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If It Ain’t Broke Don’t Fix It

This Thursday, September 28th, at 3:00 pm ET, we’ll have a Facebook live event to discuss our yearly Medicare Part D prescription drug program satisfaction survey. We’ve been doing this survey a long time, at least 14 years, so we have a rather good idea about how seniors feel about this public/private partnership that works. The results have remained extremely favorable and consistent. Over the years, the percentage of those who have a favorable view of Part D has consistently hovered around 90%. Now I haven’t researched all the surveys of government programs, but I would be extremely surprised to find one that, year after year, has a 90% favorability rating. It is important to remind ourselves that this program serves over 50 million people and has worked extremely well for 17 years, and yet our elected officials in Washington have passed legislation that fundamentally changes how Part D works.

So, why did our lawmakers decide to change this popular program? Was it due to everyone’s displeasure with the program? According to Washington, drug prices were too high, it was limiting access to people who couldn’t afford the out-of-pocket costs of their prescriptions. They also said that most older Americans agreed with them, that it was one of the few things that had bipartisan agreement. If most seniors agreed with them that drug prices were too high, how come our survey showed that 86% said that their plan provided good value and their monthly premiums are affordable, or that 80% said their out-of-pocket costs are reasonable? Maybe everyone is concerned with the 20% in our survey who didn’t think their out-of-pocket costs were reasonable and were possibly the ones that couldn’t afford their medicine—and these are absolutely the people we should be concerned for. This begs the question, is fixing the price of drugs and slowing the discovery of new drugs, which affects everyone, the way to solve the problem of the 20% who’s access is limited due to cost? The really sad part is that there isn’t any guarantee that the new law will really help the 20% who can’t afford their medicine. I wonder if the new law would be as popular if the keywords in promoting the legislation were government price fixing rather than negotiations? Multiple polls show a huge drop in popularity when it is revealed that there really aren’t any negotiations and that the new law will slow the discovery of new medicines.

The idea that this approach to lowering drug prices was a bipartisan issue flies in the face of the fact that the Inflation Reduction Act (IRA) was absolutely a partisan bill, not one Republican voted for it. Now you might say that the Republicans were against other things in the bill, and that would be absolutely accurate. This again begs the question, why did the Democrats decide to include it in the IRA, which they knew would be a partisan piece of legislation, rather than passing it as a victorious bipartisan stand-alone law? Was it only because they needed the projected savings (which the Congressional Budget Office has said may not materialize) to pay for other parts of the IRA? If that’s the case, why aren’t those savings going directly to the 20%, or anyone, who would still need help paying for their medicine? These are the questions that cause me to think we might have been sold a bill of goods, a political point getter, rather than a real long-term solution.

As you can see, I get riled up when our lawmakers seek to change something that’s working. I’m especially angered that our lawmakers went ahead and made some basic changes to a highly successful program even though, once again, our poll showed that Part D is working. We take this poll every year to level set us as to where seniors stand on this life changing, life saving program. We genuinely want to get your opinion. Prescription drugs have a huge positive impact on our lives; they play a part in everyone’s life, whether directly or indirectly.

Every year we do a Facebook live event to discuss the results of the most recent poll. We try to focus on what the numbers really tell us about how you perceive your Medicare prescription drug program. It is a great opportunity for you to see what is really important to older Americans. The survey has always been a great way for seniors to speak out. We use the survey as a way to educate lawmakers about how you feel about Part D and how important it is to you. It’s a resource you can use as you communicate with your state and federal lawmakers. I talked about the survey when I talked with the staff of my representative in the House. I will refer to it again if I get to meet with the Congressman in October. Input from constituents is always important to our elected officials. This survey is a valuable tool.

You can tune in to our Facebook live event this Thursday, September 28th, at 3:00 pm ET. Matt Monday from Morning Consult and I will discuss this year’s survey highlights and how seniors feel about their Medicare Part D plans and their concerns regarding the IRA’s price-setting provisions. Click here for more information and mark yourself as “going” on the event page. I hope you can join us.

Best, Thair

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World Heart Day

World Heart Day is September 29th. It’s one of those focus dates that help us pay attention to some aspect of our health, in this case, our heart. I personally can’t think of a more important organ. Just to get your attention – cardiovascular disease (CVD) is the world’s number one killer, causing over 18.6 million deaths per year. We continue to be awe struck by the 6.9 million people that have died worldwide since COVID started in March of 2020, yet CVD killed 18.6 million people worldwide last year! Now I know you’re thinking that having heart problems is just what happens when we get old, and there’s nothing we can do to prevent it. I can say emphatically – that’s not true!

I’ve mentioned in an earlier blog that I found out that my blood pressure (bp) was high and went to the doctor. I initially discovered my high blood pressure problem when I went to an audiologist, and they took my bp as a standard part of their pre-exam routine. In looking back, I figured out that I hadn’t had my bp checked for almost a year, which means I could have had undiscovered high blood pressure for almost a year. That’s too long to go without having my blood pressure checked. I’m happy to report that the prescribed medicine has lowered my blood pressure by 20 points, down to the mid-130s/78. We are hoping that through a little better eating habits and some exercise, I can reduce it to the 120s without increasing the medicine. The big takeaway here is that high blood pressure can be treated!

