Although the mid-term elections are over, I received a political flyer recently. The flyer was full of photos of worried senior citizens with the scary headline shown above. OK, you have my attention – what’s this all about?
The inevitable worried senior shot.
I read the flyer carefully, but I couldn’t figure out what the alarm was about. However, my sniff-o-meter was going off. Here’s some language from the flyer, see what you start to suspect:
-“Middlemen and HHS bureaucrats will interfere with doctors’ decisions about your health care.”
–“Use of “Step Therapy” or “Fail First” policies will deny patients immediate access to the most effective treatment for their illness.”
–“Unprecedented price fixing for medicine based on deeply flawed European health systems, stifling America’s leadership in cancer research and innovation.”
Do you have the same suspicion I did? Another hint: The flyer is “Paid for by Alliance for Patient Access” (AfPA). Chances are, when the advocacy organization has a vague, almost-sounds-like-grass-roots name, it’s a corporate lobby. Yup, the flyer was paid for by Big Pharma.
I looked up “Alliance for Patient Access” and came across an excellent piece of reporting by Mary Chris Jaklevic in the Health News Report. She characterized AfPA as an “organization (which) consistently opposes measures to rein ….in…skyrocketing prescription drug costs..”, adding, “rarely are its deep pharmaceutical connections called out.” AfPA is financially supported by nearly 30 pharmaceutical companies.
I looked up “Step Therapy” and it is indeed what I suspected: As of January 1, 2019, Medicare Advantage insurance plans have the option of requiring patients to start with a less expensive drug for their condition before they can move up a “step” to a more expensive drug. In return, these insurance plans are required to pass on savings to beneficiaries (that’s us). Note step therapy is an option, not a requirement for Medicare Advantage plans. Incredibly to me, until this year, Medicare regulations prohibited step therapy ; also, prior authorization by the insurance company was discouraged until this year. These both strike me as prudent ways to control drug costs.
So what does Trump have to do with these Medicare changes? He is actually trying to honor a campaign promise to lower drug prices and the above regulatory changes are part of that mission. Much to my astonishment, he signed on 10/11/18 what sounds like a progressive piece of legislation — two actually, the awkwardly named Know the Lowest Price Act and the Patients’ Right to Know Drug Prices Act. These acts do away with pharmacy “gag” clauses — pharmacy benefits managers contracted by insurance companies sometimes use “gag” clauses to prevent pharmacists from informing patients if a prescription would be cheaper if purchased out-of-pocket rather than through their health insurance plan.
On October 25, 2018, Trump unveiled a plan to overhaul how Medicare pays for certain drugs. The plan includes expanding the drug price negotiation already in place for Medicare Part D (outpatient drugs) to Medicare Part B (inpatient drugs), and benchmarking US drug prices against prices in foreign countries. Trump said, “For decades, other countries have rigged the system so American patients are charged much more …for the exact same drug,” As usual, Trump has it backwards: other countries aren’t “rigging the system” – they have systems to control drug prices. Americans have no system. Because Big Pharma has lobbied against price controls in the lucrative US market, Americans are charged much more.
Two caveats for this blogpost: 1) Medicare is a complicated subject and I’m not a professional reporter; take this content with a grain of salt, and follow the links for more information.
2) It’s easy to protest against price, um, “protection” by Big Pharma, but at the same time, I have to be nice to them — improvements in Parkinson’s drugs largely come from these companies.
YouTube extra — A post on Medicare needs to be balanced with some levity from the only doctor I want to see: “Hello Central, give me Doctor Jazz!”