Tag Archives for Donut Hole

Democrats Put High Drug Costs on Radar Screen

Published in Woonsocket Call on September 30, 2018

On August 21, at an afternoon Democratic Senate hearing titled “America Speaks Out: The Urgent Need to Tackle Health Care Costs and Prescription Drug Prices,” Senators Debbie Stabenow (D-MI), Ron Wyden (D-WA), Chris Van Hollen (D-MD), Tina Smith (D-MN), Richard Durbin (D-IL), and Joe Manchin (D-WV), gathered to hear the personal stories of witnesses who have struggled with paying for the high cost of prescription drugs and listen to an expert who tracks price trends for prescription drugs widely used by older Americans.

In the last 18 years prescription drug prices have risen 3 times faster than physician and clinical services,” says DPCC’s chairwoman Stabenow in her opening statement. “We pay the highest prices in the world. The outrages prices force people to skip doses, split pills in half and even go without the medication they need,” she says, calling this problem a “matter of life and death,” says Stabenow.

Democrats believe health care to be a basic human right, while the GOP considers it to be a commodity to go to the highest bidder, adds Stabenow, denoting the philosophical differences of the two political parties.

Wyden, Ranking Member on the Senate Finance Committee who sits on the DPCC, recalled that two years ago when then presidential candidate Donald Trump was on the campaign trail pledged to make sure Medicare would negotiate like crazy to hold down costs for seniors and taxpayers. While Trump is well into one year and a half into his term, Americans year ad half into his term Americans believe it is crazy that we are still not negotiating to hold down the cost of medicine.

Wyden and his fellow DPCC committee members also call for Medicare to allow Medicare to negotiate prescription drug prices with pharmaceutical companies.

Senate DPCCs Puts Spotlight on Rising Drug Costs

At the Senate’s DPCC’s hearing, Witness Nicole Smith-Holt, a Minnesota state employee, and mother of four children shared a tragic story about her 26-year old diabetic son, Alec, who had died because he could not afford his copay of $1,300 for diabetic supplies and insulin.

The Richfield, Minnesota resident recounted how her son tried to ration the insulin to make it last until his next paycheck, but he died as a result of diabetic ketoacidosis.

Stahis Panagides, an 80-year old Bethesda, Maryland retiree, testified that he could not afford to pay $ 400 per month for prescribed Parkinson’s medication. He could not pay for the new course of treatment, recommended by his neurologist, even with a supplemental Medicare plan, he says, so he just refused to take it.

Retired social worker John Glaser, a long-time grassroots organizer for the Washington, DC-based National Committee to Preserve Social Security and Medicare, came before the Democratic committee, saying “Medicare drug benefits and the Affordable Care Act’s closing of the coverage ‘donut hole’ have made a huge difference in my life and are invaluable for the quality of my life. Without these improvements he would have spent about $5,000 one-of-pocket on prescription drugs last year, he notes.

Glaser also shared that his brother, who is afflicted with diabetes, heart problems, and kidney disease, takes over 50 pills every day. “If my brother had to pay the full price for all of those drugs, he’d be living on the street,” he says.

Marques Jones, who has Multiple Sclerosis (MS), told the Senators that his MS medication costs about $75,000 annually. Despite having robust insurance coverage, Jones’ annual out-of-pocket spending on drug co-pays and insurance premiums for his family of five is very high. This has caused the resident of Richmond, Virginia to become a vocal advocate for those who suffer from MS.

Finally, Leigh Purvis, Director, Health Services Research, AARP Public Policy Institute, a coauthor of the AARP Public Policy Institute’s annual RX Price Watch Reports, warned that today’s prescription drug price trends are not sustainable. “The current system is simply shifting costs onto patients and taxpayers while drug companies remain free to set incredibly high prices and increase them any time that they want,” says Purvis, noting that Congressional efforts to reduce prescription drug prices could save billions of dollars.

AARP Report Tracks Skyrocketing Drug Costs

One month after Senate’s DPCC’s hearing, a new AARP report, released on September 27, 2018, says that retail prices for many of the most commonly-used brand name drugs prescribed to older adults by older adults increased by an average of 8.4 percent in 2017, greater than the general inflation rate of 2.1 percent. The annual average cost of therapy for just one brand name drug increased to almost $6,800 in 2017, says the AARP researchers.

According to the new “Rx Price Watch Report: Trends in Retail Prices of Prescription Drugs Widely Used by Older Americans: 2017 Year-End Update,” released just days ago, revealed that for over a decade, brand name drug prices have “exceeded the general inflation rate of other consumer goods by a factor of two-fold to more than 100-fold.”