I have found out that the great singer Tina Turner had untreated high blood pressure for many years. A few months prior to her death she said,

 “My kidneys are victims of my not realizing that my high blood pressure should have been treated with conventional medicine. I have put myself in great danger by refusing to face the reality that I need daily, lifelong therapy with medication. For far too long I believed that my body was an untouchable and indestructible bastion.

I’ve sometimes ignored symptoms that should have led me to consult a doctor and that sort of thinking is not healthy aging. We could have continued to enjoy the uncontainable spirit of Tina Turner if she would have sought medical help earlier for her high blood pressure.

The World Heart Day is a great time to take some action to improve our heart health. As always, there are guidelines that will help us maintain healthy hearts. You can find more information on CVD and how you can maintain a healthy heart by visiting the World Heart Federation website, which includes more information on each of these main guidelines.

  • Maintain a healthy body weight
  • Avoid tobacco use
  • Avoid alcohol
  • Manage stress
  • Know your numbers
  • Take your medication as prescribed
  • Know the warning signs

I always like to pick one of the guidelines and expound a bit on its importance. I think that knowing your numbers is especially important because it encourages, if not forces us, to go to the doctor. It’s through check-ups and blood work that you find out what your numbers are. I just attended a reunion with some of my Air Force friends, and it was amazing how everyone seemed to know their blood pressure, cholesterol levels and blood sugar levels. Like blood pressure, blood cholesterol can normally be controlled through a healthy diet and, if necessary, by appropriate medications. I can testify that my medication is helping me to lower by cholesterol number. Diabetes runs in my family, so I’m paying close attention to my blood sugar numbers.

One other thing, taking your medication is key. I’m not a fan of pills (must be something in my upbringing). But I’m convinced that these medicines we take are important. Don’t hesitate to ask your doctor about the medicines you take, what they do, any side affects they might have and how long you will need to take them. Finding out how the medicines work and then seeing your numbers get better (blood pressure in my case) helps to validate in your mind that they work and appreciate the importance of adhering to the prescription’s instructions.

It’s amazing to me that 80% of cardiovascular disease could be prevented and treated. It shortens the lives of so many people. We have the means and the medicines to treat many facets of this disease, it’s up to each one of us to take action – if not for ourselves, then for our loved ones.

Facebook live event – We will have another Facebook live event on September 28th at 3:00 PM ET where myself and Matt Monday from Morning Consult, will discuss this year’s Senior Satisfaction Survey highlights and how seniors feel about their Medicare Part D plans and their concerns regarding the Inflation Reduction Act’s price-setting provisions. Click here for more information and mark yourself as “going” on the event page.

Best, Thair

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Healthy Aging Month and a Day to Remember

This month has been designated as Healthy Aging month, but today is also the day we remember those who perished on 9/11. There are only a few days in our lives when something happens that is of such magnitude that we remember for the rest of our lives where we were when we heard about, or witnessed, the monumental event. I remember where I was when I heard President Kennedy was assassinated, I remember where I was when the first man stepped onto the moon, and I remember where I was when I saw the first terrible pictures of 9/11. A few years earlier I had worked with some of the employees of the Marsh LLC insurance company who lost their lives on that day. Many people had personal reasons for remembering that day. It is only fitting that we should pause to remember them and to recommit to the job of protecting ourselves from these horrible terrorist attacks.

On a more uplifting note, keeping ourselves healthy is an important way that we can continue to do the things we enjoy as we age. I’ve found that when I commit to myself to doing something to increase my health, it’s easier to break that commitment to myself than it is when I do it for someone else. I think of being their when my wife needs me, or my children or grandchildren need me, or the joy I get when I am able to do things with them – and I just get more committed to my goal. So, if you need a reason to stay healthy, do it for them.

There are a great many resources that are available to help you get healthy and stay healthy. The Department of Homeland Security has some excellent and concise guidelines for their employees to maintain their health as they grow old. They recommend four simple things:

  • Eat and Drink Healthy.
  • Move More, Sit Less.
  • Get Regular Checkups.
  • Be Aware of Changes in Brain Health.

You can click here to get more detail on each of the four recommendations.

On a personal note, I’m embarrassed to say that I have often neglected going to the doctor for check-ups or to investigate different maladies that have popped up. I decided that I really wanted to stay healthy for the people I love,and I’m on a much better trajectory to get healthier. I’ve even committed to starting some core exercises to help my balance and my overall health. Another trick to keeping your commitment is to get someone to exercise with you. You won’t want to let them down when you have scheduled a time when you both will exercise. My son got me interested in doing planks for increasing core strength and then I saw this article on doing wall squats, a plank exercise. When I saw it might even help your blood pressure, it sold it for me. I’m going to start the exercises… it might even help my golf game.

I hope you recommit to healthy aging, if not for yourself, for those you love.

Best, Thair

P.S. Meeting Update – While the schedules didn’t work out for me to visit directly with Blake Moore, my representative in the House, I did get to talk with a Legislative Assistant (LA) in the Washington office. The Congressman was traveling (summer recess, after all, is the chance  lawmakers have to vacation with their families), so the next best option is speaking with the LA who covers healthcare issues for the Congressman. I do want to point out that around 80% of my lobbying visits over the years has been with LAs, legislative directors or the chief of staff rather than with the member of Congress. This LA, Nick Wooldridge, knew his stuff.

