Your Pharmacist Does NOT Have a Right to Change the Rx to a Generic!

Stories have been coming out from consumers regarding how their pharmacist changed their prescription to a generic -- and this was done without telling them, and without asking their permission!

This has led to some horror stories of inadequate medication in the bloodstream for an epileptic. Her pharmacist, she learned, had exchanged her Tegretol for a generic that worked a little differently. "Just imagine what could have happened had I been behind the wheel of a car," she says. Luckily she was on a bicycle and while she sustained serious injuries, at least there was no fatality.

Pharmacists are so afraid of running afoul of insurers' pressure to use generics that they mistakenly tell patients that it is the law that they do so. Under a practice called "therapeutic substitution", pharmacists may substitute a generic for a brand-name drug even if your doctor specifies the brand name.

According to an article on MSNBC:

A pharmacist legally switched a drug prescribed by her doc — but without telling her or her physician. Usually, pharmacists replace a brand-name drug with a generic formulation of the exact same medication. Therapeutic substitution is similar but with one crucial distinction: The new drug is in the same class as the old and treats the same condition, but it's not precisely the same medication.

To understand the nuance, think of statins. They constitute a single class of medication because they all lower cholesterol by reducing its production in the liver. But not every statin lowers cholesterol by the same amount or with the same balance of LDL to HDL. So if your doctor orders a brand-name drug but your pharmacist switches it for the cheaper version of a different medication (but still a statin), you may not get the precise benefit your doctor had in mind — and may, in fact, suffer unexpected side effects.

This is horrendous -- we are all in favor of lower drug costs and in favor of using generics where appropriate, but no pharmacist should ever spring a surprise on any customer.

To read the whole article you may go here: http://www.msnbc.msn.com/id/30627962/
In one way, at least, patients can benefit from substitution — smaller co-pays. But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren't consulted. Of those, 40 percent said the new drug was not as effective, and a third said it had more side effects. "It's not okay for your insurance company or pharmacist to change your drugs without your knowledge," says NCL Executive Director Sally Greenberg.

Is it Right that Insurance Companies are Profiting from Smoking Twice?

A Canadian newspaper recently ran a story investigating how much insurance companies have invested in the tobacco industry. The June 5 issue of The Province found that Sun Life, a major Canadian insurance company, has a billion dollars invested with two tobacco companies. About $890 million of that is in Philip Morris. And the insurance industry as a whole has over four billion dollars invested in tobacco.

This brings up not only a question of business ethics, but of sending a mixed message to the public. Insurers have penalized smokers with higher rates for every type of insurance, and yet they continue to invest heavily in tobacco.

Clearly they place a higher value on profits, and obviously tobacco has been a steady producer of profits for investors of every size.

As long ago as 1995, we have known that insurance companies were rather heavily invested in tobacco. That is the year that Lancet ran an article on the subject. Insurers profit twice from tobacco: once from the higher rates charged to smokers, and again from their tobacco stock holdings.

The Province article also states that Prudential, which sells health and disability insurance, has $1.38 billion in two tobacco companies, including British American Tobacco (BAT).

Northwestern Mutual (NML), Massachusetts Mutual and the Scottish firm Standard Life also have large holdings in tobacco firms.

Do we as consumers have a right to criticize insurers for having these investments, whether or not we hold stock in the insurance companies? Or is tobacco such an old and traditional social vice that it is useless to rail against it? Remember that Prohibition against alcohol did not work.

We can simply choose to not invest in companies that invest in industries we do not want to encourage. We can simply choose to invest in green, sustainable industries and companies.

The article may be read at: http://www.theprovince.com/Health/Canadian+life+health+insurers+investing+heavily+tobacco+companies/1664704/story.html

An Alphabetical List of Insurers Offering Supplemental Insurances

by L.A.S. --

The following is a list of the major insurers offering supplemental insurances which employers may choose to offer instead or as an alternative to standard group coverage. You may also wish to investigate other companies such as AdminiStaff, which offers supplemental insurance in addition to payroll services.

AEGIS ADMINISTRATIVE SERVICES INC.
888-881-2307
www.mini-meds.com
Offered as Limited Health Benefit Plans. Offered in ALL states. Issue ages 18-65. No deductible. Guaranteed issue. Details: defined benefits for inpatient hospital, surgery, outpatient, office visits, pharmacy, dental.

AIGILIS CORP.
407-324-3921
www.Rethink-Healthcare.com
Offered as eHealth Companion. Offered in ALL states. Issue ages not stated, but available to all employees. No deductible. Details: intended to be a personal health care management system to help you transition to a Consumer Directed Health Plan. Compatible with HSA, HRA.