If retail drug price charges had reflected the general inflation rate between 2006 and 2017, the average annual cost for one brand name drug in 2017 would have been $2,178 instead of $6,798, said the AARP Public Policy report.

Taking multiple medications can be costly, says the AARP report. “For the average senior taking 4.5 medications each month, this would translate into an annual cost of therapy that is almost $21,000 less than the actual average cost of therapy in 2017 ($9,801 vs. $30,591), notes the findings of the AARP report.

“Despite years of relentless public criticism, brand name drug companies continue increasing the prices of their products at rates that far exceed general inflation,” said AARP Chief Public Policy Officer Debra Whitman, in a September 26 statement with the release of the AARP report. “It’s clear that we need long-term, meaningful policies that go beyond just hoping that the drug industry will voluntarily change its excessive pricing behavior,” adds Whitman.

“The average older American taking 4.5 prescription medications each month would have faced more than $30,000 in brand name costs last year,” adds Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the AARP report. “That amount surpasses the median annual income of $26,200 for someone on Medicare by more than 20 percent. No American should have to choose between paying for their drugs and paying for food or rent,” says Purvis.

Some highlights of AARP’s New Drug Cost Report

AARP report’s findings noted that brand name drug prices increased four times faster than the 2017 general inflation rate and that drug retail prices that year increased for 87 percent of the 267 brand name drugs studied.

Finally, research findings indicated that “retail prices for 113 chronic-use brand name drugs on the market since at least 2006 increased cumulatively over 12 years by an average of 214 percent compared with the cumulative general inflation rate of 25 percent between 2006 to 2017.”

In recent correspondence to the Secretary of the Health and Human Services, AARP calls for regulatory and legislative reforms that will allow the Secretary to be able to negotiate drug prices for Medicare, allowing the safe importation of lower cost drugs into the United States and ensuring that generic drugs can more easily enter the market. Now, AARP waits for a response.

Putting the breaks on the skyrocketing pharmaceutical costs might just be the bipartisan issue that the new Congress can tackle once the dust settles from the upcoming mid-term elections.

To watch DPCC’s August 21st Senate hearing, go to https://www.democrats.senate.gov/dpcc/hearings/senate-democrats-to-hold-hearing-with-americans-hurt-by-high-cost-of-prescription-drugs.

For a copy of AARP’s drug cost report, to http://www.aarp.org/rxpricewatch.

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Trump’s Budget Proposal Comes ‘Dead on Arrival’ to Aging Groups

Published in Woonsocket Call on February 18, 2018

Last Monday, President Donald Trump released his 2019 budget proposal, “An American Budget,” providing guidance to Congress on how to spend hundreds of billions of dollars in new federal spending plan authorized by the Bipartisan Budget Act recently passed into law. Trump’s federal spending wish list clearly shows that many programs and services for older Americans will take a huge hit if any of these proposals are picked up by the Republican-controlled Congress.

The Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) expresses concern that Trump’s budget proposal contains many of the same harmful proposals that the Administration and Republican-controlled Congress has pushed before, including $1.4 trillion in Medicaid cuts, $490 billion in Medicare cuts, and repeal of the Affordable Care Act.

Social Security on the Chopping Block

According to the NCPSSM’s analysis released this month, the President’s budget blue print calls for deep cuts to Social Security Disability Insurance, breaking his campaign promise not to touch Social Security.

Trump proposes to slash up to $64 billion from Social Security Disability Insurance (SSDI) benefits through eight demonstrations “ostensibly” geared toward helping disability beneficiaries to stay at work or return to work, says NCPSSM, noting that these Social Security Administration’s (SSA) demonstration projects, established in 1980, had only “a modest effect on beneficiaries’ workforce participation.”

NCPSSM’s analysis warns that the President’s proposed budget also calls for other benefit cuts for disabled seniors, including limiting the retroactivity of applications for disability benefits from 12 months to six months. It would also deny unemployment compensation payments to SSDI beneficiaries who work but get laid off. Social Security Income recipients that live together, even with families, would see their benefits reduced, too.

The Trump Administration also proposes $12.393 billion for SSA’s FY 2019 appropriation for administrative funding, says NCPSSM, warning that this $89 million funding cut will result in longer waits for decisions on initial disability claims and time to speak to a representative from SSA’s 800 number. “With 10,000 baby boomers reaching age 65 every day, SSA needs substantial yearly increases just to keep pace with increased workloads, says NCPSSM.

