Just a reminder: 2023 will begin what could be consequential changes in aspects of older Americans, notably those age 65-plus and covered by Medicare.<\/p>\n As part of law of the Inflation Reduction Act passed by Democrats in the Congress and pushed by the Biden Administration, diabetics on original Medicare will see their cost for lifesaving insulin capped at $35-a-month under Part-D prescription drug plans<\/a>. As the official Medicare site reports:<\/p>\n \u201cPlans can\u2019t charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take and can\u2019t charge you a deductible for insulin. Because this is a brand-new benefit, the new $35 cap may not be reflected in your estimated total costs when you review and compare plans. Your costs\u00a0<\/strong>can\u2019t be more than $35 for each month\u2019s supply of each covered insulin. For example, if you get a 60-day supply of a Part D-covered insulin, you\u2019ll generally pay no more than $70.\u00a0Starting July 1, 2023, similar caps on costs will apply for insulin used in traditional insulin pumps (covered by Medicare Part B).\u201d<\/p>\n The savings that the insulin-reliant will pocket will be significant, the nonpartisan, independent Kaiser Family Foundation has found, reporting<\/a>:<\/p>\n \u201cAggregate out-of-pocket spending by people with Medicare Part D for insulin products quadrupled between 2007 to 2020, increasing from $236 million to $1.03 billion. The number of Medicare Part D enrollees using insulin doubled over these years, from 1.6 million to 3.3 million beneficiaries \u2026 Among Medicare Part D insulin users who do not receive low-income subsidies, average out-of-pocket costs per prescription across all insulin products was $54 in 2020 \u2013 over 50% more than the proposed $35 monthly copay cap for insulin. The $54 per-prescription average in 2020 is an increase of 39% since 2007 \u2026 Some Part D insulin users spent considerably more than the average in 2020. For example, 10% of \u2026 insulin users [not receiving low-income subsidies] spent more than $1,300 on insulin in 2020 and 1% spent more than $2,300. Higher-than-average out-of-pocket spending is due to a greater number of prescription fills for insulin products and higher out-of-pocket costs per insulin prescription. In other words, taking more than one insulin product and taking more expensive formulations leads to higher out-of-pocket costs.\u201d<\/p>\n Though lawmakers considered Democratic proposals to cap insulin costs for all users, not just those on Medicare, Republicans killed those plans, maintaining the GOP\u2019s almost theocratic opposition to federal roles in U.S. health care.<\/p>\n The battle to constrain Big Pharma\u2019s rapacious cost increases turned in 2022 to ferocious arguments over insulin. Its users have besieged lawmakers, complaining that high prices force them to forgo or ration a lifesaving medication they must take. Patients say that affording insulin can mean they must skimp on other basic, necessary expenses. The drug\u2019s soaring costs, critics argued, are indefensible as the basic product has changed little, though Big Pharma keeps making tweaks so as to extend intellectual property protections and jack up prices on insulin. As NPR reported<\/a>:<\/p>\n \u201cLeading manufacturers have increased [insulin] prices by more than 600% over the last 20 years.\u201d<\/p>\n The sky-high cost of insulin especially outrages patients, their loved ones, doctors, and public policy advocates because the medical scientists who originally discovered the drug and its giant benefits for diabetics declined to benefit financially from their pioneering research, arguing that the drug should be made as widely available as possible at negligible cost to help as many people as possible.<\/p>\n More cost savings ahead for older Americans<\/strong><\/p>\n Insulin, of course, was not the only high and dubious health care cost that congressional Democrats and the administration took on in 2022<\/a>:<\/p>\n The saving to seniors of these changes also will be sizable, KFF reports:<\/p>\n \u201cBased on\u00a0our analysis<\/a>, 1.4 million Part D enrollees incurred annual out-of-pocket costs for their medications above $2,000 in 2020, averaging $3,355 per person. This estimate includes 1.3 million enrollees who had spending above the catastrophic coverage threshold (which equaled roughly $2,700 in out-of-pocket costs that year for brand-name drugs alone). These estimates are a conservative measure of how many beneficiaries will be helped \u2026 Based on their average out-of-pocket spending, these 1.4 million Part D enrollees would have saved $1,355, or 40% of their annual out-of-pocket costs, on average, if a $2,000 cap had been in place in 2020.<\/p>\n \u201cPart D enrollees with higher-than-average out-of-pocket costs will save substantial amounts with a $2,000 out-of-pocket spending cap.\u00a0For example, the top 10% of beneficiaries (145,000 enrollees) with average out-of-pocket costs for their medications above $2,000 in 2020 \u2013 who spent at least $5,567 \u2013 would have saved $3,567 (64%) in out-of-pocket costs with a $2,000 cap. Capping out-of-pocket drug spending under Medicare Part D will be especially helpful for beneficiaries who take high-priced drugs for conditions such as cancer or multiple sclerosis. For example, in 2020, among Part D enrollees without low-income subsidies, average annual out-of-pocket spending for the cancer drug Revlimid was $6,200 (used by 33,000 beneficiaries); $5,700 for the cancer drug Imbruvica (used by 21,000 beneficiaries); and $4,100 for the MS drug Avonex (used by 2,000 beneficiaries).