AIGILIS CORP.
ALSO offers another plan called Way2SaveRx which is a discount pharmacy card. Minimum age 18. Available in all states. No deductible. Over 53K participating pharmacies. No enrollment or membership fees.

ALTERNET BENEFITS
877-815-2121
www.Alternetbenefits.com
Offered as Fusion. Offered in all states EXCEPT ID, MN, NY, VT, WA. Issue ages 18-70. Deductible $750 to $15,000 on catastrophic medical. Guaranteed issue. Details: Voluntary major medical.

AMERICAN FIDELITY ASSURANCE CO.
877-967-5748
www.afadvantage.com
Offered as Hospital GAP Plan. Offered in all states EXCEPT ID, MD, MN, NH, NJ, NY, ND, WA. . Issue ages 18-69. Details: supplemental coverage to cover your out-of-pocket costs. Not portable.

AMERICAN PUBLIC LIFE INSURANCE CO.
800-256-6736
www.ampublic.com
TWO PLANS: One is offered as Hospital Indemnity. Available in all states EXCEPT NJ, NY, VT. Issue ages 17-64. NO DEDUCTIBLE. Details: includes Rx discount, flexible plan designs, options for surgery, outpatient, emergency, wellness, etc.
The other is offered as MEDlink. Issue ages 18-69. No deductible on inpatient. This is not portable.

AMERICAN WORKER PLANS INC.
866-215-9300
www.theamericanworker.com
Offered as The American Worker Plan. Available in all states EXCEPT HI, MA, NY. Issue ages 18-70. Not portable. Limited benefit, critical illness, dental, disability, mini-med.

EQUITABLE LIFE & CASUALTY
800-352-5121
Offered as EquiChoice. Available in states EXCEPT AK, CA, CT, DE, DC, FL, GA, HI, ME, MD, MA, MN, NH, NJ, NY, RI, VT, WA, WI. Issue ages 65 and up. Guaranteed renewable. Designed as a Medicare Supplement.

GREAT AMERICAN SUPPLEMENTAL BENEFITS GROUP
866-459-4272
www.gasbinsurance.com
Offered as Medicare Supplement Plans. Offered in all states EXCEPT AK, DC, HI, MA, NJ, NY. Issue ages 65-99. Guaranteed issue, with pharmacy discount card.

HARBOR INSURANCE MARKETING
866-424-2167
THREE PLANS, first is Offered as the Gap Plan. Offered in all states EXCEPT CA, CT, FL, MN, MT, NJ, NY, ND, VT. Issue ages 18-70. No deductible. Not portable but can be continued under COBRA. Details: hospital benefit, fills gaps, flexible with several optional riders like surgery, outpatient surgical facility, office visits, diagnostics, wellness, ambulance, ER, accident, Rx card, etc.
Second plan is called Hospital Indemnity. Issue ages 18-64. No deductible. Covers expenses up to $1000 per day. Optional riders include AD&D, diagnostics, emergency, ICU, outpatient, private duty nursing, surgical, wellness, etc.
Third plan is called The Answer Plan. Issue ages 0-63. No deductible on inpatient. Covers medical expense inpatient and outpatient up to $250,000 per covered person per injury.

HEALTHPLAN SERVICES
800-545-6441
www.healthplan.com
Offered as Golden Rule Medicare Supplement. Available in AK, AR, CO, IL, IN, IA, LA, MD, MI, MS, MO, NE, OH, OK, SC, TN, TX, VA, WV. Issue ages 65 plus. Deductible varies.

KEY BENEFIT RESOURCES
877-907-5511
www.keybenefitresources.com
Offered as Keygap and KeySelect. Available in all states EXCEPT CA, CT, DE, FL, MA, NH, NY, WA. Issue ages 18-no limit. COBRA eligible. One is a group supplemental policy, the other is a limited benefit group plan.

MAGNA BENEFITS SOLUTIONS INC.
616-949-1199 or 800-278-2323
www.magnabenefits.com
Offered as Retiree Group Health and Prescription Drug Plans. Available in ALL states. Issue ages 65 unless already retired and Medicare eligible. Options include dental, vision, identity theft.

TRANSAMERICA WORKSITE MARKETING
800-400-3042
www.transamericaworksite.com or transchoiceplus.com
Offered as TransChoice Plus. Available in all states EXCEPT CA, CT, HI, NH, NJ, NY, VT, WA. No age restrictions for issue. No deductible. Limited group benefit for full or part-time employees. Options include diagnostics, surgical, inpatient, wellness, ambulance, hearing, pharmacy, etc.

