibles—the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. One large employer in three surveyed by Marcotte’s group planned to offer only high-deductible plans (at least $2,600 for families) in 2015.

Employers are also scrapping co-payments—fixed charges collected during an office or pharmacy visit.

Once you might have made a $20 copay for a $100 prescription, with the insurance company picking up the other $80. Now you might pay the full $100, with the cost applied against your deductible, Marcotte says.

4. How do I compare medical prices and quality?

Companies concede they can’t push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5. Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don’t necessarily think of HSAs as money down the drain, says Osterndorf. Think of them as a different kind of retirement savings plan.

6. How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers–usually cheap generics—and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also see if a less-expensive drug will deliver the same benefit.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

TIME medicine

6 Common Prescription Mistakes You Might Be Making

Pill bottles
Getty Images

In honor of Talk About Your Medicines Month

It’s hard to imagine a time when there wasn’t a pill—sometimes dozens of different ones—to treat so many health conditions. Today, 70% of Americans take at least one prescription drug and more than half take two, according to the Mayo Clinic.

While the healing powers of modern medicine are pretty awesome, you still need to be cautious when it comes to any drug. The Food and Drug Administration (FDA) reports that medication errors cause at least one death every day and injure 1.3 million people annually.

HEALTH.COM: 14 Reasons You’re Always Tired

In honor of Talk About Your Medicines Month, read up on common mistakes to avoid with your prescriptions.

You get the brand name over generic

Yes, they’re cheaper, but generic drugs are just as effective as the brand name. To be approved by the FDA, a generic drug must have the same active ingredients as the original. The only difference is the inactive ingredients, like dye or preservatives, which don’t affect the action of the drug. “Small variations in the generic are permissible,” says Kim Russo, PharmD, chief clinical officer at VUCA Health, a medication video service available at certain pharmacies nationwide. “Most of the time we don’t even medically notice it.” If you don’t tolerate one of the inactive ingredients well, then you might need the brand name. Otherwise, save yourself the money and go with the generic.

You mix your meds with the wrong foods (or drinks)

Always check what foods or drinks could interact with your medicine. One to watch out for: grapefruit and grapefruit juice. “As many as 50 drugs on the market can be affected,” Russo says. Depending on the drug, grapefruit juice can reduce or increase absorption­—the latter could lead to overdose. Then there are certain drugs that shouldn’t be taken with calcium-rich foods because they interfere with your body’s absorption of the medication, Russo says. Plus, there are medications that cause you to lose or retain potassium, so you’ll want to talk to your doctor or pharmacist about whether you need to start (or stop) eating certain foods. And you should ask your doctor if it’s OK to drink alcohol while taking your prescription. “Alcohol can turn possible mild side effects into dangerous ones,” Russo says. The FDA has more info on bad food-drug combos.

HEALTH.COM: 16 Worst Birth Control Mistakes

You don’t check your Rx label at the pharmacy

To save yourself the stress of a medication error, make sure you have the right prescription before you leave the pharmacy. If your pharmacist only asks for your name at the counter, provide another identifier, like a birth date or address. That way you’ll know the drug is filled under the correct person, Russo says. Another good idea: open your bag. “I would read the label and open the prescription to see if you recognize it,” Russo says. A different color or shape may just mean the drug is coming from a new generic manufacturer, but it never hurts to be safe.

You don’t talk to your pharmacist

Most pharmacists will ask if you have questions about your medication. But when’s the last time you actually voiced one? It’s never a good idea to rush through picking up a new prescription. That’s the time to find out what the medicine is for as well as the benefits and possible side effects or drug interactions, Russo says. If you’ve been on the medication a while and have noticed unexplained changes lately, say a rash or constant headache, that’s also a good time to speak up. On three or more medications? “It’s a great idea once a year to make an appointment with your pharmacist to review them,” Russo suggests.

HEALTH.COM: 15 Tips for Saving Money on Prescription Drugs

You store your meds in the wrong spots

The number one worst place you could keep your medication is the bathroom. That’s because moisture can degrade medicine, Russo says. Medications also need to be protected from light. “That’s why prescription vials are the amber color, to block UV light,” Russo says. Still, you should keep medication in a dark place, especially if you have a pill organizer that’s clear and light can get through. Certain drugs shouldn’t be taken out of the vial at all. Some medications, like insulin, might need to be refrigerated initially, but can be taken out to warm up before injecting and then stored at room temperature for a set number of days. Just keep in mind some drugs are meant to be kept in the fridge and they can lose their effectiveness if left at room temperature for even a few hours, Russo says. Check with your pharmacist to know how long is too long.