\u201d<\/p>\n Those familiar with public insurance programs for seniors will know that different varieties of Medicare Advantage deal with prescription drug coverage differently that does \u201coriginal\u201d Medicare, and much of the discussion about medication savings may not affect participants in the increasingly popular, newer programs.<\/p>\n A crackdown on Medicare Advantage plans<\/strong><\/p>\n Consumer complaints about the advantage programs have increased significantly and the Centers for Medicare and Medicaid Services (CMS) announced late in \u201922 a planned crackdown in response. As the New York Times reported<\/a>:<\/p>\n \u201cFederal health officials are proposing an extensive set of tougher\u00a0rules<\/a>\u00a0governing private Medicare Advantage health plans, in response to wide-scale complaints that too many patients\u2019 medical claims have been wrongly denied and that marketing of the plans is deceptive. Medicare Advantage is the private-sector alternative to the federal program covering those 65 and over and the disabled. By next year,\u00a0more than half<\/a>\u00a0of Medicare recipients are expected to be enrolled in private plans. These policies are often less expensive than traditional Medicare and sometimes offer attractive, additional benefits like dental care. Despite their popularity, the plans have been the subject of considerable scrutiny and criticism lately. A recent\u00a0report<\/a>\u00a0by the inspector general of the U.S. Department of Health and Human Services found that several plans might be inappropriately\u00a0denying care<\/a>\u00a0to patients. And nearly every large insurance company in the program, including UnitedHealth Group, Elevance Health, Kaiser Permanente and Cigna, has been\u00a0sued<\/a>\u00a0by the Justice Department for fraudulently overcharging the government. The period leading up to this year\u2019s enrollment deadline, Dec. 7, amplified widespread criticism about\u00a0the deceptive tactics<\/a>\u00a0some brokers and insurers had used to entice people to switch plans. In November, Senate Democrats issued a scathing\u00a0report<\/a>\u00a0detailing some of the worst practices, including ads that appeared to represent federal agencies and ubiquitous television commercials featuring celebrities.\u201d<\/p>\n In my practice, I see not only\u00a0the harms that patients suffer while seeking medical services<\/a>, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications,\u00a0too many of which turn out to be dangerous drugs<\/a>.<\/p>\n We\u2019ll need to see the outcomes of proposed federal action on insulin costs, seniors\u2019 overall prescription drug expenses, Medicare\u2019s medication negotiations with Big Pharma, and tougher oversight of Medicare Advantage programs. Further changes may be needed. But credit is due to lawmakers who heed the outcry from their constituents and pass bills that aim to make regular folks\u2019 lives better and more affordable. Voters need to keep this mind as the country rumbles inevitably toward the next presidential campaign and tussling over control of the House, Senate, and statehouses from coast to coast.<\/p>\n We have much work to do to ensure that, in the wealthiest nation on the planet, health care is a right, not a privilege for a wealthy few. Many more Americans beyond our vulnerable seniors need more protection from Big Pharma profiteering and we need to see Congress and the White House provide this.<\/p>\n<\/div>\n\n Editor\u2019s note: The blog will shift in \u201923 to more episodic publication. Just a reminder: 2023 will begin what could be consequential changes in aspects of older Americans, notably those age 65-plus and covered by Medicare. As part of law of the Inflation Reduction Act passed by Democrats in the Congress and pushed by the …<\/p>\n","protected":false},"author":1,"featured_media":39265,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[161],"tags":[],"_links":{"self":[{"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/posts\/39264"}],"collection":[{"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/comments?post=39264"}],"version-history":[{"count":0,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/posts\/39264\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/media\/39265"}],"wp:attachment":[{"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/media?parent=39264"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/categories?post=39264"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.brandon.ddtest.info\/multisite-test\/wp-json\/wp\/v2\/tags?post=39264"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"cardmedicare-300x194\"](\"https:\/\/www.protectpatientsblog.com\/wp-content\/uploads\/sites\/69\/2022\/12\/cardmedicare.jpg\")
<\/a>Editor\u2019s note: The blog will shift in \u201923 to more episodic publication<\/em>.<\/p>\n\n
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