UNUM
207-575-4942
www.unum.com
Offered as MedSupport. Available in all states EXCEPT CT, FL, KS, MA, MN, NJ, NY, WA. Issue ages 17-64 and spouse. No deductible. Inpatient confinement and outpatient surgery, diagnostics, ER.

What is in the New ARRA Law that Obama signed? Some details on COBRA changes, while we wait for details on implementation.

by L.A.S. --

While the thousand-page ARRA law (American Recovery and Reinvestment Act) became law on March 1, 2009 when President Barack Obama signed it on Feb. 17, your employer was awaiting the details on the law in order to be in compliance with it. This means as a practical matter that thousands desperately waiting for help in keeping up their former employer's insurance under COBRA provisions could not be assured of a smooth transition to the emergency provisions of the law.

The law itself is written rather vaguely and so employers are scrambling for guidelines on implementation of the new rules. Granted, the ARRA law was written under pressure and so some parts are less defined than others.

THE OLD COBRA LAW: a qualified beneficiary who elected to continue health insurance coverage under his former employer's group plan had to pay the full premium, plus a small percentage (two percent) toward handling fees.

THE NEW COBRA LAW: Employees who were terminated between Sept. 1, 2008 and Dec. 31, 2009 “due to an involuntary loss of employment” will have 65 percent of the premium subsidized by the federal government for a period of UP TO nine months. Included in the group of employees covered by this new provision are those former employees who already declined COBRA coverage. Former employees will be covered for a total of 18 months: nine months of subsidized coverage and nine months of unsubsidized coverage.

The subsidy is NOT available to employees whose modified adjusted gross income exceeds $145,00 (or $290,000 for joint filers). Those with incomes between $125,000 and $145,000 will see a proportional decrease in their subsidy.

The subsidy is supposed to paid out of credits against the employer's payroll tax liability. In other words this is an immediate tax exemption for the employer and should not be a crushing burden to them financially. Anyone who claims otherwise is not understanding the ARRA provisions.

To restate it more simply: eligible individuals pay 35 percent of the total premium while the employer pays the other 65 percent, which is then reimbursed to the employer as a tax credit.
Some confusion may exist over some proposals that did not become part of the final bill. One major item that was changed was the proposal to allow those former employees over age 55 to re-enter the COBRA umbrella of coverage, at least until they became Medicare eligible or obtained coverage through another employer. Again, that proposal failed to become part of the final bill.

Other proposals that died in the talking phase includes one that would have extended coverage under COBRA ; it would have been far too costly and would have essentially rewritten the whole COBRA program. While we might discuss such issues again one day, it was deemed entirely inappropriate for emergency or stimulus legislation.

Will the sickest former employees likely rush to get covered under this new COBRA provision? It is likely that the answer will be yes, just because of the fact that people with ongoing health issues need uninterrupted checkups and medications. People do not elect COBRA unless they already have health issues that make it difficult to be accepted for other health insurance policies.

Nevertheless, one must bear in mind that for most people, even those with serious health challenges, do recover and return to the realm of the healthy.

The other significant part of the ARRA bill which impacts health care costs is the provision to speed up conversion of medical records to an electronic, computerized form. Nineteen billion dollars was earmarked for this huge effort. We already have the proven example of the VA which has converted its medical records to an electronic format, and has seen it raise levels of accuracy and speed of transmission to other providers.

A major barrier to this conversion is agreeing on a format that is compatible with the majority of providers, and observing the laws regarding privacy and security of medical records as per HIPAA requirements. While the impetus for writing the HIPAA law was to maintain security of medical records when electronically submitted to insurers, it is at times used to block or deny proper access to those medical records.

An E.R. doc makes a documentary prescribing tough medicine for "Our Ailing Healthcare System"

(reprinted by permission of Minnie Apolis, from her Newsvine column)

A documentary made by an emergency room physician would seem have an edge at giving viewers an up-close look at the pressures faced by doctors from insurance and drug companies. And this film, titled Health, Money and Fear by Dr. Paul Hochfeld is an intelligent and incisive analysis of the myriad problems facing the healthcare industry in the United States.

