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Seniors

Trump Drug ‘Plan’ Could Punish Seniors With Cancer

Washington, D.C. – After new research from Avalere and a CBS News investigation exposed the dangers seniors with cancer could face under the Trump Administration’s drug pricing blueprint, Protect Our Care Campaign Director Brad Woodhouse said:

“The Administration has no answers on how its proposed changes to Medicare would protect seniors from prohibitively high out-of-pocket costs for specialized cancer treatment. This is more proof that the Trump Administration’s drug pricing ‘plan’ is a day late and a dollar short. Americans are already worried enough about rising health care costs; let’s not find new ways for the Trump Administration to make care more expensive.”

A tricky wrinkle in Trump’s Medicare Rx “Blueprint”

CBS News // Walecia Konrad // May 22, 2018

The Trump administration’s “Blueprint” to lower drug prices and reduce patient costs made one thing clear: The government will not directly negotiate with drug companies to secure lower prescription prices. But that doesn’t mean it isn’t proposing changes that would dramatically alter the way Medicare pays for some of the most expensive drugs, and in the process, potentially raise out-of-pocket costs for some of the country’s sickest patients.

A cornerstone of the Trump plan calls for all Medicare drug payments to be consolidated under Medicare Part D, the prescription drug plan for Medicare enrollees administered by private insurers. Under Part D, insurers and middlemen known as pharmacy benefit managers (PBMs) negotiate with drug companies for discounted prices in exchange for the drug companies’ products being included in the PBMs’ list of covered drugs.  

But drugs intravenously administered in physicians’ offices, such as chemotherapy and vaccines, are usually covered as a medical treatment under Medicare Part B. Physicians buy these drugs directly from manufacturers, and Medicare reimburses doctors for the drugs’ average sales price plus 6 percent.

Alex Azar, Health and Human Services secretary and former president of the U.S. division of pharmaceutical giant Eli Lilly (LLY), has been touting the move to consolidate Medicare drug payments during several public appearances since he and President Trump unveiled the Blueprint earlier this month. Azar and other proponents of the plan point out that the 6 percent markup included in Medicare Part B creates incentives for doctors to purchase more expensive drugs to get a higher dollar profit. Better, said Azar, for insurance companies and PBMs in Medicare Part D to negotiate discounts and lower prices.

Pharmaceutical companies are against the idea, partly because they generally are paid more under Part B than Part D. “Bringing negotiation to Part B drugs is such a potent way to bring down prices that PhRMA is already protesting the idea,” Azar said in a recent speech at the American Enterprise Institute in which he referred to the drug industry trade group called Pharmacuetical Research and Manufacturers.

But Azar and others have shed little light on exactly how this change would take place, leaving patients worried about the potential for astronomically higher out-of-pocket costs.  

Sky-high co-pays?

“If they shift Medicare Part B medicines to Medicare Part D without making any changes in the Part D structure, it will have a horrible effect on patients,” said David Mitchell, president and founder of Patients for Affordable Drugs. Mitchell, who’is currently undergoing cancer treatment, noted that he and most cancer patients with Medicare Part B have supplemental insurance that covers out-of-pocket costs, including drug co-pays, incurred under Medicare Part B insurance.

Mitchell points to his own regimen of cancer drugs, which adds up to about $23,000 each time he visits the infusion clinic. He pays $2,100 a year for a supplemental policy that covers his Part B co-payments. Medicare Part D recipients are not eligible to buy supplemental prescription drug insurance.

If his drugs were to fall under Medicare Part D, Mitchell explained that he would quickly pay enough in out-of-pocket co-pays to fall into a category called catastrophic coverage. Once in that category, Mitchell would pay 5 percent of his drug costs, which he estimates would equal about $15,000 in a year’s time. “That’s a completely unaffordable amount,” he said.

An analysis released Monday from health care consultants Avalere Health backs up Mitchell’s point. In 2016, average out-of-pocket costs were about 33 percent higher for Part D-covered new cancer therapies than for those covered in Part B. “Medicare beneficiaries typically have lower out-of-pocket costs in Part B — especially since so many seniors carry supplemental coverage,” said Richard Kane, senior director at Avalere, in a press release. “Any proposal for shifting drugs to Part D needs to account for these differences.”  

Logistical problems

“Having a doctor purchase, mix and handle the infusion of a drug is a completely different medical experience than going to the pharmacy and picking up a bottle of pills,” said Marc Samuels, founder of ADVI Health and former White House health policy adviser for President George H.W. Bush. Cancer treatments and other physician-administered drugs are complicated and personalized, often changing from week to week or even day to day depending on the patient’s reaction to the drugs.  

Patients and physicians are wondering how the actual delivery of drugs would work. “I heard someone say that I’d have to go to the pharmacy to pick up my drugs then bring them to the infusion center,” Mitchell of Patients for Affordable Drugs said. “That isn’t going to work.”