As you might imagine, most of my questions focused on the Inflation Reduction Act (IRA), and I started out by asking how his boss viewed the “negotiation” part of the bill. He said that this part of the IRA didn’t seem like it accomplished the goal they were looking for. He was especially concerned about the impact on restricting research on how orphan drugs for a rare disease might be helpful against other diseases. He recognized that research into a drug’s second indication benefits patients. I thought this was an astute and knowledgeable reaction to a very real impact of the IRA. He did voice his approval of the out-of-pocket cap for Part D, while also voicing his concern for the overall impact of the IRA on our Nation’s debt. He had a wait and see approach to the results of the lawsuits that have been brought against the IRA. He was against the Senate bill, the SMART Act, that would double down on the number of drugs subjected to the price fixing negotiations. I asked him about his boss’ stance on the proposed bills dealing with prescription benefit managers (PBMs). (Some background, there are two sides to how PBMs are viewed, on the one hand they are touted as the ones that negotiate with drug manufacturers for insurance companies to obtain lower prices, on the other hand, some see them as a costly part of the business process that is driven by non-cost saving incentives.) The Congressman had a remarkably interesting stance on these proposed bills. He is cautious about focusing on just one part of the business process, the PBMs, when we should evaluate the whole process and strive to make it all more efficient.

I appreciated Nick taking the time to talk with me, and I was excited to hear about Congressman Moore’s selection to be on the Budget Committee Health Care Task Force. I also am looking forward to a possible meeting with the Congressman in October. I certainly see Congressman Moore as a friend of older Americans and their access to affordable and excellent healthcare.

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Vacation is Over!

It’s the end of August and there are definite indications that vacation time is coming to an end. There are some well documented rumors that the Centers for Medicare and Medicaid Services (CMS) will release the first list of the 10 drugs selected under the new Inflation Reduction Act (IRA) before the stock market opens tomorrow morning. These first 10 drugs will be selected from costly drugs that have no generic or biosimilar competition. The purpose of the so called “negotiations” will be to arrive at a maximum fair price (MFP) for each drug. As I have done in earlier blogs, I put the term “negotiations” in quotes since the term is misused. When I use the term negotiations, it identifies two parties that each have some degree of leverage and use that leverage to have a back-and-forth discussion until an agreeable solution is reached or one of the parties pulls out of the negotiations because the final terms of the proposed solution are unacceptable. This isn’t how the IRA negotiations will work.

Under the IRA, the government can present a price to which the manufacturer can then counter with another price. The government can then refuse the counteroffer and publish their final MFP. If the manufacturer disagrees with the published MFP for the drug and pulls out of the negotiations, the manufacturer is banned from selling any of its drugs to the Federal government’s programs (i.e., Medicare and Medicaid), or face a tremendous fine. Either option would be financial suicide for the manufacturer. One of the big problems with this scheme is that the IRA stipulates that “[t]here shall be no administrative or judicial review” of the negotiations or their outcome. So, the government can set the price without fear of any review as to the legality of their actions, and the manufacturer has no recourse but to comply with the MFP the government set.

To many, this whole “negotiation” process seemed to infringe on the rights of the manufacturers and the law has been besieged with numerous legal challenges. These pending cases were brought by six manufacturers and two organizations, the manufacturer’s association, PhRMA, and the U. S. Chamber of Commerce. While you would expect the manufacturers, who would be financially affected by the price fixing and their association, to bring legal challenges, it is interesting that the U.S. Chamber of Commerce would weigh in. The Chamber states that, “the new provisions in the Inflation Reduction Act (IRA) violate fundamental protections for free enterprise enshrined in our Constitution, which would have far-reaching implications in the future”. This stance by the Chamber carries a lot of weight with me. I’ll have more to say about this below.

The second thing that indicates that vacation time is over is the return of Congress to Washington from their summer recess. To borrow a quote from Punchbowl News: “The rest of 2023 will be extremely hectic and high-wire for Congress and Washington.”  Suffice it to say that some of this hectic and high-wire action will involve our healthcare. There is already a lot of focus on next year’s election and the legal battles of former President Trump. The most immediate concern of Congress is the passage of a spending bill by the September 30th deadline. What concerns me is the situation where late in the negotiations a deal is struck where an amendment impacting healthcare access and quality is used to garner votes to pass the spending bill. I’ve seen this happen and these types of deals almost always turn out to be bad for seniors. For instance, I’ve talked before about the SMART Act, a piece of legislation that doubles down on the IRA price fixing scheme by increasing the number of drugs singled out for price fixing each year. While a continuing resolution may extend the deadline to pass a spending bill to the end of the year that will do little to lesson the chance for deals to be struck and the SMART Act is just the type of incentive offered to reluctant lawmakers to garner votes.

Another new wrinkle is the announcement that House Budget Committee Chairman Jodey Arrington (R-TX) and Budget Committee Member Rep. Michael C. Burgess, M.D. (R-TX) have launched a new Budget Committee Health Care Task Force. The task force will be expected to, “Find solutions to reduce health care spending, examine opportunities to modernize and personalize the health care system, and support policies to fuel innovation and increase patient access to quality and affordable care”. These committees can be really good or really bad so it will be important to pay attention to their actions. My own Representative from the 1st District in Utah, Blake Moore, has been selected to serve on the committee. I will ask him about what he thinks this committee will do, if and when I get to meet with him. There is a lot going on this fall and it is sure to affect us all.

