Tag Archives for Senator Debbie Stabenow

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.

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.