Democratic House Passes Landmark Legislation to Drive Down Spiraling Prescription Drug Costs

Published in the Woonsocket Call on December 16, 2019

Just days ago, the Democratic House leadership successfully pushed for passage of landmark legislation, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), that would give Medicare the power to negotiate directly with drug companies to bring down pharmaceutical prices and make those savings available to seniors.

House Democrats passed Speaker Nancy Pelosi’s sweeping legislation on Dec. 12 to lower the cost of prescription drugs on a largely party-line vote. The bill, which passed 230 to 192 with unanimous Democratic support and the backing of two Republicans, Reps Brian Fitzpatrick (R-Penn) and Jamie Herrera Beutler (R-Wash), is considered “dead on arrival” in the Senate. The White House has indicated President Trump would veto H.R. 3 it if it came to his desk.

The House Republicans fought to block passage of H.R. 3 by releasing their own legislative proposal, H.R. 19, to lower drug costs. The bill, consisting of bipartisan legislative provisions to lower drug costs that had already been adopted, would have achieved lower drug prices without imposing government price controls that House Republicans believed would decrease research and development spending for new drug cures.

Although House Republican Whip Steve Scalise called on the Democratic leadership to bring H.R. 19, with 135 sponsors and no Democrats, to the House Floor, the GOP proposal did not receive a vote on its own. It was offered by Rep. Greg Walden (R-Ore.) as an amendment to H.R. 3 and failed by a vote of 201 to 223, getting eight Democrat votes.

The Nuts and Bolts

H.R. 3 would put the brakes of spiraling drug cost by giving power to the Secretary of the Department of Health and Human Services to negotiate directly with drug companies to force real price reductions while also ensuring that seniors never lose access to the medicines they need. The legislation also expands access to the lower, negotiated drug prices to persons with private insurance, not just Medicare beneficiaries.

The 320-page House bill also prevents pharmaceutical companies from price gouging patients by capping the maximum price for a negotiated drug at the average price people in countries similar to the U.S. pay. It would create a brand new, $2,000 out-of-pocket limit on prescription drug costs for Medicare beneficiaries and even delivers vision, dental, and hearing benefits to Medicare beneficiaries for the first time.

H.R. 3 also increases the number of low-income seniors eligible for assistance with their drug costs and cost sharing for hospital and doctor visits. By extending guaranteed issue protections to disabled beneficiaries and to individuals who want to switch from Medicare Advantage to traditional Medicare, the legislation improves access to private supplemental coverage that helps fill in Medicare’s gaps for beneficiaries in traditional Medicare.

“The U.S. House of Representatives resoundingly defied Big Pharma today by-passing historic legislation to lower prescription drug prices for America’s seniors and their families. The Lower Drug Costs Now Act (H.R. 3) accomplishes what we and other advocates have long demanded — that Medicare be empowered to negotiate prices with pharmaceutical companies, which the CBO says will save more than $450 billion in drug costs. It also caps Medicare beneficiaries’ out-of-pocket prescription drug costs at $2,000 per year, says Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, in a statement.

The Pros and Cons of H.R. 3

Richtman says that it is time for the Senate Chamber to act. Drug pricing legislation that passed by the Senate Finance Committee has not been brought up for a vote on the Senate floor. “We insist that the Senate follow the House’s lead and act now to lift the burden of crushing prescription drug prices. Seniors who have been rationing pills or foregoing other necessities in order to afford crucial medications have waited long enough,” he says.

In a statement released following House passage of H.R. 3, AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond, called the legislation” a bold step toward lowering prescription drug prices and high out-of-pocket costs for millions of older Americans.”
“High drug prices disproportionately hurt older Americans, particularly Medicare Part D enrollees, who take between four and five prescription medications each month and have an average annual income of just over $26,000 a year. The average annual price of a specialty drug used on a chronic basis is now $79,000. Medications cannot work if they are unaffordable, says LeaMond.

Adds AARP Rhode Island State Director Kathleen Connell, “Drug companies are price-gouging older Americans and taxpayers– who pay the highest drug costs in the world,” noting that “AARP is proud to support H.R. 3, which would allow Medicare to negotiate drug prices and cap out-of-pocket costs for Part D enrollees. The bill also enhances Medicare by improving access and adding needed dental, hearing, and vision coverage.”

