Health insurance plans, the Times reports “would under the proposal, reduce the number of prescription drugs that must be made available to people with cancer, AIDS, depression, schizophrenia”.
Robert Pear writes:
Approximately 45 million people have outpatient drug coverage through Part D of Medicare. Benefits are delivered by prescription drug plans offered by insurance companies under contract with Medicare.
The insurers secure discounts on many medicines by negotiating prices with drug manufacturers. If they could exclude certain drugs in the six therapeutic classes, they could negotiate better deals, the Trump administration said.
The coverage requirement has been in place since it was adopted by the George W. Bush administration in 2006 to ensure that Medicare beneficiaries would have access to “all or substantially all drugs” in the six treatment categories.
Trump administration officials say that drug makers have little incentive to negotiate because they know that Medicare’s prescription drug plans must cover almost all drugs in the six protected classes: antidepressants; antipsychotic medicines, used to treat schizophrenia and certain related disorders; immunosuppressant drugs, to prevent rejection of organ transplants; anti-epilepsy drugs; antiretrovirals, used in treating H.I.V./AIDS; and many cancer drugs.
POZ Magazine comments on the news reported by the New York Times.
“The Trump administration proposal is bad medicine and dangerous to people living with HIV,” Carl Schmid, the deputy executive director of the advocacy group The AIDS Institute, told the Times. “Not all HIV medications are the same. The Medicare Part D program is working well for people with HIV, and there is no reason to take these draconian actions.”
What’s more, the proposal could allow insurers to require a client to obtain prior authorization for a medication as well as to try a cheaper medicine before the insurer would cover a costlier one for the same condition—the latter requirement is a process known as step therapy.
“Step therapy is unheard of in the treatment of HIV due to the danger of developing resistance to an entire class of drugs and potential side effects,” writes The AIDS Institute in a related press release condemning the Trump plan.
“This proposal,” the institute continues, “runs contrary to current U.S. government HIV treatment guidelines, which state that prior authorizations for HIV drugs ‘result in fewer prescriptions filled and increased nonadherence….and have substantially reduced timely access to medications.’”
Thankfully, Nancy Pelosi and the new Democratic Congress will be able to nip this boneheaded plan in the bud. This is why we vote.
“The concern however is people lose access to specific medications” because plans stop providing them, Juliette Cubanski, associate director of the Program on Medicare Policy at Kaiser Family Foundation, told CNBC. “And that concern is outweighed by any potential savings.”
The current proposal, which is open for public comment until Jan. 25, would still require insurers to cover at least two drugs in every therapeutic category. But they could exclude some protected-class drugs when prices increase faster than the rate of inflation or when new drug formulations “are not a significant innovation over the original product,” according to Medicare and Medicaid Administrator Seema Verma.
Pharmaceutical companies “have been able to say you have to cover my drug no matter what and have to pay whatever I want on my plan,” Health and Human Services Secretary Alex Azar said Tuesday on CNBC’s “Squawk Box.” That ends under this proposal, he said.
Spending on Medicare Part D drugs totaled $137 billion in 2015, according to Kaiser. Total health care spending in the U.S. represented 18 percent of gross domestic product, according to Medicare, and is expected to continue to rise.
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