President Trump’s budget plan only funds production and mailing of only 15 million Social Security statements. “This proposal is part of SSA’s overall plan to limit sending statements only to individuals who are 60 or older rather than sending them to all workers every five years,” says the aging advocacy group, urging the Administration “to send these important financial planning documents to all workers, as is required in section 1143 of the Social Security Act.”

Medicare Takes a Blow

President Trump’s draconian budget calls for over $500 billion in cuts to Medicare, many of these savings coming from cuts to Medicare providers and suppliers. This is another campaign promise broken.

NCCPSSM warns that President Trump’s 2019 budget proposal also includes policy changes to the prescription drug benefit that would impact Medicare’s spending and beneficiary costs. It would create an out-of-pocket maximum for Part D. Medicare t beneficiaries with very high drug costs would no longer have cost sharing responsibility once they hit the catastrophic threshold. This would add $7.4 billion in costs over 10 years.

Trump’s budget proposal would also change the way the threshold for moving out of the coverage gap or “donut hole”” is calculated that would make it more costly to seniors to move through it. “Taken together with an out-of-pocket cap, it will mean savings for some seniors with very high drug costs, but costs will climb for a larger number of seniors. This saves $47.0 billion over 10 years,” reports NCPSSM.

Finally, Trump’s 2019 budget proposal saves $210 million over 10 years by eliminating the cost-sharing on generic drugs for low-income beneficiaries.

Hurting Medicaid Recipients

In FY 2015, federal and state governments spent about $158 billion or 30 percent of Medicaid spending on long-term services and supports (LTSS). The federal and state partnership pays for about half of all LTSS for older adults and people with disabilities.

The President’s 2019 budget proposal slashes the program’s funding by changing the structure of the program into either a per capita cap or Medicaid block grant, with a goal of giving states more flexibility of managing their programs. Through 2028, the president’s budget would cut $1.4 trillion from the Medicaid program through repealing the Affordable Care Act, restructuring the program.

NCPSSM expresses concern that if states lose money under per capita caps or block grants, state law makers would have to make up the funding themselves if federal funds do not keep up with their Medicaid population’s needs. This can happen by either by cutting benefits and/or limiting eligibility, requiring family members to pick up more nursing home costs, or scaling back nursing home regulations that ensure quality, service and safety protections.

And That’s Not All

NCPSSM’s analysis says that Trump’s budget proposal also calls for the elimination of the Older Americans Act Title V Senior Community Service Employment Program (SCSEP). The program, funded $ 400 million in FY 2017. provides job training to nearly 70,000 low-income older adults each year.

Community Services Block Grants ($715 million), the Community Development Block Grant ($3 billion) and the Social Services Block Grant ($1.7 billion) programs are also targeted to be eliminated. Some Meals on Wheels programs rely on funding from these federal programs, in addition to OAA funding, to deliver nutritious meals to at-risk seniors.

Trump’s 2019 Budget proposal would also eliminate funding for the Low-Income Home Energy Assistance Program (LIHEAP) This program received $3.39 billion in FY 2017. “Of the 6.8 million households that receive assistance with heating and cooling costs through LIHEAP each year, 2.26 million or one-third are age 60 or older,” says NCPSSM.

Trump’s budget plan also eliminates funding for Senior Corps programs including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. Current Senior Corps funding at the FY 2017 level is $202.1 million. “These programs enable seniors to remain active and engaged in their communities, serving neighbors across the lifespan, and benefitting their own health in the process. In 2016, 245,000 Senior Corps volunteers provided 74.6 million hours of service,” says NCPSSM. .

Finally, research into cancer, Alzheimer’s Parkinson’s and other diseases affecting older persons will be negatively impacted with $ 46 million in funding cuts to National Institute on Aging at the National Institutes of Health.

Aging advocacy groups view Trump’s second budget “flawed,” jam-packed with “damaging policies” for Congress to enact with an aging population. It’s “Dead on Arrival.” If Trump and GOP lawmakers choose not to listen to their older constituents, the results of the upcoming mid-term elections might just get their attention.

Older Americans to Benefit from Bipartisan Budget Act

Published in the Woonsocket Call on February 11, 2018

While many were sleeping, funding to operate the federal government expired midnight Thursday, though it was restored about eight and a half hours later with action from Congress to end the brief government shutdown, when President Donald Trump signing the 652-page Bipartisan Budget Act of 2018 early Friday morning.