I do want to talk a little about the lawsuits that have been filed. It bothers me that Congress has decided to pass legislation that ventures into the legal gray areas. The legal challenges deal with possible infringements of the First, Fifth and Eighth Amendments of the Constitution. Is this the direction we want our country to go? Do we want our lawmakers passing laws that have a chance to be challenged on the basis of our constitutional rights? It seems that Congress is willing to sacrifice our rights for political expediency. I worry about the precedent this law sets, about the power it gives our government.

The next few months are going to be busy; I’ll work hard to keep you up to date.

Update – The schedular from the Washington office of my Representative got back to me and said she was working through “some staggered out of office schedules” to satisfy my meeting request, that was four days ago. I’m going to call again tomorrow.

Best, Thair

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A Government Success Story – Medicare Part D

The Medicare Part D prescription drug program was voted into law 20 years ago and began full operation a little over 17 years ago. Adding a prescription drug program to Medicare was a long and arduous journey with many false starts and valiant attempts. You would think that installing a benefit that reduced suffering, kept people out of the hospital and saved lives would be a “no brainer” but the politics and timing seemed to continually work against its passage.

President Johnson first wanted to add it quickly after the creation of Medicare, but that idea languished as the Vietnam war escalated and President Johnson declined to run for a second term. President Reagan included a prescription drug plan in the ill-fated Medicare Catastrophic Coverage Act, but it died when the Act was repealed. President Clinton included a drug benefit in his healthcare initiative, but that legislation never got to a vote. President George W. Bush finally found that the stars had aligned in such a way that the passage of a prescription drug benefit was possible. Through a lot of wrangling and political arm twisting the law was narrowly passed in November of 2003 and Medicare Part D was born.

It is interesting that many of the same issues we’ve debated recently were part of the debate in 2003. Many lawmakers back then wanted to open the flood gates to allow the direct importation of drugs from foreign countries. The director for the Centers for Medicare & Medicaid Services (CMS) nominee, Mark McClellan, MD, argued that CMS couldn’t guarantee the safety of these imported drugs and the safety attestation on restriction stayed in the legislation. It is still part of the Part D program today stating that drugs can only be imported if the Secretary of HHS certifies their safety. That certification has not been granted for 17 years, although Florida is pursuing a program that has yet to be fully approved by the federal government. Another debate happened when the Bush administration, as a stop gap to the slow pace of passing the drug benefit legislation, wanted to institute a mandatory discount on drugs. The courts found that the Administration didn’t have the legal authority to impose this discount on the manufacturers. The power of the government to impose prices is again in the courts as several manufacturers and other entities have entered lawsuits claiming that parts of the Inflation Reduction Act (IRA) exceed the government’s legal authority.

One of the most important results of the passage of Medicare Part D was its cost. The actual cost of the program was below the government’s original estimates. According to a 2008 CMS report, the cost for Part D “is about 37 percent lower than originally projected when the benefit was established in 2003.” I have never found a government program that came in 37% below its original estimate.

So . . . For four decades multiple administrations knew we needed a Medicare prescription drug program but for a myriad of reasons couldn’t get one passed. Each of these attempts refined and expanded on a workable approach, with different solutions being examined and debated. The final legislation was a public/private partnership that has successfully operated below budget for 17 years, remained a steady approximate 11% of total Medicare spending and, according to our yearly survey, has around a 90% approval rating from its beneficiaries. It is this program that our lawmakers have decided needed huge changes, and so they passed the IRA. This new law allows the government to dictate the price of drugs, an approach that was debated and rejected by both the courts and lawmakers 20 years ago. They want to change a program that has made America the world center for the discovery of new medicines, ignoring the prediction that this law will cause a decrease in the discovery of new medicines. They want to alter a system that discovered and manufactured a COVID-19 vaccine in record time that saved millions of lives. It just doesn’t make sense.

There is a milestone coming up on September 1. This is when CMS will release the first 10 medicines to face the price fixing constraints dictated by IRA. The drug makers affected will have one month to decide if they will participate in the “negotiations” which in essence gives them the option to sell their medicine at the price the government dictates or to exit the Medicare marketplace which is a huge percentage of their total sales. That’s why it’s more of “it’s our way or the hi-way” than it is a negotiation. It is this chilling process that has already affected the research and development of new medicines. I will continue to keep you up to date on how this process plays out. Don’t miss an opportunity to tell your lawmakers that you value the discovery of new medicines over the shortsighted political maneuvering of the IRA.

Update – Meeting with my lawmaker. The staff of my Utah congressional safety district 1 Representative, Blake Moore, has responded to my request for a meeting. They asked if I would rather meet with a member of their staff, which I declined. They also asked for some more information about where I live (to ensure that I was actually a constituent) and what were the questions I had. I wanted to be up front with them, so I recounted my career in public policy and my current position as a spokesperson for Seniors Speak Out. I am waiting for their return communication.

