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I Told You So!

Published by Thair Phillips

The slow walk down the path toward the government’s total control of Medicare’s prescription drug program has begun and it flies in the face of one of the most successful public-private partnerships in history.

A little background, the Medicare Prescription Drug Benefit, Part D, was signed into law in 2003. Those who wanted a government-controlled program asserted that there wouldn’t be enough competition and choice of plans and the government’s cost would skyrocket if the public-private partnership was enacted. After much debate, the partnership plan was passed in a narrow vote early in the morning and it has proven the naysayers wrong. It has continued to cost 40% less than was projected and the number of plans offered in each state range from 19 to 28. Since its inception, those using Part D continue to give it an overall satisfaction rate around 90%. I don’t know of any other government program that has such sterling credentials, yet Washington is determined to, step by step, insert itself into this successful program.

Last year the Inflation Reduction Act, which passed in August 2022, included a provision that allowed the government to set the prices of certain drugs, starting with 10 in 2026, adding 15 in 2027, another 15 in 2028 and then 20 in 2029 continuing with 20 more each following year. The law also contained a provision that limited the amount a drug’s price could be increased each year. I maintain that this government intervention in a hugely successful program had more to do with politics than it did to lowering the cost of prescription drugs to Medicare beneficiaries and I think it’s part of the administration’s plan to control Medicare Part D.

Last October I wrote a blog titled “Beware the Camel’s Nose,” about how politicians can introduce small, seemingly insignificant legislation, rules or executive orders that will start small but can open the door to much larger impactful changes. I talked specifically about the Inflation Reduction Act (IRA), which is now law, that contained price controls. As outlined above these price controls affected a relatively small number of drugs and they were limited to drugs that had been available for the accepted exclusivity period. These exclusivity periods were necessary to encourage innovation and have been working effectively since 2006. To some it seemed a small insignificant step, but to me it was the camel’s nose pushing under the edge of the tent. Here’s a few quotes from the blog from last October:

“Soon, this approach” (legislation that inserts the government into a part of our healthcare) “won’t shock us, and we won’t think it’s so bad when they propose that they limit access to a small portion of accelerated-approved drugs, maybe like in the IRA, where it is 10 drugs for the first year and then adding 15 more and then . . .”

The . . . at the end of the quote is what scared me last October – it was the fear of what would be next and now, unfortunately, I have good reasons to say, “I told you so!”

The President just released his proposed budget for next year and it is clearly the next steps in controlling our prescription drug program. The budget would:

  • Increase the number of drugs eligible for price controls from 10 to as many as 40, effectively doubling the number of eligible drugs.
  • Decrease the time that drugs are eligible for price controls from 9 years for small molecule drugs and 13 years for biologics to 5 years!
  • Insert these government price controls into the commercial marketplace.
  • Increase the HHS budget by 11.5%.

There it is! The government has now stuck, not only its nose into our healthcare, but wants to stick its head and neck and one shoulder in and it has a huge budget increase to accomplish it. While the President’s budget has little chance of passing, it clearly shows his intent and fits into his expected rhetoric for his quest for reelection. Their hope is that we won’t be so surprised and upset when we see these proposed changes again, in other legislation, rules and executive orders.

These new proposed changes would further chill innovation, threaten Medicare, and discourage investments in future research and development. It clearly shows that the administration’s direction continues to move away from the discovery of new treatments and cures. What scares me is that these policies could mean that the next life altering, or lifesaving discovery will be postponed or remain undiscovered and be unavailable for me, my children, or my grandchildren.

It gives me no satisfaction to say I told you so. While politicians can often be predictable, they can also decide to do the right thing. The amount of money a patient pays for a drug at the pharmacy counter is impacted by a convoluted supply chain that has many twisted incentives that inhibit the reduction in the final price the patient pays. There are ways to maintain the competition and the investment in innovation without government intervention and price controls. We need to step back and decide on a long-term way that we can ensure both accessibility and innovation.

Click here to tell your members of Congress to reject the dangerous direction outlined in the President’s budget. Tell them you want to find ways to increase accessibility and finding new cures. It would be sad if we found ways to fix inflation, emerge from the pandemic and return to prosperity only to find we don’t have the future innovative drugs that would keep us healthy enough to enjoy those newfound bounties.

Best, Thair

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Check Out the Results of the Latest Senior Satisfaction Survey!

Published by SSO

It’s that time of year—the results of the Senior Satisfaction Survey from our partners over at Medicare Today are in! Since 2007, researchers have surveyed seniors to measure our level of satisfaction with our Medicare Part D plans in order to take a critical look at the program and ensure that our needs are being addressed.

