Fixing rising pharmaceutical drug costs once and for all

Published in RI News Today on September 27, 2021

Just days ago, WBUR.org, Boston’s NPR News Station, featuring NPR News and Programs, aired a 45.37 minute program, “Steps to Fix America’s Broken Prescription Drug System,”  clearly illustrating the need to fix America’s ailing prescription drug program.  While Americans are traveling to Mexico in search of affordable prescription drugs, referred to as “Pharmaceutical Tourism,” the NPR program added a new twist. Now some state insurance companies are sending their beneficiaries to Mexico to purchase cheaper their pharmaceuticals manufactured in the United States at a lower price, on their tab.  

For instance, let’s take a look at Ann Lovell, of  Salt Lake City, Utah. The NPR Program, aired on Sept. 24, 2021, introduced us to the hearing-impaired former teacher who worked at an early-intervention program for deaf students that’s part of the Utah Schools for the Deaf and Blind, who traveled from Utah to Mexico five times to purchase Enbrel, to treat rheumatoid arthritis, with travel costs and a $500 cash incentive paid by her insurer, the Public Employees Health Program (PEHP). 

Lovell’s Utah physician writes her a prescription, and each tie she travels to Mexico she sees a physician at the Tijuana-based hospital as well.  She updates the physician on her medical condition, gets her prescription, and takes it to the pharmacist, who gives her the medication. 

NPR’s program noted that the Utah initiative was created under a 2018 state law, “Right to Buy,” by Republican Congressman Norm Thurston.  PEHP offers it only for people who use a drug on a list of about a dozen medications were the state can see significant savings.  Of the 150,000 state and local public employees covered by the insurer, fewer than 400 are eligible to participate.

Responding to a tweet promoting the offer, Levell quickly enrolled for as they say an offer she could not refuse.  She and a companion would travel on an all-expenses paid trip from Utah to Tijuana, Mexico to pick buy her pharmaceuticals at a steep discount paid for by the state of Utah’s public insurer to slash the high cost of prescription drugs. PEHP would only have to pay half of the cost of Embrel versus if Levell got it in the United States, saving tens of thousands of dollars. The annual U.S. list price for the drug, Enbrel, is over $62,000 per patient. 

It was one long, exhausting travel day.  At 5:00 a.m., Lovell and her friend flew from Salt Lake City to San Diego.  There, an escort picked them up and took them across the boarder to a Tijuana hospital, where she got a refill on her prescription.  After that, they were shuttled back to the airport and arrived back home by midnight. 

Lovell said she initially began paying $50 a month for her pharmaceutical, increasing to $450 in co-pays.  It would have increased up to $2,500 if she hadn’t started traveling to Mexico.  Without the program, she would not be able to afford the medicine she needed

With the COVID-19 pandemic closing the borders, PEHP’s “Pharmaceutical Tourism” initiative came to an end with the borders closing.   Lovell’s insurer came up with a new option of getting Enbrel at lower cost.  That’s when Lovell was told about the drug manufacturer’s coo-pay program where she would only have to pay five dollars a month.  

Calls for Medicare Negotiating the Cost of Pharmaceuticals 

Although traveling to Mexico or Canada to purchase more affordable pharmaceuticals is a temporary fix, the Washington, DC-based AARP calls for a permanent solution.  The national AARP advocacy group has launched a $4 million ad buy calling Medicare to step in to lowering the spiraling costs of pharmaceuticals.  

The Washington, DC-AARP noted that a recent AARP survey of voters found that 80% agreed or strongly agreed that drug prices could be lowered without harming innovation of new medicines. Strong majorities of voters, regardless of political affiliation, want Congress to act on the issue this year, with 70% saying it is very important. The survey also found that 87% of voters support allowing Medicare to negotiate prescription drug prices. 

AARP’s full-scale ad campaign blitz, including a $4 million ad buy, pushing back on false claims from the pharmaceutical industry that reforms would limit Americans’ access to medicines. AARP has called for fair drug prices for years and is urging Congress to pass legislation that would allow Medicare to negotiate drug prices, put a cap on out-of-pocket costs that older adults pay for their prescription drugs and impose penalties on drug companies that raise prices faster than the rate of inflation.

AARP’s new national ad campaign points out that Americans’ tax dollars subsidize new drug development even as Big Pharma charges Americans dramatically higher drug prices. The ad goes on to urge Congress to “stop the Big Pharma scam. Let Medicare negotiate drug prices.” Beginning tomorrow, it will air nationally on MSNBC and CNN; and in the DC metro area on the Sunday political shows and local radio stations, as well as on digital platforms including the New York Times, Washington Post, CNN, and Politico. In addition to paid advertising, AARP members began taking part in grassroots action beginning September 20. A social media campaign calling for older adults to #ShowYourReceipts has led thousands to share their monthly medication costs with AARP, with their monthly “bills” now running over $11 million.

“Americans are fed up with paying the highest prices in the world for prescription drugs,” said Nancy LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer in a Sept. 17, 2021 statement announcing this advertising campaign. “Our 38 million members are watching and they are counting on their members of Congress to do what’s right and vote to let Medicare negotiate for lower drug prices.”