Best, Thair

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It’s a Good Time to Speak Out

Over the last few years, I’ve talked about a lot of different healthcare issues. I’ve tried to explain how each of the issues and the proposed solution will affect older Americans and almost always at the end asked you to contact your lawmakers and tell them how you feel about the proposed rule or legislation. I’ve stressed how powerful your voice is when those that represent you in Washington hear from a constituent. The most powerful scenario I know of is when a constituent sits down at an appointment with one of their senators or their representative in the House and their opening goes something like this, “Hi, my name is _______ and I’m one of your active constituents. Every Saturday morning a few of my friends and myself meet at McDonalds and talk about our government and the issues that are being discussed in Washington that affect us. I’ll be going back to see them next Saturday and I’d like to tell them where you stand on the following issues”. It’s this kind of meeting that gets right to the roots of a representative democracy. We have the power of the vote, and we also have the power of speaking directly to our lawmakers to tell them where we stand on the current policies. Your senators and representative should be extremely interested in what you have to say, and there are some things you can do that will increase the impact of your meeting.

Meet with your lawmaker – It is important that you not be pushed off to meet with a member of the lawmaker’s staff. As a lobbyist, I often met with the chief of staff, or the legislative director or a legislation assistant who had jurisdiction over the particular policy on which I was lobbying. That was fine, but as a constituent, whether you’re meeting in Washington or more likely in the local office, you have the right to speak directly to the person who represents you in Washington.

Do your homework – Do some research to find out how your lawmaker has voted on related issues. Find out what committees and sub-committees they belong to. Read their news releases and op-eds. Find out what legislation they have introduced. Listening to their statements and questions at congressional hearings can give you some valuable insight as to what is important to them. Prepare 2 or 3, no more that 4, questions for the meeting. You should expect the meeting to last 15 to 20 minutes, so you need to be brief.    

Be organized – Make sure your questions are concise and brief. After the beginning pleasantries, the meeting should move to your specific questions on the particular polices or stances that you are interested in. This is the time for you to listen, not only to the answers but to the body language and attitude of your senator or representative. She or he is a person, and it’s good to get to know them as an individual. Ask follow-up questions if you don’t understand some part of the answer. This isn’t the time to voice your opinion, it’s the time to listen.

Voice your stance – After listening to the answers give a brief overview your position then communicate where you agree with their answer to each question or, if you disagree with some or all of their stance, where you disagree and why. This is the time to be direct and concise.

Be respectful and gracious – Representing you in Washington is a hard and often thankless job. Be sure to relay how you respect and honor their willingness to be a public servant and to meet with you. Thank them for sharing their position on these important questions and assure them that you will relay their answers to those you talk with.

As you can see, it takes some work to have a successful meeting with those who represent you in Washington, but it can have a big impact. Any good lawmaker will listen intently to a constituent who comes prepared and is thoughtful and articulate in voicing their opinion. I encourage you to take this opportunity during the summer recess to make an appointment with one of you lawmakers and take advantage of one of the most powerful aspects of a representative democracy. You can find out who your lawmakers are by clicking here.

Along those lines, I have begun the process to meet with my Representative in the House, Blake Moore, a Republican, who has served since 2021 in Utah’s District 1. He is a fairly new member of the House but serves on the powerful House Ways and Means committee, on the subcommittees on Health, Social Security and Work and Welfare. He also serves on the House Committee on the Budget. As you can see, he serves on committees that affect older Americans, so I’m looking forward to a productive meeting.

My first step was to fill out an on-line request for a meeting in the local district office. I did that on August 7th. Since I haven’t received any communication back, I sent a follow-up email asking about the meeting application on August 13th. I’m not too concerned about the lack of return communication since this is a terribly busy time at the local office, but I will continue to follow-up to get a meeting scheduled.

I will continue to keep you advised on the meeting in upcoming blogs. Hopefully, it will get you motivated to schedule a meeting of your own.

Best, Thair

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Another Step Forward for Alzheimer’s

I’ve talked before about the U.S. Food and Drug Administration’s (FDA) approval of a drug that slows the advance of Alzheimer’s for those in the early stages of the disease. The controversy that followed this approval was the decision by the Centers for Medicare and Medicaid Services (CMS) to make this approved drug available only to those who qualify and join a clinical trial (you can click here to read that earlier blog). My problem with that whole process was the fact that a civilian agency, with limited scientific expertise in drug development and manufacturing, was limiting access to this new drug. In the past the word rationing, when discussing healthcare policy, has been criticized as being inflammatory, but when I look at the definition, I think it absolutely applies in this situation. Rationing is defined as “the controlled distribution of scarce resources, goods, services, or an artificial restriction of demand”. When a drug is approved for use by the FDA and then the demand is artificially restricted, I would call that rationing. That’s what happened with Aduhelm, and it continues to experience restricted access. Well, I’m glad to report that a new Alzheimer’s drug has just been approved by the FDA, and (maybe because of the uproar you and I and others made about Aduhelm) CMS has not restricted this drug’s access to those in a clinical trial. They did, however, require the use of a registry to collect data.

