1. 29: That’s the number out of every 1,000 children age 8 that have autism in the state of New Jersey according to a study found conducted by the CDC. New Jersey is the state with the highest rate and Arkansas is the lowest with 13. Rates increased to 1 out of every 59 8-year-olds with autism according to the same study conducted in public schools, health care facilities and special education programs. The 11 states that have shown increases are Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee and Wisconsin. To read more about autism into adulthood click here.
2. 93: That’s the amount of cents, not dollars, spent on eating disorder research per affected individual according to the U.S. Department of Health and Human Services online research portfolio. The small number pales to the $44 spent per person on autism, $81 spent on schizophrenia, and $88 spent on Alzheimer/s disease. Anorexia nervosa has the highest mortality rate of any psychiatric disorder.
3. Tails California: Aetna is partnering up with four California health systems in what they are calling Regional Aetna Whole Health, a Southern California managed care plan with access to 1,400 primary care doctors, 8,300 specialists, 51 hospitals, and 122 urgent care facilities across five counties. The partnership includes Sharp, MemorialCare, Primecare and Providence.
4. Pharma Safety School: Kroger Pharmaceutical Company announced a prescription drug safety program for teens in a partnership with EVERFI to provide classrooms and high school students with drug abuse prevention education. The Prescription Drug Safety Network broadcasts the interactive scenarios and self-guided activities to help students learn about drug safety. The Prescription Drug Safety Network partners include a diverse group of state leaders, healthcare companies, pharmaceutical manufacturers, pharmacies, and foundations.
5. Binge Worthy: Netflix released its second season of the popular series “Atypical” a show about a family working through the challenges of having an autistic son in high school transitioning into college. The series has added 5 actors on the spectrum to more accurately depict young adults with the developmental disorder. The characters are in a peer group in the show and make for a more genuine and fun representation. Read more on the popular Netflix show here.
6. Proton Pumps Out: Beginning January 1, 2019, all proton pump inhibitors will be excluded from Blue Massachusetts’ pharmacy benefit coverage, except for members under the age of 18 and those taking combination medications to treat H. Pylori, a bacterial stomach infection). Formulary exceptions, including those previously approved, will no longer be available for this class of medication, except for kids under the age of 18 and those taking combination medications to treat H. Pylori.
7. Hurricane Help: Back after Katrina, the number of approved pre-authorizations spiked from BCBS of Louisiana. Today, there’s almost an even more active strategy by insurers to ensure patients have limited access during storms. Aetna was helping patients affected by Tropical Storm Gordon in Louisiana, Mississippi and Alabama with early script refills, and they extended claim and appeal filing times. Magellan, for its part, created a help line for those in the path of Hurricane Florence.
8. Gender Dysphoria Surgery: In another sign that gender related procedures are getting more attention from managed care, BCBS of Minnesota’s Medicare Advantage (PPO) released an updated prior authorization list for 19 different gender dysphoria procedures this month. Let us know if you’d like to see the list.
9. Extra Point: We brought in this sweet Romanian gal Carla for a fall house cleaning this week, sort of our family’s version of the annual dental check-up. Usually our 5 kids rotate the vacuuming and scrubbing (and complaining), but with school back and homework at a red alert stage already, the house was starting to resemble a decayed tooth. The fridge, not just the food in it, needed an extraction. That rolling dust ball was building up faster than a teenager’s tarter. Our kitchen tile began to take on a red spaghetti sauce hue like coffee staining on those lower molars. Carla billed us for a deep clean, 4 extractions, a pair of sealants, and a restorative procedure inside Jack and Tommy’s closet that she described as ‘you don’t want to know what was there Mister Cote – maybe it was guacamole at one time.’ But not 5 hours after she left, the house was a hot mess – a dog hair walkway was re-emerging, an apple sauce pond had formed on the couch, and a ‘are you kidding me who spilled cranberry juice’ sticky path was now guarding the fridge. That deep clean was more cosmetic lift than preventive lifestyle changer. Our kids’ compliance was dismal. I now know why dental and health insurers complain, and why dentists have a job. Insurers in many states seem to putting more resources into evaluating the necessity and efficacy of certain services, from oral health procedures to pain management, and putting more cost share on families. My family, for its part, wants Carla back once a month, not once a year. But there need to be limits. That $150 may have seemed necessary at the time, but upon review, it was wasted. ‘We don’t need more cleaning,’ I told them. ‘We need more accountability around here.’ Either that, or we eat all our meals outside.