PBS高端访谈:药物费用的增长会怎样影响老板们的健康计划?

 　　JUDY WOODRUFF: But, first, a look at the concerns some U.S. companies are starting to voice over the growing costs of certain prescription¹ medicines, and what those costs might mean for the health care plans they offer their employees.

　　Hari Sreenivasan has that report.

　　HARI SREENIVASAN: A new survey finds that more than half of large U.S. employers will more tightly manage their employees' use of prescription drugs next year. Some of these drugs, especially those used to treat cancer, HIV, and hepatitis C, can cost $10,000 per month and are rising at double-digit annual rates.

　　The increased expenses threaten to push some employer health care plans over a threshold set by the Affordable² Care Act, making them subject to a 40 percent tax, the so-called Cadillac plan tax.

　　Brian Marcotte is president and CEO of the National Business Group on Health, which did the survey, and is here to explain the findings.

　　So, for those of us who haven't been paying attention to the Affordable Care Act too closely, a refresher on the Cadillac tax — or Cadillac plan tax.

　　BRIAN MARCOTTE, CEO, National Business Group on Health: Sure.

　　The Cadillac tax is a provision of the Affordable Care Act. And it is an excise³ tax, 40 percent excise tax on high-cost health plans beginning in 2018. And by high-cost health plans, it's intended to focus on the generous plans, the rich plans, the plans that have low deductibles, low co-pays, the intent being if you discourage participation⁴ in high-cost plans, you can slow the growth of health care costs, and they could use the taxes to help finance coverage⁵ in public exchanges.

　　HARI SREENIVASAN: But it's not just the plan for the well-to-do anymore, right, because you can get to a high-cost plan depending on lots of things, like the people you insure in your company.

　　BRIAN MARCOTTE: That's right.

　　I think that the Cadillac tax is really a tax on all plans at the end of the day. And there are many factors that drive the cost of a health plan. And when we talk about the cost of a health plan, you are really talking about for the most part the premium⁶, the premium that you pay as an employee, the premium that the company pays, the combination.

　　We're talking about the premium. And where you live, the age of your work force can have as much or even more of a factor in determining the cost of the plan than the generosity⁷ of the plan.

　　HARI SREENIVASAN: So what did your survey find? What is happening? What is almost like an unintended consequence of the Affordable Care Act?

　　BRIAN MARCOTTE: Well, nearly half of employers believe that by 2018, when the tax goes into effect, if they do nothing else to control the cost of their plans, at least one of their plans will trigger the Cadillac tax.

　　The more interesting thing is that, in the next decade, all the companies believe that nearly all of their plans will trigger the Cadillac tax, for the reasons we just described. There is one other problem or challenge with the Cadillac tax the way it's structured, and it's the way it's indexed.

　　And in indexing the cost, there is an individual maximum and a family maximum. Individual is $10,200. Family is $27,500. And those are indexed over time to grow because costs increase. But it is indexed to the consumer price index, where health care costs increases at a much faster rate or higher rate, at least twice the consumer price index.

　　So even the moderate plans over time will eventually hit the Cadillac tax. And that's the challenge.

　　HARI SREENIVASAN: So, health care costs, as you mentioned, climb regardless of the consumer price index. But some of these drugs, the price of the medication is growing at 25 percent, 50 percent year-over-year. That's something that no plan has budgeted for.

　　BRIAN MARCOTTE: Yes, I think the challenge we're seeing is that specialty⁸ pharmacy⁹ medications.

　　And by specialty pharmacy medications, I mean they're complex drugs. They are for things like multiple sclerosis or cancer or HIV or hepatitis C, which got a lot of attention last year. They are complex, typically, in terms of how they are administered. They can be very expensive. They may be — they need special handling because they may need be to refrigerated, whatever the case.

　　And then employees need to be monitored because of side effects of dosage changes and the like. So there is a lot of complexity¹⁰ around these drugs. But they can be very high-cost. And employers in the survey said that specialty pharmacy has jumped to the number two driver of their overall medical trend.

　　Now, the interesting thing is specialty pharmacy only affects about 3 or 4 percent of their population.

　　HARI SREENIVASAN: But it's the most expensive 3 or 4 percent.

　　BRIAN MARCOTTE: Yes. And so it's going to cross traditional pharmacy in terms of overall costs by 2018.

　　HARI SREENIVASAN: And so what are companies doing about this?

　　BRIAN MARCOTTE: Well, they are really starting to focus on how you manage the specialty pharmacy costs.

　　So they are contracting either with an independent specialty pharmacy manager or a specialty pharmacy group within a prescription benefit management company that they already have. But it's a focused effort to really manage both who is getting the medications, making sure it's appropriate, making sure the dosage is appropriate, and also making sure site of care is appropriate, because there could be a wide variation in price depending on where you go to have that drug administered.

　　HARI SREENIVASAN: I also hear a lot more about the health saving account-types plans coming into workplaces. What are employees likely to see more of as companies start to prepare for this Cadillac tax?

　　BRIAN MARCOTTE: Well, there has already been a significant migration¹¹ over the last five years or so of companies moving to these consumer-directed plans, thee high-deductible plans.

　　And by high deductible, I mean $1,300 individual deductible, $2,600 family deductible, tied to a savings¹² account. And many of our companies put in more than half of that deductible of value into the savings account. They seed those accounts to help defray some of the costs. So we have seen that migration. And I would say about 80 percent of companies offer them as a choice already.

　　But the interesting thing is, we have seen a big jump in the number of companies that have gone to a option-only consumer directed plan as the only option they will offer employees.

　　HARI SREENIVASAN: Brian Marcotte, thanks so much for joining us.

　　BRIAN MARCOTTE: My pleasure.

1 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

2 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

3 excise   

n.(国产)货物税；vt.切除，删去

参考例句：

• I'll excise the patient's burnt areas.我去切除病人烧坏的部分。
• Jordan's free trade zone free of import duty,excise tax and all other taxes.约旦的自由贸易区免收进口税、国内货物税及其它一切税收。

4 participation   

n.参与，参加，分享

参考例句：

• Some of the magic tricks called for audience participation.有些魔术要求有观众的参与。
• The scheme aims to encourage increased participation in sporting activities.这个方案旨在鼓励大众更多地参与体育活动。

5 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

6 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

7 generosity   

n.大度，慷慨，慷慨的行为

参考例句：

• We should match their generosity with our own.我们应该像他们一样慷慨大方。
• We adore them for their generosity.我们钦佩他们的慷慨。

8 specialty   

n.(speciality)特性，特质；专业，专长

参考例句：

• Shell carvings are a specialty of the town.贝雕是该城的特产。
• His specialty is English literature.他的专业是英国文学。

9 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

10 complexity   

n.复杂(性)，复杂的事物

参考例句：

• Only now did he understand the full complexity of the problem.直到现在他才明白这一问题的全部复杂性。
• The complexity of the road map puzzled me.错综复杂的公路图把我搞糊涂了。

11 migration   

n.迁移，移居，（鸟类等的）迁徙

参考例句：

• Swallows begin their migration south in autumn.燕子在秋季开始向南方迁移。
• He described the vernal migration of birds in detail.他详细地描述了鸟的春季移居。

12 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。