What’s more, Samuels argued that the 6 percent markup that doctors receive under Medicare Part B isn’t as profitable as it may sound.  Doctors purchase these expensive drugs then often have to discard them because the patient has serious side effects or needs a different drug for another reason. “The 6 percent is designed to help cover that cost,” Samuels said.

For now the Trump administration isn’t disclosing any details about how this part of its Blueprint would work. “I’m hoping,” said Mitchell, “we can work with the administration to find a way to allow negotiations to take place without harming patients.”

Seniors’ Medical Expenses Rising as GOP War on Health Care Spikes Costs Nationwide

Meta Capitol

“Lost in the State of the Union coverage was yesterday’s new report from the Kaiser Family Foundation highlighting massive increases in out-of-pocket medical costs for seniors – and they’re projected to keep skyrocketing. While President Trump has claimed he wants to lower health care costs, including the prescription drug costs that drive seniors’ medical expenses, the reality is the opposite. President Trump has consistently supported proposals that make health care more expensive, from repeal legislation which would have allowed insurance companies to charge people over 50 an ‘age tax’ with rates five times higher to the tax scam that’s set to raise premiums double digits, and he recently put a Big Pharma executive in charge of HHS. The first step toward containing costs for American seniors and families is for Trump and the GOP to end their war on Americans’ health care and stop paying allegiance to Big Pharma.”

Seniors’ out-of-pocket medical costs are rising

Axios // Sam Baker // January 30, 2018

On average, Medicare beneficiaries are spending about 41% of their Social Security income on out-of-pocket health care costs, according to new research from the Kaiser Family Foundation. And half of all Medicare beneficiaries spent roughly 14% of their total income — not just from Social Security — on health care.

Why it matters: Health care is eating up more and more of everyone’s income — but that’s an especially difficult burden for seniors, who often live on fixed incomes.

The gritty details, per KFF:

  • These percentages are expected to grow.
  • Those expenses include premiums, cost-sharing, and spending on services Medicare doesn’t cover, such as long-term care.
  • Not surprisingly, older, sicker and poorer seniors were all more likely to spend a greater share of their income on health care expenses.

Don’t forget: This is also a good reminder that while “Medicare for all” polls well as a synonym for single payer, actual Medicare for all would still leave plenty of room for out-of-pocket spending and even privately administered benefits.

Go deeper: Corporate profits have dramatically outpaced wages and health benefits since the turn of the century.

Graham-Cassidy-Heller Bill Would End Medicaid As We Know It

Latest GOP Repeal Bill Hurts Seniors, Kids, People with Disabilities, Working Families, and Leaves States in Crisis on Their Own

The GOP has been consistent this year in its crusade against Medicaid, and the latest repeal proposal from Senate Republicans is no different. The Graham-Cassidy-Heller bill would end Medicaid as we know it, hurting seniors, children, people with disabilities, and working families, breaking key promises that the bill’s sponsors have made.

The Graham-Cassidy-Heller proposal would destroy Medicaid, turning it into a shrinking block grant that would not be able to support the nearly 75 million Americans who rely on Medicaid for their health care.

Here’s a look at just how damaging the latest repeal proposal is for Medicaid:

Graham-Cassidy-Heller would force states to raise taxes or make draconian cuts to schools and other priorities, and states would be left on their own when they need help the most in times of crisis and natural disasters.

  • The severe cuts to Medicaid would blow a hole in state budgets, forcing states to either raise people’s taxes or make draconian cuts to schools or other vital programs.
  • States and people would be left on their own at risk during natural disasters. Per capita caps would mean states facing higher costs due to increased health care needs during an epidemic like the Zika virus, or following a natural disaster like Hurricanes Harvey and Irma would be left on their own.
  • Medicaid funding helps schools support children with disabilities get individualized attention and therapy, and helps eligible kids get vision and dental screenings. Severe cuts to school funding will affect not only students on Medicaid, but will trigger a domino effect that leads to across-the-board education cuts, threatening extra-curricular programs and forcing schools to expand class sizes.

End Medicaid expansion, which has extended coverage to over 14 million low-income adults.

  • Graham-Cassidy-Heller ends the Medicaid expansion entirely, replacing it with a small, temporary block grant, and would threaten the health coverage of over 14 million Americans who currently rely on the program
  • The block grant would then disappear altogether after 2026, repealing the program altogether despite the major coverage gains as a direct result of allowing states to expand Medicaid.

Disproportionately harm states that chose to expand Medicaid coverage, like Alaska, Louisiana and Nevada.

  • States that expanded Medicaid are seeing record low uninsured rates according to the latest Census data. Under Graham-Cassidy-Heller, these same states would see the most significant cuts in federal funding.
  • Louisiana, for example, had an uninsured rate of nearly 15 percent in 2014, and after expanding Medicaid that number dropped 5 points to just 10 percent in 2016.
  • Louisiana would lose more than $3.2 billion in federal funding under Graham-Cassidy-Heller.
  • Sen. Cassidy’s own bill would wipe out the recent progress made due to Medicaid expansion, and cost his state more than $3 billion.