Opposing the passage of H.R. 3, the White House says in a statement, “Heavy-handed government intervention may reduce drug prices in the short term, but these savings are not worth the long-term cost of American patients losing access to new lifesaving treatments.” Noting that lowering the price of prescription drugs is major concern for seniors, the White Houses warned that H.R. 3 is the wrong approach to address this issue, “especially when bipartisan legislative alternatives that encourage innovation while lowering prescription drug

During a briefing with reporters over two months ago, President and CEO Stephen Ubl, of the Pharmaceutical Research and Manufacturers of America (PhRMA), warned the passage of H.R.3 would trigger “nuclear winter” for biotech innovation. Fiercely opposing passage, PhRMA has called on the Senate to “stop H.R. 3 in its tracks.”

Putting the Brakes on Rising Drug Costs in Rhode Island

“We all know someone who has been forced to ration the medication they need to live so that they can afford to keep a roof over their family’s heads or put food on the table. In America, in 2019, this should never be the case,” said Congressman David N. Cicilline (D-RI), who voted to pass the measure. “Pharmaceutical companies have abused American patients and taxpayers to increase their profits hand over fist without recourse for too long. The Lower Drug Costs Now Act will put an end to the price gouging by big pharma that sees American patients and taxpayers paying more for their prescription drugs than people in other countries, says the Rhode Island Congressman representing the state’s first congressional district.

In his 2016 campaign, President Donald J. Trump supported the government to negotiate drug prices. Cicilline calls on the president to honor this promise and urges Republican Senate Majority Leader Mitch McConnell to bring a companion measure to the Senate floor for consideration. At press time more than 300 House passed bills are stuck in the Senate (about 275 are bipartisan).

According to Cicilline, the out-of-pocket savings to Rhode Islanders will be substantial. “This year alone, more than 1,000 women in the state will be diagnosed with breast cancer, 550 people will be told they have prostate cancer, and 190 folks will be diagnosed with leukemia. H.R. 3 will lower the average costs of many popular medications for these and other cancer treatments. The cost of Ibrance for treating breast cancer will be reduced by as much as 65 percent. Zytiga, a common prescription for people with prostate cancer, will be reduced by as much as 66 percent. And the cost of Tasigna, which is commonly prescribed to people with leukemia, will go down by as much as 71 percent,” says Cicilline, who serves as the Democratic Policy and Communication Committee Chair.

Earlier this year, the Rhode Island Congressman released information detailing how much more Rhode Islanders with diabetes pay for their insulin than people in other countries. Currently, 8.6 percent of Rhode Islanders, just over 83,000 people, have diabetes. They pay from $1,200 to $20,000 per year for the most commonly used insulin medications. Under the newly passed H.R. 3, the average total cost of NovoLOG Flexpen, a common insulin medicine, would decrease by as much as 76 percent. Under H.R. 3, Rhode Islanders could spend 3.5 times less on insulin, and some of the commonly used insulins could cost as little as $400 per year.

According to Cicilline, seniors in his Congressional District will see Medicare improvements if H.R. 3 becomes law. At this time, Medicare does not provide coverage for: oral exams for 71 percent of beneficiaries, eye exams for 66 percent of beneficiaries, hearing exams for 66 percent of beneficiaries, dental exams for 75 percent of beneficiaries, eye glasses for 75 percent of beneficiaries, and hearing aids for 86 percent beneficiaries.

Under H.R. 3’s Medicare expansion, 93 percent of beneficiaries (98,800 people) stand to gain from adding a dental benefit, 75 percent of beneficiaries stand to gain from adding a vision benefit, and 97 percent (102,700 people) of beneficiaries stand to gain from adding a hearing benefit.

On December 6, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) released an updated version of their bipartisan Prescription Drug Pricing Reduction Act of 201. Will McConnell, who controls its legislative fate, allow it to be considered on the Senate floor? Can a conference committee iron out the different between a Senate bill and H.R. 3, that can be pass both chambers and be signed by the president?

The legislative clock is ticking. It’s 324 days until the upcoming 2020 presidential election and the voters are demanding Congress to put aside philosophical policy differences and come up with a compromise that will truly put the brakes on rising drug costs. We’ll see.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Caregivers Find it Difficult to Shop at Retail Stores

Published in the Woonsocket Call on September 22, 2019

Survey findings from a recently released national study, by the Washington, DC-based AARP and NORC at the University of Chicago, will send a strong message to America’s businesses.

With the graying of America, retail stores must change the way they do business in order to attract customers who provide unpaid family caregiving to their loved ones.

The study, “Family Caregiver Retail Preferences and Challenges,” and its survey findings were presented at the AARP Executive Summit, The Price of Caring, on September 10 in Washington, D.C. The summit’s mission was to highlight public- and private-sector solutions to support Americans who care for an older or ill loved one.

