HealthBiz: HSAs get boost from BCBS

WASHINGTON, Nov. 18 (UPI) -- The 41 Blue Cross and Blue Shield Association plans cover healthcare for some 91 million Americans and their entry into the health savings account field likely will drive growth of this new insurance option.

Blue Cross and Blue Shield HSA compatible plans are rolling out now in 34 states for both the large and small group markets, and in 32 states for individuals. Expansion to cover the rest of the country is expected by 2006.

HSAs include a savings account coupled with a high deductible insurance plan. People save money tax free to pay for medical expenses until a deductible of at least $3,000 for families is met, at which point the insurance kicks in. Money left over in the savings account rolls over from year to year, accumulating interest tax free, right into retirement, when it can be used for healthcare expenses.

Cary Badger of the BCBS Regence Group, with plans in Washington state, Utah, Oregon and Idaho, told UPI's HealthBiz the rollout is accompanied by a lot of education for consumers, brokers and employers.

"With high deductible plans you have to educate them on the benefits, Badger said, as well as the risks and liabilities so people can determine if an HSA is the right plan for them.

He said if a person has anticipated healthcare costs, such as for a chronic illness like diabetes, and can predict their out-of-pocket costs would exceed the deductible, the HSA might not be the best plan for them.

"If you are going to use up your savings account in a given year, there's not much value in having one," he said.

Badger said HSAs can be great retention options for health plans that have seen membership drop because increasing premiums, deductibles and co-pays are making insurance too costly. An employee might not sign up for the company health plan or not include his spouse or dependents to save money.

Therefore, he doesn't believe HSAs are a risk for an employer-sponsored group health plan risk pool. One worry is that healthy people will leave the more expensive group plans for HSAs, leaving the group plan with sicker, more expensive patients and higher costs.

"It's a positive on the risk pool," he said. "This will get people back in the plans."

"The bigger the family the better the deal," Badger said because while the family deductible is high, it covers the entire family and therefore spreads out the per-person costs.

Critics have said HSAs will be for only the healthy and wealthy, but Badger said interest so far has been diverse because "there is something very attractive about that high deductible," especially to small businesses that are struggling to afford the cost of providing health benefits.

John Maginnis, vice president of marketing for Blue Cross and Blue Shield of Louisiana, said so far more than 53,000 people had joined BlueSaver, that plan's HSA option.

FDA SCIENTIST CRITICAL OF AGENCY'S ACTIONS ON VIOXX

One of the Food and Drug Administration's own scientists Thursday harshly criticized the agency's actions concerning Merck's Vioxx -- the arthritis drug the pharmaceutical company voluntarily pulled from the market after it was linked to a 50 percent increase in the risk of heart attacks and stroke.

David Graham, associate director for science in the FDA's Office of Drug Safety, told the Senate Finance Committee he felt pressured to change a report he had written to present at a conference on FDA-funded research he had done with Kaiser Permanente that uncovered a heightened cardiovascular risk with Vioxx.

"I was pressured to change my conclusions and recommendations, and basically threatened that if I did not change them, I would not be permitted to present the paper at the conference," he testified.

In a statement issued before the hearing, Dr. Lester Crawford, acting FDA commissioner, said some scientists in the FDA disagreed with Graham's conclusions "and, as a result, the project officer voluntarily chose to revise his conclusions, and he did so, in his own words, 'without compromising my deeply held convictions.'"

Graham said he changed his report because otherwise "there was no way that data would see the light of day."

Dr. Sandra Kweder, acting director of FDA's Office of New Drugs, testified, "Disagreement is part of science. It's what we do," and added athe FDA will implement ways to ensure scientists who believe they aren't being heard can speak their minds.

Merck Chief Executive Officer Raymond Gilmartin testified Graham's study, released several weeks before Merck's own studies concluded there was a significant cardiovascular risk with using Vioxx for longer than 18 months, "played no role" in the company's decision to withdraw the drug.

Merck had known for several years about the cardiovascular risk of using high doses of Vioxx -- 50 milligrams -- and had worked with the FDA to change the drug package labeling informing patients and physicians. Gilmartin said it wasn't until September, however, that Merck had definitive results showing the cardiovascular risk from its own long-term clinical trials using 25 mg doses of Vioxx -- the usual daily regimen for people with arthritis. At that point the drug was removed from retail sales.

"In fact, my wife was taking Vioxx, using Vioxx, up until the day we withdrew it from the market," he testified.

Committee Chairman Sen. Charles Grassley, R-Iowa, reprimanded the FDA, however, over the second incident in months in which an FDA scientist said he was pressured against presenting data that showed a drug was harmful. Aside from Graham, he recalled Andrew Mosholder had linked antidepressants to suicidal behavior in children but had been squelched by his bosses when he tried to go public.

Bruce M. Psaty, professor of medicine and epidemiology at the University of Washington in Seattle, testified that the shorter regulatory process implemented by FDA in recent years to approve drugs to market more quickly has created a problem of drugs coming to market well before long-term clinical trials looking at side effects are finished.

"There is a system problem," he said. "A lot of attention is on rapid drug approval .. but there hasn't been comparable attention to drug safety."

He said in the 1990s, when the U.S. approval process was longer, drugs often appeared on European markets well before they were approved in the United States -- a test market of sorts that allowed the FDA to see what side effects developed in actual use and to act accordingly.

Now, Psaty noted, 68 percent of drugs are appearing in the United States first. "We are the test market now," he said.

Kweder said FDA knows "there are concerns ... about how sound our (drug approval) system is" and "look forward to change" the system and fix any problems.

SPEAKING OF INTIMIDATION....

Earlier this week, at a hearing on the vaccine shortage before the Senate Special Committee on Aging, committee Chairman Sen. Larry Craig, R-Idaho, said his staff had a difficult time finding witnesses to testify about problems in the vaccine manufacturing sector.

"All should be willing to come forward to be open and frank (in such a critical discussion) and yet, frankly speaking, many were hesitant," Craig said. "I found it very disturbing that my staff had a difficult time finding witnesses to speak."

Craig said worries about liability issues surrounding vaccines and a fear of criticizing the regulatory review process were part of the problem.