The documentary is ninety minutes of well-done analysis and interviews with physicians and other health care professionals about the reasons why healthcare costs are out of control. The list includes:

*Insurance and Administrative Expenses: Processing costs eat up too many healthcare dollars and are inefficient.
*Malpractice Issues: Fear of being sued leads most doctors to order unnecessary tests just to cover themselves.
*Medical Records Chaos: Paper records are prone to errors and are not shared in a timely fashion with emergency or other providers.
*Pharmacy Costs: Pharmaceutical companies claim that drug prices are high because they need to recoup research expenses, yet marketing expenditures are twice what is spent on research.
*End of Life Care: If an elderly person develops a grave illness like a brain tumor, should we spend a half million to a million dollars on surgery and therapy, or just make them comfortable?
*Primary Care Crisis: The lack of new doctors going into primary care means that no one is encouraging positive lifestyle changes that could keep symptoms from becoming chronic diseases.

And the completely rational proposals to solve each of these problems are:
*Adopt a Single-Payer Health Plan
*Liability Reform
*Electronic Medical Records
*Disallow Mass Marketing of Prescription Drugs
*Public Education
*Funding of Primary Care

Stay tuned to the end of the DVD where the single-payer plan is compared to a Prom Committee that can negotiate better prices, and more efficiently, than many payers each trying to contract for different services from a plethora of providers.

More information on the Single-Payer plan is available online at: Health Care Meltdown by Bob Lebow from Amazon.com, Single-Payer FAQ from pnhp.org/facts/singlepayer_faq.php, and Campaign for a National Health Program at cnhpnow.org.

The 48-minute DVD, Health, Money and Fear is by Dr. Paul Hochfeld and produced by Dr. Graham Walker. It is dated February 2009. Dr. Hochfeld can be reached at phochfeld @ msn.com. More information is available at ourailinghealthcare.com.

A Strategy to Keep Inheritance Taxes Low as Possible

By the Columnist
What might be your best strategy for maximizing growth while shrinking the tax bite from your estate? Most of us want to leave as much as possible to our heirs, rather than to the government, or to other beneficiaries like a college, school or charities.

And there is nothing illegal in that. Designing your portfolio to legally minimize the tax bite is perfectly rational and legitimate. Using well-designed life insurance policies, which are not taxable, is one way to do that.

One option to do so is to pay a single-premium immediate annuity. This HAS to be a life-only annuity, in order to avoid being included in the estate. This immediate annuity will generate a comfortable annual income. Depending on how high-value a plan you buy into, you could hit the 40 percent tax bracket. But this is still going to be a smaller hit than the estate tax to the full value of the the estate had you not purchased the annuity.

You could still use money that you do not need to live on, and pay that into a life insurance policy in an irrevocable trust. This will sweeten the inheritance pot for your heirs. You can also
use this idea for joint and survivor plans in the case of husband and wife. Designate the surviving spouse as the primary beneficiary, and the children as secondary beneficiaries who receive an equal share of the payout. Seek advice on how to minimize gift taxes to your beneficiaries.

Some number-crunching backs this up. If you deposit one million dollars in certificates of deposit for say, 5 percent interest, you generate income of $50K and a tax of $20K. The inheritance tax will take a large bite, and you will leave $550K (roughly) to your heirs. If you put a million dollars into this immediate annuity, your yearly income could be $90K (if the plan pays 9 percent), but the tax bite is lower, only $5,600. In the end, your estate is still worth $1.1 million at the end of the tax year. You have managed to leave twice as much to your heirs, and much less to the government.

Of course, should you be so lucky as to die in 2010, you would avoid the federal estate taxes altogether. But few of us a privileged to know when we will leave this earth and this mortal shell. And that also brings up the only possible negative about this strategy: if you outlive your life expectancy, the proceeds of the annuity will be fully taxable once you have received all your original principal. Natch.

The parameters of the ideal candidate for this strategy are as follows: is over age 70, is insurable, and possessing an estate worth at least $3.5 million and facing tax liability on that estate. 'Estate' includes all forms: cash and other liquid assets, stock, property, insurance policies, art or collectibles, etc.

Improve Your Financial Advising Skills For Pennies, or Less!

What is the cheapest way to improve your financial advising skills and business? Is it to go to some posh seminar (at a cushy spa) that you earned for free on a company contest? That might be a very pleasurable way to do so, sure. But how about doing something all year to improve your business, and yet it costs only pennies or better yet, is FREE? Yes, free.

You may qualify for free magazine subscriptions that will keep you abreast of all the top news and tips in your field.

Do you know what is the hottest area of interest now in investing? It is still global investing; where are the new burgeoning economies? Where do we go now? Is China's economy going to flatline because of the United States recession? And what about Europe? Europe is even more dependent on monetary issues than Americans are.

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