This new drug is lecanemab (brand name Leqembi), and while it is one of the first FDA-approved treatments to favorably affect the underlying biology of Alzheimer’s disease, it is not a cure. It has shown to help the body to reduce the plaque that has accumulated in the brains of Alzheimer’s suffers. According to the FDA, the reduction in this plaque is reasonably likely to lead to a slowing in the clinical decline due to the disease. The clinical decline was slowed by 27% relative to the placebo group, over 18 months of treatment.

It should be pointed out lecanemab has only been studied in people living with early Alzheimer’s disease and mild cognitive impairment due to Alzheimer’s who showed evidence of a buildup of amyloid plaques. The therapy has not yet been tested on people with moderate or more advanced cases of Alzheimer’s or on individuals with other forms of dementia.

The drug does have some side effects which cause a small percentage of the trial participants to have some bleeding in small blood vessels in the brain. Most of this small percentage had no symptoms, and the situation resolved itself. There were, however, some who had longer term symptoms. This medicine should not be used on people that were prone to this type of problem, like people who were taking blood thinners.

While I’m always leery of any CMS restrictions or obstacles to access, the idea of using a registry to document results, if used in an efficient manner, may show that there is a possibility of expanded use of lecanemab to include those with moderate to advanced Alzheimer’s or those with other forms of dementia.

I can’t over emphasize the importance of these new drugs. This disease has never had any drugs approved that have slowed the onslaught of this terrible disease, and there is now some hope for those that suffer from Alzheimer’s and those that care for them. If the disease continues on with no cure or slowing of symptoms, it would cost our country’s healthcare system an estimated 1 trillion dollars by 2050. Which begs the question, “why are we passing legislation that will restrict innovation?”

If in 2050 we will spend 1 trillion dollars a year on Alzheimer’s caregivers and treatments, and in 2022 we spent 340 billion dollars, then we are talking at least 14 trillion dollars will be spent by 2050. It seems from just a financial point of view that we should be passing legislation that expands innovation, not restricts it. The impact on those with the disease and the American caregiver families from an emotional and physical point of view is the greatest reason for expanding research to find a cure or a treatment for Alzheimer’s.

It seems we are finally unraveling some of the secrets of this debilitating disease. As people begin taking this medicine, I think their results will help advance the understanding of what causes this disease and will spur more resources dedicated to finding a cure or a treatment for Alzheimer’s. I only hope that our lawmakers don’t continue to restrict investment in the research and development that will be required to make these life changing discoveries.

I’m very thankful for the hope these new drugs have given to those that suffer from Alzheimer’s and to those that care for them.

Best, Thair

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August Recess – It’s Not Necessarily All Play

Lawmakers look forward to the August recess. It’s the longest break they get from being in D.C. and from the often-hectic schedules they face in Washington. There continues to be a flurry of activity as they try to get some final work done before their August recess, which is scheduled to start on July 31st and go until the day after Labor Day, September 5th. There are two appropriation bills, agriculture and military construction, that seem to be moving forward. However, there is also a slew of appropriation bills that need to be passed before the end of the fiscal year (September 30th) to avoid shutting down the government. This time-honored game of Russian roulette seems to happen every year, and it’s embarrassing.

Politicians of both parties use the threat of shutting down the government as a way to add controversial amendments to important legislation that funds our government. Some politicians even consider shutting down the government as a badge of courage rather than a failure of those we elected to handle the country’s finances effectively. Unfortunately, some of these controversial amendments concern your and my healthcare. We have been lucky enough to defeat some of these harmful bills, but they could be resubmitted on this must pass “keep the country running” bill. Legislation by blackmail is not how we get effective, well thought out laws. Legislation that supports using foreign countries’ methods of pricing prescription drugs as a guide for setting the price of our medicines is one of these bills that should have no place in our healthcare system yet might be slipped in as a last-minute amendment.

You might wonder how this could happen. I’ve seen lawmakers who have been stalwarts in their support of efficient, accessible healthcare for older Americans suddenly remove their support when they are given assurances of the passage of a bill that helps them in their specific district or state. I do realize that the number one goal of lawmakers is to get reelected, which makes these back-office deals very real and very concerning. I also know that the antidote to these deals are the voices of their constituents.

This fall will be busy when it comes to defending the efficient and affordable access to healthcare for America’s seniors. There will be many pieces of healthcare legislation considered as well as implementation of existing laws, such as the final release of the first 10 medicines to fall under the price setting policies of the Inflation Reduction Act (IRA). Lawsuits have been brought regarding infringement of rights in the IRA. Lawmakers will consider bills to deal with the complicated business environment of pharmacy benefit managers and bills to further expand the government’s powers to set prices in the IRA.

Members of Congress most often use these days back home to do exactly what the name of the recess indicates: state work period. Most use the summer recess to meet with their constituents, give speeches, and schedule town hall meetings. Each of these venues offer a chance to get to know your senators and your representative on a more personal level. The elections are fast approaching, and it usually is the case that not much is done legislatively in the year running up to a presidential election, so this fall may be the best chance for both good and bad legislation to get passed.