The $400 billion budget agreement funds the federal government through March 23 to give lawmakers time to pull together the details needed to craft full appropriations bills that become the official federal budget.

Lawmakers had expected the massive budget bill to pass before the midnight deadline to avoid a government shutdown but Sen. Rand Paul (R-Ky.), delayed the Senate vote past midnight to protest the additional billions of dollars being added to the federal budget deficit by the legislation.

Ultimately the House approved the bill by 240 votes to 186, almost four hours after the Senate had passed the budget bill by 71 to 28 three hours earlier. The GOP-controlled House needed the help of 73 Democratic lawmakers to pass the budget bill because 67 House Republicans voted against the legislation.

The Nuts and Bolts

The two-year budget deal eliminates strict budget caps that were set in 2011 to reduce the federal deficit and allows Congress to increase military and domestic spending by $300 billion, along with adding another $90 billion for emergency disaster aid for Texas, Florida and Puerto Rico and throws in billions more for infrastructure, the opioid epidemic and health programs. It also suspends the debt limit for one year – until after the upcoming midterm elections.

Specifically, the newly enacted Bipartisan Budget Act of 2018, would allocate $165 billion to the Pentagon and defense spending while $131 billion would be directed to domestic programs. In addition, $20 billion would be spent on infrastructure programs such as surface transportation, rural water and wastewater systems, $ 7 billion in community health centers to provide care to low-income people, $6 billion to fight the opioid crisis, and $4 billion directed to veteran’s health care.

The budget agreement also repeals the controversial Obamacare’s Independent Payment Advisory Board (IPAB), which was designed to limit Medicare costs. It also gives a ten-year extension to the Children’s Health Insurance Program (CHIP), which is four years longer than the previous spending bill passed last month. Finally, the legislation did not address the dilemma of 700,000 “Dreamer immigrants who are in the United States illegally after being brought here as children and who” are enrolled in the Deferred Action for Childhood Arrivals program, set to expire on March 5, nor did it provide funding for President Trump’s proposed southern border wall.

“A Pretty Good Deal for Seniors”

Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare, sees the Bipartisan Budget Bill of 2018 “a pretty good deal for seniors.”

“Seniors will feel these changes in their pocketbooks and even in the way they feel physically,” says Richtman, in a released statement. “We have been fighting for these measures for quite some time and are happy to see Congress take action on a bipartisan basis.”

According to Richtman, the Bipartisan Budget Act of 2018 closes Medicare Part D “donut hole” in 2019. The prescription drug coverage gap embedded in the original law, which the Affordable Care Act has been gradually closing, will be altogether eliminated one year early. This will save seniors thousands of dollars in out-of-pocket prescription drug costs., he says.

Richtman says that the enacted Budget agreement also repeals Medicare therapy caps. The bill scraps arbitrary caps on physical, speech, language and occupational therapies that have cost senior’s money – or delayed care at crucial times. Beneficiaries will now find it easier – and more affordable – to get the therapies they need without undue interruption, he notes.

The Bipartisan Budget Act of 2018 also lifts non-defense domestic spending caps, allowing Congress to appropriate more adequate funding for the Social Security Administration’s (SSA) operating budget, says Richtman, noting that the federal agency has suffered from draconian budget cuts since 2011 which have impinged on customer service, even as 10,000 Baby Boomers retire every day. He notes that “this badly-needed (but yet unspecified) higher level of funding should allow SSA to improve customer service for the program’s 67 million beneficiaries.”
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But, on the negative side, says Richtman, the new law increases Medicare premiums for some individuals by further expanding Medicare means-testing. “Congress continues to expand Medicare means-testing, and they will not stop until middle-class seniors are burdened with higher Medicare premiums,” he warns.

“We are particularly pleased that this legislation permanently repeals Medicare’s therapy caps, something that AARP has long supported. Millions of vulnerable patients who need occupational, physical, and speech-language therapy will now be protected from an arbitrary limit on how much Medicare will pay for needed therapy,” said Nancy LeaMond, AARP’s Executive Vice President and Chief Advocacy & Engagement Officer, in a released statement..

“AARP is also pleased that Congress expedited the closing of the Medicare prescription drug coverage gap known as the ‘donut hole,’ which will now close in 2019, one year earlier than currently scheduled. Medicare beneficiaries will soon get permanent relief from higher out-of-pocket costs for prescription drugs. We also applaud the provision that adds biosimilar drugs to the Medicare Part D Coverage Gap Discount Program. This change will lower out-of-pocket costs and encourage the development and use of these drugs,” adds LeaMond.