General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsBig PhRMA opposes the new CMS rule.
(reposting)
NYT:
Weve been scratching our heads over this, said John J. Castellani, the chief executive of the Pharmaceutical Research and Manufacturers of America, the drug-industry trade group. Medicare Part D, he noted, is the rare government program that not only gets high marks from consumers but also has cost taxpayers billions of dollars less than originally expected. Why is the administration trying to make such extensive changes to a program that isnt broken?
Mr. Castellanis organization was one of more than 200 groups that signed a letter this week asking that the rule be withdrawn. Earlier this month, Republican and Democratic members of the Senate Finance Committee warned that the proposal could diminish access to needed medication without saving much money.
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http://www.nytimes.com/2014/02/22/business/plan-to-alter-medicare-drug-coverage-draws-strong-opposition.html
Here's one of the reasons, from the letter:
http://www.hlc.org/blog/wp-content/uploads/2014/02/Comment-Ltr-as-of-2-19.pdf
I can't imagine any progressive making that case.
enough
(13,262 posts)what point you are making. I am not doubting or arguing with you.
My perspective is from having had a very elderly father who was a picture of robust health but suffered from Alzheimer's Disease. When his anger, paranoia, and violence became too much for me and my mother, Seroquel was the reason that he was able to stay at home with us for a very long time. Without that medication, he would have had to be in some facility that could control him physically.
Also, I have relatives who have benefited from antidepressants.
Are you saying that I should not be concerned about this, and that something other than what I think is happening is what is going on?
"Are you saying that I should not be concerned about this, and that something other than what I think is happening is what is going on?"
...that's not the point. The rule changes Part D formularies, and the concern expressed seems to be that this will limit choice. I don't see it. Making "all or substantially all" drugs available, but limiting pharmacy choice seems more limiting in my view. It seems the rule is changing to limit big PhRMA's influence on drug pricing.
Here is what I posted yesterday:
The current rule appears to be about implementing the process of negotiating drug prices. The NYT article quotes people from across the spectrum, but the concerns appear more rooted in fear of change than the actual effects of the policy. I mean, how will negotiating drug prices limit choice?
By Elise Viebeck
Republican committee leaders are pushing the Obama administration to call off proposed changes to the Medicare prescription drug program, arguing the overhaul would jeopardize seniors' plans and raise premiums.
The charges pertain to recent regulations proposed by the Centers for Medicare and Medicaid Services (CMS). The rules would allow the agency to participate in negotiations between insurance companies and pharmacies in Medicare Part D for the first time out of concerns over cost and access.
Supporters of the change argue the CMS needs new authority to ensure the market for prescription drugs in Part D works for patients. But Republicans said the proposal will allow the agency to unnecessarily interfere with existing drug plans, potentially forcing millions of seniors out of their coverage.
"Despite the program's far-reaching success, CMS is proposing to fundamentally undermine the program and jeopardize the prescription drug plans that million [sic] of seniors rely on for their health and peace of mind," the members wrote.
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http://thehill.com/blogs/healthwatch/medicare/198800-gop-slams-proposed-changes-to-medicare-part-d
The proposed rules would empower the agency to participate in Part D negotiations between insurance companies and pharmacies for the first time out of concerns about cost and access.
The regs would also open plans' preferred networks to a wider range of pharmacies, limit plan bids within a region and remove "protected class" designations for certain types of drugs.
The CMS argues the changes are necessary to save money, hold plans and providers to account, and enhance consumer choice within Part D.
But despite praise from some quarters of the healthcare world, most of the reaction from business groups, insurers and drug companies has been negative.
http://thehill.com/blogs/healthwatch/politics-elections/198816-gop-debuts-new-campaign-attack-line-on-medicare
Pharmaceutical Research and Manufacturers of America (PhRMA) stated yesterday that it is opposed to the proposed rule on Medicare Advantage and Part D that CMS released in early January because it could disrupt care for millions of beneficiaries.
The Part D program is already working well, making the proposed rule unnecessary and harmful. Quite simply, it is a solution in search of a problem, says PHRMA senior vice president Matthew Bennett, adding: Since 2006, the Part D program has developed a strong track record of success. Currently, total Part D costs are 45% - or $348 billion - lower than initial projections for 2004-2013. Additionally, average beneficiary premiums are stable at $31 per month in 2014 - less than half the level originally projected. And several surveys have found that 90% or more of Part D beneficiaries are satisfied with their coverage.
Would unlawfully interfere in a competitive, market-based program that is working
He continued: Despite Part Ds success, the proposed rule represents a fundamental shift in CMS administration of Part D and would erode key features at the core of the programs competitive structure to the detriment of beneficiaries. The proposed changes would restrict patient access to needed medications, limit beneficiary choice of affordable plan options, and unlawfully interfere in a competitive, market-based program that is already working. Not only are these changes unnecessary; they could increase costs for both beneficiaries and taxpayers.
In light of Part Ds track record, PhRMA urges CMS to withdraw the proposed rule which, as written, would undermine Part D and harm beneficiaries who rely on the program for affordable access to comprehensive prescription drug coverage, Mr Bennett concluded.
http://www.thepharmaletter.com/article/phrma-opposes-proposed-rule-on-us-medicare-advantage-part-d
National Center for Policy Analysis (Koch funded) is against it.
Most Popular Seniors Medicare Drug Plans May Be Banned by CMS: 14 Million Could Lose Medicare Part D in 2015: NCPA Study
http://www.prweb.com/releases/2014/02/prweb11601939.htm
National Center for Policy Analysis
http://www.rightwingwatch.org/content/national-center-policy-analysis
Here is the rule: http://www.gpo.gov/fdsys/pkg/FR-2014-01-10/pdf/2013-31497.pdf
From the PDF:
Interesting mention of "rebates." Medicaid has one of the best rebate drug policies.
<...>
The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.
The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturers drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drugs coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html
The ACA increased Medicaid's drug rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html
<...>
Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drugs price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).
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http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates
ProSense
(116,464 posts)okaawhatever
(9,462 posts)misinformation is coming from corporate media and big pharma should tell people a lot about the trustworthiness of the info. Castellani, a lobbyist for a pharma trade group is making the claim that Part D is costing less than originally expected. While technically true, we've known for years the reason is because fewer people signed up, more ended up taking generic than expected, and the expiration of patents on some big meds has lowered prices.
Sadly, it's hard to get accurate information on this subject. The billions in profit that could be lost to pharma gives them a good reason to spend hundreds of millions putting false info out there.
thanks for trying to educate those at DU
ProSense
(116,464 posts)Cha
(297,655 posts)what you mean, PS. Oh well.. it's not like they're changing their MO.