You don’t dispose of old meds properly

Most pills remain effective up to two years after the expiration date, Russo says. When it’s time to get rid of them, though, don’t count on the toilet as your go-to disposal method. “Flushing certain cardiac, seizure, or hormone medications can be very harmful to the environment,” Russo says. Only a few medications, including ones for pain, are recommended by the FDA for disposal by flushing. The rest you should throw in a plastic bag with kitty litter or used coffee grounds so kids or pets won’t be tempted to eat them. Then, the bag’s ready for the trash. You could also ask your pharmacist about upcoming medicine take-back programs.

HEALTH.COM: 27 Mistakes Healthy People Make

This article originally appeared on Health.com

MONEY Medicare

Some Medicare Advantage Plans Have Hidden Risks—Here’s How to Avoid Them

hands using measuring tape
Nils Kahle

Although they promise quality care at lower cost, some Medicare Advantage plans fall short. Before you enroll, here are key questions to ask.

Seniors have flocked to Medicare Advantage in recent years, attracted by savings on premiums and the convenience of one-stop shopping. But as the annual Medicare enrollment season began this week, a memorandum from federal officials to plan providers surfaced that serves as a big red warning flag.

The upshot: Assess the quality of any Advantage plan before you sign up.

The memorandum, first reported by the New York Times, described ongoing compliance problems uncovered in federal audits of Advantage and prescription drug plans. These include inadequate rationales for denial of coverage, failure to consider clinical information from doctors and failure to notify patients of their rights to appeal decisions. The audits also uncovered problems with inappropriate rejection of prescription drug claims.

Advantage is a managed care alternative to traditional fee-for-service Medicare. It rolls together coverage for hospitalization, outpatient services and, usually, prescription drugs. Advantage plans also cap your out-of-pocket expenses, making Medigap supplemental plans unnecessary.

The savings can be substantial. Medigap plan premiums can cost $200 monthly or more, and stand-alone drug plans will average $39 a month next year. Enrollees have been voting with their wallets: 30% are in Advantage plans this year, up from 13% in 2005, according to the Henry J. Kaiser Family Foundation.

Advantage plans are subject to strict rules and regulations, and must cover all services offered in original Medicare, with the exception of hospice services. Some offer extra coverage, such as vision, hearing, dental and wellness programs.

And there is evidence that the quality of these plans is rising. Medicare uses a five-star rating system to grade plan quality, and plans can earn bonus payments based on their ratings. Average enrollment-weighted star ratings increased to 3.92 for 2015, from 3.86 in 2013 and 3.71 in 2013, according to Avalere Health, an industry research and consulting firm. Avalere projects that 60% of Advantage enrollment will be in four- or five-star plans next year, up from 52% this year.

But the Medicare memorandum focuses on problems outside the rating system. “It’s about basic blocking and tackling and whether a plan adheres to the program’s technical specs,” says Dan Mendelson, Avalere’s chief executive officer. “These are the basic functions that every plan should be able to handle.”

Nevertheless, consumer advocates say they deal with these compliance problems regularly, and more often with enrollees in Advantage than in traditional Medicare.

“The most typical problems have to do with plans that are making it difficult or impossible for people to get their medications,” says Jocelyn Watrous, an advocate for patients at the Center for Medicare Advocacy. “They impose prior authorizations or other utilization management rules that they make up out of whole cloth.”

Consumer advocates urge Medicare enrollees to restrict their shopping this fall to four- and five-rated plans, of which plenty are available in most parts of the country. “If a plan consistently gets four or five stars, all other things being equal it will be a high performer,” says Joe Baker, president of the Medicare Rights Center.

Few Medicare enrollees roll up their sleeves to shop, however. A study by Kaiser found that, on average, just 13% of enrollees voluntarily switched their Advantage or drug plans over four recent enrollment periods. And focus groups with seniors conducted by the foundation last May found that few pay attention to the star ratings.

“Seniors said they don’t use the ratings because they don’t feel they reflect their experiences with plans,” said Gretchen Jacobson, associate director of the foundation’s Medicare program. “Even when we told them that their plan only has two stars, many just wanted to stay in that plan.”

Advocates say the star ratings are just a starting point for smart shoppers.

They say you should check to make sure health providers you want to see are in a plan’s network. You should also consider how you would react if any of those providers disappeared during the 12 months that you are locked into the plan. Advantage plans can—and do—drop providers. UnitedHealth Group, the industry’s largest player, made headlines last year when it dropped thousands of doctors in 10 states. Advantage plans in Florida, Pennsylvania, California and Delaware also terminated provider relationships.