In-store Shopping is a Struggle

While juggling a multitude of caregiving tasks, caregivers say a lack of accommodations for their frail family members is a problem for shopping at retail stores. The study’s findings reveal that in-store shopping is a struggle for one-third of the nation’s 40 million unpaid family caregivers. Many leave their loved ones at home or choose to shop online, despite strongly preferring the in-store experience.

A whopping 93 percent of caregivers surveyed say they shop for the person they care for. Among these caregivers, most report shopping monthly for groceries (87 percent), basic household items (65 percent), toiletries (61 percent), prescription drugs (58 percent) and other health products (52 percent for persons they regularly care for.

“Americans who take care of loved ones are often strapped for time, and many face logistical challenges doing something as simple as going to the grocery store,” said Nancy LeaMond, AARP executive vice president and chief advocacy & engagement officer, in a September 10th statement announcing the study’s findings. “Retailers can score big with caregivers if they make it easier for them to bring their loved ones along when they shop,” says LeaMond.

The AARP survey findings detail simple but important changes retailers should consider to enhance the shopping experience of caregivers. Businesses can provide dedicated parking spots and ample comfortable reserved seating for older shoppers to rest, wider aisles that easily accommodate both wheelchairs and shopping carts, longer store hours, and train their staff to specifically work with caregivers.

The Pros and Cons of In-Store and On-Line Shopping

The survey findings in the 26-page study reveal that 82 percent of the caregiver respondents prefer to shop in-store because of the ability to touch the products and they don’t have to wait for a product’s delivery or pay for shipping charges. But 84 percent say they shop online for ease and convenience, despite preferring an in-store experience. Forty three percent of the respondents say a major reason they leave their loved one at home when shopping is because the store environment is too difficult for the recipients of their care.

More than 56 percent of the caregiver respondents say that when shopping on behalf of their loved ones they spend at least $50 per month. Forty one percent note they spend more than $250 or more a month when shopping for a loved one.

Businesses Must Listen to the Shopping Needs of Caregivers

We listen to a lot of caregivers and it seems clear that, regardless of the challenge, the help they want most is for somehow to find a convenient, time-efficient and accommodating means of getting what they need, when they need it,” said Rhode Island AARP State Director Kathleen Connell. “In retailing, convenience is a huge competitive advantage these days. But there are aspects of convenience that – for caregivers – go beyond finding what you need on Amazon and having it delivered the next day or two,” says Connell.

“Some caregiver needs are in the ASAP category and they head for brick and mortar retail establishments. Shopping for food and clothes, picking up a prescription or medical supplies, even simple things such as picking up dry cleaning feel like ‘emergencies’ because time is so. Imagine this in the context of being with someone in a walker or wheelchair,” notes Connell.

Connell urges retailers to take this report to heart. “There is an incredible amount of goodwill to be earned if you think about caregivers, as well as those in their care, and give them the consideration that makes their tasks a little easier.”

The AARP survey was conducted by NORC at the University of Chicago and is based on a nationally representative survey of 1,127 Americans who provide unpaid care for an adult age 18 or older. The survey was funded by AARP and used AmeriSpeak®, the probability-based panel of NORC at the University of Chicago. Interviews were conducted between Aug. 1-19, 2019, online and using landlines and cell phones. The overall margin of sampling error is +/- 4.1 percentage points at the 95% confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

To read the full report, visit: http://www.aarp.org/caregivershopping.

For more details about AARP’s Caregiver Shopping study, contact Laura Skufca, AARP Research, Lskufca@aarp.org.

Fogarty Retiring as Elderly Affairs Director

Published in Woonsocket Call on January 28, 2018

Just days ago, Director of Rhode Island’s Division of Elderly Affairs (RIDEA), Charles J. Fogarty, announced his retirement to take place at the end of June, after 4 decades of public service. There have been nine directors since the establishment of DEA, including Fogarty.

Fogarty’s plans to retire at the end of the current legislative session. When this occurs, Governor Gina Raimondo will make an appointment to the RIDEA director position. The position requires advice and consent of the RI Senate.

Fogarty began his career in public service in 1978 as a junior policy advisor for Governor J. Joseph Garrahy. He served as lieutenant governor, from 1999 to 2007, having the distinction of being the last lieutenant governor to preside over the State Senate. From 2011 to 2015, Fogarty served as the director of the Department of Labor and Training, ending up his career as the Director of RIDEA.