Now, Congress Must Act…

Congress is currently debating measures to rein in the cost of prescription drugs, and the House Ways & Means Committee advanced legislation this week that includes many of AARP’s priorities on fair drug prices.

Nursing facilities gear up for October vaccination deadline

Published in RI News Today on September 20, 2021

Over a month ago, the U.S. Centers for Disease Control and Prevention (Centers for Disease Control and Prevention) issued a Health Alert Network (HAN) Health Advisory to public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm health care capacity, and widen existing COVID-19-related health disparities.

According to the July 27 Health Advisory, there is growing medical evidence that the Delta variant is at least twice as contagious as the original SARS-CoV-2 virus. It is reported that most cases of COVID-19 hospitalizations and death are in unvaccinated people; however, there are breakthrough infections in vaccinated people because of the surge of infections among the unvaccinated. This is a particular concern in nursing homes, where vaccinated residents are infected by unvaccinated staff.

The Biden Administration announced plans in August to require COVID-19 vaccinations for nursing home staff as a condition for those facilities to continue receiving federal Medicare and Medicaid funding. Rhode Island Governor Daniel J. McKee, along with other states’ leadership, took similar steps to protect nursing home residents by requiring all healthcare staff to be vaccinated and the new federal mandate will ensure consistent and equitable standards throughout the country. At a COVID-19 update held at the state capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect.

COVID Cases Rise in Rhode Island Nursing  Homes

Coronavirus continues to increase in nursing homes, warns AARP Rhode Island in a statement issued on September 17. According to the latest data from AARP’s Nursing Home COVID-19 Dashboard, in the four weeks ending August 22, resident cases increasing from 0.05 to 0.34 per 100 residents and staff cases increasing from 0.11 to 0.88 per 100 residents since the mid-July report.

Nationally, cases are concentrated among the unvaccinated, and those residents were three times as likely to contract COVID-19 last month compared to residents who are fully vaccinated.

The last eight months have shown vaccines to be the most effective tool in preventing COVID-19 related deaths, says AARP Rhode Island’s statement. There were modest increases in vaccination rates during this four-week period, with 92% of Rhode Island Nursing Home residents and 76% of staff fully vaccinated as of August 22.

“This month’s dashboard underscores why all staff and residents in long-term care facilities must be vaccinated as quickly as possible,” said AARP Rhode Island State Director, Catherine Taylor. “For unvaccinated nursing home residents, their risk of an infection is back up to the levels we saw a year ago. Too many people in Rhode Island who lived and worked in nursing facilities have died from COVID-19, and no one wants to see that tragedy repeated,” said Taylor.

The AARP Nursing Home COVID-19 Dashboard also found over a 300% increase in RI nursing homes reporting an urgent need for PPE in the period ending August 22, with almost 10% of facilities in Rhode Island reporting they did not have sufficient PPE.

Nursing Facilities Struggling to Maintain Adequate Staffing

While the Rhode Island Health Care Association supports Governor McKee’s decision to mandate COVID-19 vaccinations across the health care continuum, says John E. Gage, President and CEO of the Rhode Island Health Care Association, representing 64 of the 77 nursing facilities in the Ocean State, nursing homes are struggling to maintain their staffing levels to meet the state’s direct care requirements, but many are struggling to maintain that level, he says, noting that next month’s deadline requiring nursing facility staff will further strain the already “precarious staffing crisis in the state’s nursing facilities”.

Gage noted that the state’s Department of Health has surveyed facilities this week regarding the number of staff that will be unable to enter facilities in two weeks because they are unvaccinated. “It is reported that nursing facilities will lose 7% of their workforce – 706 staff of 10,137 in the workforce across all disciplines,” says Gage, noting that 495 out of the 706 are clinical staff members.

According to Gage, “Rhode Island nursing facilities are ranked the fourth best state for resident vaccinations and fifth best state for staff vaccination rates in the country. He notes, when taking a look at the Centers for Medicare and Medicaid Services data released last week, in Rhode Island 92.65% of residents are fully vaccinated compared to 84.1% nationwide. As to staff, 78.99% of Rhode Island’s nursing facility staff are fully vaccinated compared to 63.7% nationwide.

Gage says, “The vaccine mandate will further add to the challenge of staff retention and recruitment. We are facing the implementation of a minimum staffing mandate to take effect 1/1/22. There’s not adequate staff available to hire, and the legislature did not provide for adequate funding to achieve the upcoming mandate”. 

Finally, Gage notes that while visitation is currently open at Rhode Island nursing facilities there are many factors that make it difficult to stop the spread of COVID-19 from staff to residents. “Our staff are members of each and every community in Rhode Island  They interact with others outside of work who may or may not be vaccinated, and many have children under the age of 12 who are not eligible for vaccination. To further complicate matters, there are breakthrough cases among those who are fully vaccinated, especially now with the prevalence of the Delta variant,” says Gage.

“Rhode Island facilities will continue to take all steps necessary to mitigate the risks of COVID-19 infections,” says Gage, noting that vaccinations are the key to eradicating this pandemic, together with the proper use of personal protective equipment.  