The more you can understand the true nature and workings of a piece of legislation, the better you can avoid the political sound-bite definitions. The names of proposed legislation have always intrigued me. I marvel at how hard lawmakers work to come up with catchy names for their proposed legislation as if the name alone will garner votes. For instance, the ABLE [Achieving a Better Life Experience] act was legislation aimed to improve the lives of those among us who are disabled. It’s a great name, but will the law really help them to achieve a better life? Whether the legislation can achieve this lofty goal depends on the specifics contained in the complicated laws and regulations within the legislation. The CARE Act of 2015 [Children’s Act for Responsible Employment] was written to strengthen child labor laws. It’s only through understanding the law’s details that one can assess whether this law really has a chance of accomplishing its goal of caring for children. Politicians often use over simplified ways to describe a bill, thinking it’s the only way “lay” people can understand it. I’ve always been of the opinion that lawmakers continually underestimate the intelligence of their constituents.

You will read this blog on the last day that the Congress will be in session prior to the August break, that is unless either the House or Senate is held over to complete business, which would be a very unpopular move. I’ll report in August on what transpired and what healthcare legislation might make it into law. I’ll especially focus on the 10 medicines that CMS will list by September 1st. In the meantime, stay cool the best way you can, and stay involved.

Best, Thair

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Medicare – Complicated but Essential

It’s the middle of summer and a great time to review our understanding of Medicare and maybe find a nugget of knowledge that might help us as we travel through this complicated world of healthcare. Okay, maybe it’s not the most fun thing you can think of doing, but it might help you save time and money. Staying healthy when you get old is a full-time job. I’ve often thought that it’s too bad we usually get sick when we’re old… if we could schedule getting sick when we were younger, we could really have a good time in our retirement years. Hence the saying, youth is wasted on the young. Unfortunately, that’s not the way it works, which is probably a good thing since our kids would have to raise themselves, given we wouldn’t have the time or the energy to do it ourselves. There is one thing I know; healthcare is complicated, and it’s often very difficult to understand what the impact will be on us when the lawmakers make changes to Medicare. Understanding what is happening as we interact with different healthcare providers might help us make better decisions and understand what the impact will be when lawmakers make those changes. So, let’s talk about the different parts of Medicare that we will encounter as we work through our health challenges.

When you are an inpatient in the hospital, the costs are paid under Medicare Part A, which has no premium.

When we go to the doctor for outpatient types of treatments, those costs come under Medicare Part B. There is a monthly premium for this coverage that ranges from $164.90 to $560.50 depending on your income. If you’re drawing Social Security, you may not even know you are paying this premium since it is automatically deducted from your monthly check. That premium can change each year. Some prescription drugs, mostly injectables, are paid for under Part B. These drugs are often expensive.

Medicare Part C encompasses Medicare Advantage. This is a program where the government pays a private insurance company to take care of Medicare eligible beneficiaries. Each Medicare eligible person has the choice to enroll in a Medicare Advantage plan. These programs may or may not have a monthly premium. Almost 50% of us have chosen to enroll in Medicare Advantage.

Medicare’s prescription drug benefit is Medicare Part D. There are many different plans to choose from. Often Part D is included in a Medicare Advantage plan. You can change plans once a year or more often under some circumstances. The best plan for any beneficiary depends on the medicines they take and what their out-of-pocket costs will be, which means we should reevaluate our Part D plans every year.

All of these parts have some or all of three different types of out-of-pocket costs — the healthcare costs that we open our purses and wallets and pay for out of our own money. Often, people choose different Medicare Advantage or prescription drug plans depending on what their estimated out-of-pocket costs will be. People buy Medicare supplemental insurance to cover some of these costs to reduce the risk of big costs from a serious illness. The amount we pay will differ depending on the situation and the plan we have chosen. Our out-of-pocket costs are mainly in three areas.

Deductible – You pay 100% of the cost for any service until the deductible is reached. Usually, high deductible Medicare Supplemental plans have lower premiums since you pay more of the initial cost.   

Co-pay – Medicare often requires co-pays for different services and prescriptions. This is a fix amount paid for a defined service or product no matter what the actual price was. Many prescription drugs have a co-pay, for example, $5 for any generic drug, $10 for any name brand drug.

Co-insurance – This is often misunderstood. This is usually a percentage, such as the patient is responsible for 25% of the hospital bill. This caused some people who were treated with extremely high-priced drugs to run into big financial difficulties. This often happened when people were in the catastrophic phase of Part D and were paying 5% of the cost. This doesn’t seem like a lot, but 5% of medicine that costs $15,000 a month is $750 a month. This was in addition to the deductible and donut hole money they had already paid. The good news is, starting in 2025, the Inflation Reduction Act capped the yearly Part D out-of-pocket cost at $2,000. This will benefit those who were burdened with the costs related to ultra-expensive drugs. Co-insurance costs can also be high when a patient has an extended hospital stay and/or surgery.

While it’s early, it’s not a bad idea to begin gathering the information you need to predict what your actual out-of-your-pocket costs will be for Medicare itself, Medicare Supplemental Insurance, or Medicare Advantage. It requires predicting how your health will be next year, what medicines you now take and what new medicines you might require. Medicare has well defined co-pays, co-insurance, and deductibles. You have more choices in setting the co-pay/co-insurance/deductibles as you research Medicare Supplemental, Medicare Advantage, and Part D prescription drug plans.