During his years of public service, Fogarty, 62, has been focused on long term care and home- and community-based services and supports for older Rhode Islanders. He played a key role in steering and expanding the work of the Long-Term Care Coordinating Council during his tenure as Lieutenant Governor for two terms. Under his leadership at the Department of Labor and Training, he reformed the unemployment insurance process. During his stewardship as Director at Elderly Affairs (since January 2015), he has led a division providing services and advocacy for over 166,500 older adults living in Rhode Island.

As a Glocester resident he was elected to the Glocester Town Council in 1984 and in 1990 was elected as a state senator, where he served for eight years. While a state senator, he served as both majority whip and Senate President Pro Tempore.

Fogarty Reflects on RIDEA Tenure

“Throughout my career, I have felt drawn to serve the people of Rhode Island. I look back fondly and feel fortunate to be a part of the forward progress Rhode Island is experiencing–particularly working with Governor Raimondo to empower seniors and help them to remain independent and living in the community,” said Fogarty.

According to Fogarty, under his helm, RIDEA has continued to process of supporting community-and home-based services for seniors and caregivers, but more needs to be done in order to really rebalance Rhode Island’ long-term care system. Aging in the community- in our own homes- is what many Rhode Islanders want for ourselves and our loved ones, he says.

“We’ve restored funding for Meals on Wheels, provided additional funding for respite services, and this year are proposing to double the amount the state invests in senior centers. Senior centers are primary gateways in the community that connect older adults and caregivers to services that can have profound impacts upon their ability to remain healthy and independent,” notes Fogarty.

Fogarty says, “If the general assembly follows Governor Raimondo’s lead and doubles the funding for senior centers, Rhode Island will be taking a huge step in the right direction of providing the appropriate support to these essential senior services.”

“We need to prepare for the shift in demographics that is occurring, and accept that the old model of providing long term care services isn’t working for the large number of Boomers who are marching towards retirement and old-age. RIDEA and other key partners are engaging in the Age-Friendly Rhode Island initiative, and we all need to work together to provide more choices and options for Rhode Islanders as they age, empowering them, and helping them to remain independent and healthy,” adds Fogarty.

Tributes to Fogarty

“Charlie has dedicated his entire professional life to Rhode Island and we thank him for his decades of service to our state,” said Governor Gina M. Raimondo, in a statement, recognizing the key role he played as DEA Director in expanding Meals on Wheels and in repealing the tax that seniors pay on their Social Security.

“As sitting Lt. Governor, I appreciate Charlie being a resource to me on issues important to our state’s seniors. Under his leadership, the Division of Elderly Affairs has been a hands-on partner in executing the initiatives of the Long Term Care Coordinating Council and the Alzheimer’s Executive Board,, says Lt. Governor Dan McKee.

“We are especially grateful for Charlie’s support in launching our Age Friendly RI Report in 2016. In a few weeks, we will be announcing an exciting development in Rhode Island’s Alzheimer’s State Plan that would not be possible without Charlie’s participation. I have enjoyed working with Charlie and I wish him all the best as he begins this exciting new chapter,” adds McKee.

Maureen Maigret, Vice Chair Long Term Care Coordinating Council, sees Fogarty’s experience as oversight as Lt. Governor of the state’s Long-Term Coordinating Council, gave him the insight ad understanding of long term care issues and the needs of older Rhode Islanders.

Maigret says that professionals in the aging network will remember Fogarty for his strong support for and educating the community about need to expand services that help older persons to stay at home and live independently for as long as possible and to pay attention to caregiver support needs.

Adds AARP Rhode Island State Director Kathleen Connell, “I have known Charlie for many years and know him to be a worthy heir of his uncle, the late-great RI Congressman, who was a leading champion of legislation and policy benefiting older Americans.”

“At Elderly Affairs, he utilized many skills and resourcefulness acquired through his time as a legislator, Lt. Governor and Labor & Training director — not to mention his personal interest in the health and wellbeing of all Rhode Islanders. His leadership has been an enormous asset at the Division of Elderly Affairs,” says Connell.

After his retirement from four decades of state service, he will continue to serve on the faculty at Johnson & Wales University, as Adjunct Professor of Leadership Studies. He also plans to volunteer with Meals on Wheels, having seen the significant impact the home-delivery meal program has on combatting senior isolation. He will also continue to be involved at his church.

On a personal level, Fogarty plans to “learn to cook,” by enrolling in cooking classes, travel and perhaps learn to speak Spanish.