The AARP Nursing Home COVID-19 Dashboard analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available  www.AARP.org/nursinghomedashboard, and an AARP story about this month’s data is available here. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

“Gray voting block” watching Congress

Published in Rhode Island News Today on September 14, 2021

With recess ending, budget reconciliation begins in the House and Senate as lawmakers come back to Capitol Hill to begin crafting a budget. Last month a $ 3.5 trillion budget resolution bill was passed which gave instructions in the Fiscal Year (FY) 2022 budget resolution to allow up to $1.75 trillion of the package to come from new borrowing. It also gave instructions to both the Senate Finance Committee and House Ways and Means to reduce deficits by at least $1 billion each. With lawmakers promising that the package be fully paid for, both Committees must come up with offsets for the full $1.74 trillion of borrowing in addition to any new spending and tax breaks proposed. 

The 11 Senate authorizing committees and 12 House authorizing committees are currently in the process of writing text for their respective portions of the reconciliation bill with a nonbinding completion deadline of Sept. 15. The reconciliation process allows for each chamber’s Budget Committee to combine each part into one reconciliation bill, to be given a floor vote in each chamber.   

The House also has on its legislative agenda a scheduled vote on a Senate-passed bipartisan infrastructure bill (H.R. 3684) on Sept. 27. With the 2021 fiscal year up at the end of September, Congressional leaders must vote on a short-term continuing resolution to keep the government running. 

Don’t Forget Support Service for Seniors

As Congress crafts and finalizes its budget, don’t forget to provide adequate support and services to America’s seniors, warns the LeadingAge, representing 5,000 nonprofit providers across the nation. The Washington, DC-based aging advocacy group announced the results of poll in June that shows an overwhelming majority of Democratic and Republican voters call on Congress to support programs and services to seniors – and they believe that this should happen now.

The findings from an online survey finding, gleaned from the responses of 800 U.S. adults ages 18 and over from June 15 to June 20, 2021, also revealed that Americans are very concerned about how seniors are treated and believe that elected officials have failed them.

“American families are in crisis. Millions of us are growing older without access to the affordable care and support we need, and demand is surging for critical services,” said Katie Smith Sloan, president and CEO of LeadingAge in a statement announcing the release of the polling results. “Americans agree that for too long our country has ignored and underfunded our aging services systems,” she says.

Sloan adds, “Americans will no longer accept that millions of older adults living at home can’t get the care and services they need, from help getting in and out of bed to bathing and eating meals,” Sloan added. 

According to Sloan, a large number of seniors can’t access the needed services to age in place in their homes. They are “stuck on affordable housing waiting lists for years, are living in places they cannot afford, are skipping meals and medicine to pay rent or are experiencing homelessness,” she says.

 “Millions of family members and friends are struggling to balance the demands of caring for loved ones—and are increasingly stressed, stretched and in unsustainable situations. It’s time for our elected officials to listen to Americans from both parties and act now to support older adults,” said Sloan.

Here’s a Sampling of Key Findings

LeadingAge’s poll findings revealed that 85 % of the respondents agree that now is the right time to think about building a better aging services system for seniors. This belief is bipartisan, with 91% of Democrats, 83% of Independents and 80% of Republicans, agreeing that now is the time to begin improving programs and services for seniors. This view is also consistent regardless of where people live, with 85% of urban Americans, 87% of suburban Americans and 82% of rural Americans agreeing.

The poll’s findings also call on Congress to make a greater investment in services for seniors, this view is overwhelmingly bipartisan. Eighty six percent say the government must make a bigger investment in services and care for seniors. This includes 92% of Democrats, 80% of Republicans and 84% Independents.

The poll’s respondent’s overwhelmingly support proposed investments for older adults that are currently being considered by Congress. Eighty-nine percent support public investment in affordable home care services to help older adults with essential needs like bathing and dressing, medication management, transportation, and basic daily chores. Eighty-six percent support public investment in housing and support for low-income older adults to address the shortage and waiting lists that lead to homelessness, instability and skipping meals and medicine to pay rent. Finally, 83% support public investment in broadband internet to ensure equitable access for older adults who need this basic utility for telehealth and other care services, and to fight social isolation.

According to the poll’s findings, Government plays a critical role to ensuring that appropriate care and services are available to seniors. Eighty five percent of respondents agree that every person has a right to receive a basic level of housing,  and essential support regardless of age. Regardless of political party affiliation support is robust: 92% of Democrats, 85% of Independents, and 75% of Republicans agree.

More than half of all respondents say that seniors are not treated well in the United States. Eighty-three percent says that elected officials have failed older adults and the people who care for them by ignoring and underfunding America’s aging services for decades. This belief is consisted across communities, with 85% of Americans in rural settings, 83% in urban settings and 83% in suburban areas agreeing.

It’s just 421 days before the midterm elections. LeadingAge’s poll findings should be a stark warning to lawmakers who underfund and ignore the needs of their older constituents. If things stay the same, the gray voting block may well just send a message of their discontent at the polls.

For poll survey details, go to https://bit.ly/393hBRs