Also be sure to examine the prescription drug “formularies” in your plan—the rules under which your medications are covered. And talk with your doctors about any plan you are considering, especially if you see specialists for a chronic condition.

The Medicare memorandum to plans also underscores the importance of appealing denied claims, Baker says. “Appeal, appeal, appeal—it’s like ‘location, location, location’ in real estate.”

MONEY Medicare

What You Need to Know About Medicare Open Enrollment

Pharmacy
Getty Images—Getty Images You can shop for a new drug plan starting October 15.

Your once-a-year chance to change your drug coverage or switch plans begins in two weeks. Here's what to expect.

Medicare beneficiaries who want to make changes to their prescription drug plans or Medicare Advantage coverage can do so starting Oct. 15 during the Medicare’s program’s annual open enrollment period. There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say.

And although premiums aren’t expected to rise markedly overall in 2015—and in some cases may actually decline—some individual plans have signaled significantly higher rates. Rather than rely on the sticker price of a plan alone, it’s critical that beneficiaries compare the available options in their area to make sure they’re in the plan that covers the drugs and doctors they need at the best price.

The annual open enrollment period is also a once-a-year opportunity to switch to a private Medicare Advantage plan from the traditional Medicare fee-for-service plan or vice versa. Open enrollment ends Dec. 7.

Although the Centers for Medicare and Medicaid Services has released some specifics about 2015 premiums and plans, many details about provider networks, drug formularies and the like won’t be available until later this fall. Here’s what we know so far:

Standalone Prescription Drug Plans

The number of Part D standalone prescription drug plans (PDPs) will drop 14%, to 1001 plans. This is the smallest number of offerings since the Medicare Part D program began in 2006.

Even so, “seniors across the country will still have a choice of at least two dozen plans in their area,” says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

The drug plan consolidations that are driving the reductions in choices will likely shift many beneficiaries into lower cost plans, resulting in an average premium decline of 2%, to $38.95, according to an analysis by Avalere Health.

But that overall average premium obscures significant price hikes by some of the biggest plans. The average premium for the WellCare Classic plan, for example, will increase 52% in 2015, to $31.46, while the Humana Walmart RxPlan premium will rise 24%, to $15.67, according to Avalere.

Insurers are expected to continue to shift more costs to beneficiaries next year. The percentage of PDP plans with no deductible will decline to 42% from 47%, and, once again, about three quarters of plans won’t offer any coverage in the “donut hole”— the coverage gap in which beneficiaries are responsible for shouldering a greater share of their drug costs.

Underscoring the importance of evaluating plan options, 70% of standalone drug plan members will likely see their premiums increase if they stick with the same plans in 2015, says Ross Blair, senior vice president for eHealthMedicare.com, an online vendor.

Seniors, though, have historically not voluntarily switched plans in great numbers during annual enrollment. Between 2006 and 2010, on average only 13% did so, according to a 2013 analysis by researchers at Georgetown University, KFF and the University of Chicago.

Medicare Advantage

Enrollment in Medicare Advantage plans continues to grow: 30% of Medicare beneficiaries are now in the private plans, which typically are managed care plans that often provide additional benefits such as vision and dental coverage. Concerns that Medicare Advantage plans would disappear in large numbers as the health law gradually reduces their payments to bring them in line with the traditional Medicare program have proven unfounded to date. In 2015, the number of plans will drop by 3%, to 2,450, continuing a gradual decline.

“You still have lots of plans and robust selection,” says Caroline Pearson, vice president at Avalere Health, a research and consulting firm. Some parts of the country appear to be harder hit by plan reductions than others, including the Southeast and mid-Atlantic regions, Pearson says.

Medicare Advantage coverage has always been concentrated in health maintenance organizations, and this trend will continue in 2015. The number of HMOs will increase by 1.5%, to 1,747, while the number of preferred provider organizations will drop by nearly 9%, to 541, according to Avalere. About two-thirds of Medicare Advantage beneficiaries are currently in HMOs, while 31% are in PPOs.

The average premium will increase by $2.94 to $33.90, but nearly two-thirds of beneficiaries won’t see any premium increase, according to CMS. Like standalone drug plans, however, fewer Medicare Advantage drug plans will offer no deductibles and gap coverage, according to Avalere.

“It’s one example of how plans are tightening up coverage,” and pushing more costs onto consumers, says Pearson.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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