The purpose of the Senior Satisfaction Survey is to gauge the success of Medicare Part D, examine what aspects of the program are working, and take a look at what the program can be doing differently to achieve maximum success for American seniors. Each year, the survey has demonstrated that seniors are pleased with their Medicare Part D plans, including their coverage options and the prices they pay for their medications.

This year, nearly nine in 10 seniors report being satisfied with their Medicare Part D coverage. Some other key findings include:

  • 93 percent of seniors say their prescription drug plans are convenient to use
  • 86 percent of seniors report that their Part D plans work well
  • 85 percent of seniors view their prescription drug plans as a good value that provide coverage at a fair price
  • 81 percent of seniors are happy with their ability to compare prescription drugs covered under Part D and choose what best works for them
  • 88 percent of seniors say that their Medicare Part D plans are delivering on their promises

 

These results are exceptional and demonstrate just how happy seniors are with the current state of their Medicare Part D coverage. Although some changes are being proposed to the program by the Administration and Congressional leadership, it is critical that seniors continue to advocate for ourselves by urging lawmakers to protect the integrity of Medicare Part D. We must also continue to push policymakers to support improvements that will strengthen affordable access to medications.

For more information and past survey results, please visit Medicare Today’s website at: www.medicaretoday.org, and share your thoughts with us on Twitter and Facebook today!

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Tell Congress to Reject Cuts to Medicare Part D!

Published by SSO

There is a rumored proposal in the works that could harm Medicare Part D and the seniors that rely on this critical program. This proposal would harm Medicare by applying a government-imposed inflation rebate on Part D medications that could negatively affect the program’s successful market-based structure.

By unnecessarily inserting government-imposed inflation rebates, this policy would violate the spirit of the non-interference clause, which has allowed competition between Part D plans to hold down costs and has been key to Part D’s success since its inception. This penalty could also raise premiums for beneficiaries, as this type of change has the potential to eliminate the privately negotiated price protection rebates that are currently used to subsidize premiums.

Not only would this type of proposal undermine the success of the Part D program, but it could also reduce the incentive for future innovation in health care. Inflicting such a policy on Part D medications could have the harmful consequence of discouraging future investment in medical research, harming beneficiaries, especially those with chronic or complex conditions who rely on the program to access new break-through cures.

There are numerous proposals that, if enacted, would serve to meet the needs of seniors. This is not one of them. It is critical that you act NOW to tell your Member of Congress that these cuts to Medicare through government-imposed inflation rebates are the wrong way to lower Part D costs. Join us TODAY in making our voices heard by clicking here!

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Back to Basics: Medicare Part D

Published by SSO

It’s summer already, and the year seems to be flying by! Before we know it, the fall open enrollment period will be here for the Medicare Part D prescription drug benefit as well as Medicare Part C, better known as Medicare Advantage. It’s important that beneficiaries know about the Medicare program and how we can utilize its resources, particularly access to prescription drug coverage that comes through Medicare Part D as well as most Medicare Advantage plans. A great way to get an easy refresher on the Medicare program overall is by watching this short clip here, which provides a brief overview of these important benefits. Arming yourself with the most comprehensive knowledge about Medicare is critical, especially for those of you who are turning 65 this year, or have friends or relatives that are becoming eligible.

Today, let’s go back to basics with an easy primer on one of the parts of Medicare—Medicare Part D!

Medicare Part D is the part of Medicare that covers prescription medications. One thing that differentiates Part D from other parts of Medicare is that the program is optional. Beneficiaries are automatically enrolled in parts A and B of Medicare when they reach age 65, however, beneficiaries must choose to opt-in to the Medicare Part D program and are not automatically enrolled.

Unlike other parts of Medicare, which are administered by the federal government, Medicare Part D coverage is provided through private insurers. Under the program drug manufacturers and private plans negotiate drug prices directly, allowing for a wider variety of treatment options and medication choices for beneficiaries.

This unique structure allows for and encourages increased competition among insurers, which aids beneficiaries by allowing individuals to shop around for the best-tailored plan for their unique health care needs. You can watch a quick video about how this competitive structure drives down the overall cost of Medicare Part D plans here.

There are a variety of Medicare Part D plans to choose from, each with different prescription drug formularies, coverage options, and costs. An easy way to find a plan that works for you is to use this interactive tool, which can help provide easy access to information about uniquely-tailored plans that could work for you.

Open enrollment will be here before we know it, and it is imperative that beneficiaries are equipped with the information we need to make smart decisions for our health. Opting in to Medicare Part D is an important part of maintaining a healthy lifestyle, so make sure you utilize these resources to keep up-to-speed on all things Part D!