I’ll have more to say as we get closer to open enrollment time, emphasizing how important it is to choose the right plans for you. Sadly, a small percentage of eligible Medicare beneficiaries switch plans during the open period. During the 2020 open enrollment period, only 10% of seniors switched their Medicare Advantage plans and only 18% switched their prescription drug plans. Your prescription drug plan is one place where things can change during the year that could cause a big change in your out-of-pocket costs. It’s only through your due diligence that you can keep your costs as low as they can be. Have a great week!

Best, Thair

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July 22– World Brain Day

July 22nd is World Brain Day, a time to pause and consider not only our own brain health but those who suffer with brain disorders and brain disabilities. The theme this year is “Brain Health and Disability: Leave No One Behind.” The World Federation of Neurology is hoping that this increased focus will inspire global initiatives to expand awareness of disability and improve healthcare access for people with disabilities. We all need to recognize that disabled people also need care and services and have a right to brain health across the life span without the stigma that is still prevalent around this disability.

The World Brain Day has five points that they hope we all become aware of:

  • Prevention: Brain disabilities can be prevented, treated, and rehabilitated.
  • Awareness: Global brain health awareness can reduce the disability associated with brain disorders.
  • Access: Universal access to care, treatment, rehabilitation, and assistive technology is essential.
  • Education: Education increases equity for those living with brain disabilities.
  • Advocacy: Brain health is a human right that applies to everyone, everywhere.

As I pondered these points and the goals of this World Brain Day, I wondered how do I bring this down to my, and hopefully your, personal level? What does this really mean to me? As I’ve grown old (I’m about 6 weeks away from ¾ of a century old), I’ve had a front row seat to my physical decline. The aches and pains have sadly become the main topic of conversations with my friends. A bigger fear for me was witnessing a decline in my mental abilities. I’ve began to see firsthand people I know from parents to even friends fight dementia or other brain disabilities. I lost a dear friend and fellow B-52 crew member to the ravages of Lewy body dementia. I witnessed his decline and the change in his personality. I don’t think I’m alone when I wonder if those instances when I go into another room and forget what I went in there for is the first sign of some sort of dementia. I get frustrated when I know that I once knew a great word that would precisely describe a situation but can’t pull it out of my memory banks. It’s frustrating because I worked hard during my life to develop a broad vocabulary and I know I once knew the word but now I can’t remember it. The saving grace of this situation is that most of my friends have this same problem, so I feel like maybe this is just getting old and not the onset of a serious problem.

So, what can we do? We all should know the signs of the onset of dementia:

  • Memory loss that disrupts daily life
  • Poor judgment, leading to bad decisions
  • Loss of spontaneity and sense of initiative
  • Losing track of dates or knowing current location
  • Taking longer to complete normal daily tasks
  • Repeating questions or forgetting recently learned information
  • Trouble handling money and paying bills
  • Challenges in planning or solving problems
  • Wandering and getting lost
  • Losing things or misplacing them in odd places
  • Difficulty completing tasks such as bathing
  • Mood and personality changes
  • Increased anxiety and/or aggression

The most important thing to know is, if we have any questions or symptoms, the first thing we should do is go see our doctor. There are tests that can be done to evaluate if what we are experiencing is the onset of some type of dementia. It’s not the easiest disease to identify — there are no blood tests that can precisely conclude we are experiencing Alzheimer’s or dementia, but through cognitive tests and other methods a diagnosis can be made.

The yearly Medicare wellness exam is one opportunity to review your cognitive health. I must admit, I haven’t been a big fan of this exam because it isn’t a full physical and doesn’t include many things I was used to. What I have come to appreciate is the myriad of questions asked in the exam, questions that delve into your living environment, your nutrition, and your mental health. I can see the wisdom in this exam because it goes beyond just aches and pains and looks at your broader overall health and living situation. It’s an opportunity for the doctor to uncover cognitive problems, deficient nutrition, and even elder abuse. I’ve become more of a fan.

There are indications that there are things we can do to keep our minds engaged and maintain our cognitive health. There are indications that keeping ourselves in good physical health, especially maintaining a healthy blood pressure, are helpful in keeping our brains healthy. Exercise and healthy eating seem to be the universal medicine for everything that ails us. The National Institute on Aging’s website is a great place to find answers and suggestions about Alzheimer’s and dementia.

While I’ve focused on the personal things we can do for our brain health, there is also something we can do that could help our fellow seniors (I know you would be disappointed if I didn’t talk about some timely issue that we need to be aware of). One of the biggest disappointments for scientists has been the lack of breakthroughs for treatments or cures for Alzheimer’s. Finally, in June 2021, the U.S. Food and Drug Administration (FDA) approved a drug for Alzheimer’s, but the Centers for Medicare and Medicaid Services (CMS) decided to only make it accessible to patients who were part of a clinical trial. I’ve discussed this in earlier blogs where I pointed out what a dangerous precedent this set. A few days ago, another Alzheimer’s drug got a full approval. Many pundits have talked negatively about both of these approvals. The FDA approved both these drugs for a disease that, up to this point, had very few treatments. The FDA has been a trusted gold standard for decades. How is it possible that the CMS can suddenly limit access to an approved drug? Those who suffer from Alzheimer’s and those who are their caregivers need all the help they can get. We need to tell our lawmakers to respect the FDA’s proven track record and stop any efforts to limit access to these approved drugs.

I hope each of us takes the time to focus on our brain health on this upcoming World Brain Day.

Best, Thair