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May is Arthritis Awareness Month!

Published by SSO

Each May, we celebrate National Arthritis Awareness Month in honor of the more than 50 million Americans that are impacted by this disease. As seniors, is critical to be informed about the risk factors, causes, and treatment options available for those with arthritis. In fact, 1 in every 5 adults are impacted by arthritis in the U.S.—making it the number one cause of disability in the country.

Arthritis is not actually a single disease, but rather an umbrella term for the more than 100 different types of joint pain or joint disease. Arthritis affects individuals of all ages, races, and sexes, but is more common in women and occurs more frequently as people age. Common arthritis symptoms are swelling, pain, stiffness, and decreased range of motion in joints, which can progress, stay the same, or feel better with time.

Although there are more than 100 types of arthritis and related joint conditions, the most common form is osteoarthritis—which occurs when cartilage wears away and causes bones to rub together. This often causes pain, swelling, and stiffness, and risk factors for developing the condition include family history, being overweight, previous injury, and aging.

Fortunately, mild or moderate symptoms of osteoarthritis and other common forms of arthritis can be alleviated by simple actions, such as regular physical activity, maintaining a healthy weight, strengthening affected areas, and taking anti-inflammatory medications, which are often covered by Medicare Part D.

According to the CDC, walking is one of the easiest ways to improve arthritis symptoms while also keeping up with your overall fitness. That’s why it is important that this May, you take some time to get outside, take a walk, and keep yourself healthy! There are numerous opportunities to get involved with arthritis awareness and prevention efforts, including community walks, volunteering events, and fundraising efforts. There are constant scientific discoveries that help those living with arthritis, so this May, get involved with efforts to help expedite the process of finding a cure!

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Have You Checked Your Plan Recently?

Published by SSO

We have recently discussed a number of different proposals that could alter seniors’ access to the medicines through the Medicare programs we rely on to stay healthy. It is critical that we, as seniors, are our own best advocates and that includes making sure we are up-to-speed on the provisions of our personal Medicare plans.

Health insurance can be complicated, which is why we are here to provide guidance for seniors so we can make the best decisions for our personalized needs. As we have discussed, Medicare Parts A and B, the parts that cover hospital and medical insurance, are included in your Medicare coverage as soon as you turn 65 years old. However, Medicare Part D, which is an optional add-on service, covers many of the prescription medications that we rely on every day.

Although Medicare Part D is optional, an overwhelming majority of seniors choose to add this important part of health coverage to their plans. In fact, out of the 60 million American Medicare beneficiaries, 43 million were also enrolled in Part D coverage as of May 2018—showing just how important this part of the program is to seniors’ overall quality of life.

It is critical that we keep on top of our Medicare plans to make sure they are working for us and our needs. The fall open enrollment season may seem far away now, but it is right around the corner! Make sure you are checking your coverage options, and stay informed, empowered, and independent!

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The Importance of Medicare Part D’s Non-Interference Clause

Published by SSO

We often stress the importance of being knowledgeable about Medicare in order to best advocate for our health care needs. That’s why it is important not only to know about the different parts of Medicare, but also be up-to-date on legislative provisions that could have an impact on critical aspects of this program.

Under Medicare Part D, which covers prescription medications, plans are offered by insurance companies, and seniors select the plans during open enrollment period each fall. Last year, 43 million of the 60 million people with Medicare were enrolled in Part D coverage, a testament to the immense value the program provides for patients.

Unfortunately, Medicare Part D is facing a serious threat that could undermine the competitive marketplace structure of the program that helps improve affordability and patient choice. This threat involves proposals that would repeal an important feature of Part D called the non-interference clause, which prevents the government from entering into the private market negotiations that drug manufacturers and insurance companies engage in to provide patients with a wide variety of coverage options. This clause protects seniors by encouraging competition between plans, ultimately leading to better access to crucial prescription drugs for seniors.

Medicare beneficiaries deserve to be able to select the plans that best address our health care needs. Because of the free-market principles that the non-interference clause relies on, beneficiaries are able to save money on their prescription medications because they are empowered to shop around for plans without government influence on prices or availability.

Recent proposals to repeal the non-interference clause are dangerous and harmful to seniors, and it is critical that we urge lawmakers not to repeal this important provision of Medicare Part D. As seniors, we have the collective voice to make a difference, and should feel empowered to advocate for our needs. We encourage you to share your thoughts with us on our Facebook and Twitter pages, and urge you to tell lawmakers not to repeal the non-interference clause!