Tag Archives: Medicare

Successful Outcome on Medicare Part D Reminds Us Why Advocacy is Important

By Chuck Ingoglia, Senior Vice President of the National Council for Behavioral Health

Chuck Ingoglia, Senior Vice President, Public Policy and Practice Improvement, National Council  for Behavioral Health

Chuck Ingoglia, Senior Vice President, Public Policy and Practice Improvement, National Council for Behavioral Health

In January, the Centers for Medicare & Medicaid Services (CMS) surprised the patient and provider community when it issued a proposed rule seeking to make unprecedented changes to the successful and popular Medicare Part D drug program.   One of the most concerning of these proposed changes was the introduction of new criteria to evaluate the “drug classes of clinical concern,” most commonly referred to as the six protected classes.  These six “protected” classes of medications were identified by CMS during the implementation of the Medicare prescription drug benefit as needing special access for patients and providers, including drugs to treat mental illness, organ transplant, cancer, HIV and seizure disorders.

The proposal not only introduced new criteria, but it applied these criteria to the  protected classes and proposed removal of two classes in plan year 2015 – immunosuppressants and antidepressants – as well as removal in plan year 2016 for antipsychotics.  After hearing from patients, providers, legislators and the pharmaceutical industry, including the National Council for Behavioral Health and AstraZeneca, CMS announced on March 10th that it would abandon its recent proposal to strip mental health and immunosuppressant drugs of their protected status in Medicare Part D.

CMS’ decision comes on the heels of an overwhelming outpouring of bi-partisan support that was the result of unified and swift advocacy.  In addition to the National Council and AstraZeneca, members of Congress, the Partnership for Part D Access, and other concerned patient and provider groups submitted well over 1,000 comments to CMS opposing the changes.  This reversal demonstrates the power of various sectors working together – providers, patients and industry.

The National Council and AstraZeneca applaud CMS for its decision not to finalize the proposed changes to the protected class policy.  This change will allow millions of the most vulnerable beneficiaries to continue to confidently rely upon Medicare to provide them the drugs they need.

CMS noted it will gather additional input and reserves the right to advance changes in these areas in future years, and this possibility necessitates ongoing vigilance and willingness to continue to work together on matters of common interest.  The National Council and AstraZeneca are committed to such a partnership to preserve patient access and choice within the Part D program.

Chuck Ingoglia is Senior Vice President, Public Policy and Practice Improvement for the National Council  for Behavioral Health. There he directs the federal and state affairs function and oversees practice improvement and technical assistance programs offered to more than half a million behavioral health professionals.


Keeping Prescription Drugs Accessible

The Medicare Prescription Drug program, Medicare Part D, has been a successful public-private program that has literally changed lives by providing improved access to prescription drugs.  We believe it works for the seniors who rely on it and that its competitive, market-based structure has kept overall program costs low.  For these reasons, we have suggested:  Don’t mess with success.

We do not support policy proposals that suggest altering the benefit structure for those who receive Part D’s low-income subsidy (LIS).  These patients are among the most vulnerable in the program and stand to be harmed by proposals that would lower nominal co-pays on generics, while increasing brand drug co-pays.

Changing Part D prescription drug cost-sharing policies may have negative consequences for the people the program serves.  First, decreasing or eliminating some co-pays while increasing others can impact the prescribing decisions of physicians who are best suited to provide care and make clinical treatment decisions for their patents.  Second, a policy to encourage generic medication use by increasing co-pays for brand medicines assumes that patients’ financial considerations drive physicians’ prescription choices, as opposed to severity of illness or other health factors.

At AstraZeneca, we believe in the right medicine for the right patient.  Sometimes the right medicine will be a generic drug and sometimes a patient will require a branded product.  This decision is made by the  physician, and when a branded product is recommended, arbitrary cost-sharing proposals should not render the medication out of reach for the patient.  Generics are not always medically appropriate substitutes for brand medicines in a given class of drugs, and for the treatment of some diseases, a generic version of a branded drug may not even exist.

It should be noted that MedPAC, an independent Congressional agency that advises Congress on issues affecting Medicare, shows high generic use among Part D enrollees – approximately 74 percent of LIS beneficiary prescriptions in 2011.

LIS beneficiaries  – a group that MedPAC says are more likely to be disabled and tend to have a greater disease burden than non-LIS enrollees – would as a result be gravely impacted by any proposed changes to increase brand medicine co-payment amounts.  These proposals unfairly penalize patients who need brand medicines rather than generics, and patients who need multiple brand drugs, including those with chronic conditions who need medications on a regular, sometimes monthly basis.

If faced with higher out-of-pocket expenses, the most vulnerable Part D patient population may attempt to switch to less costly alternatives or worse – may delay or forego their use of prescribed medicines.  Such an outcome may actually lead to higher overall Medicare costs.  In 2012, the Congressional Budget Office (CBO) acknowledged that policies that increase the use of prescription medicines would decrease Medicare medical spending, and we believe the converse to be true as well. We want to encourage adherence, not discourage it.

In the end, it comes down to choices we like and those we don’t.  Medicare Part D beneficiaries have an increasing number of plan options in 2014 from which to choose – that’s a good thing.  Beneficiaries making choices that vary from their physicians’ recommendations, likely leading to higher overall healthcare costs – that’s a bad thing.  That’s why we return to the same refrain about Medicare Part D:  Don’t mess with success.

Take Time to Evaluate Options During Medicare Part D Enrollment

AZ Stock_10.25.13With Medicare enrollment now open, seniors across the country have an opportunity to select the Part D prescription drug plan that best suits their needs and budgets – and that may mean making a change from the previous year.

However, a recently issued Kaiser Family Foundation report indicates that on average, only 30 percent of Medicare Part D enrollees choose to switch plans during the annual enrollment period.  The same study showed that the average premium is expected to increase by five percent across all prescription drug plans from 2013 to 2014, unless enrollees select lower-priced plans.

With a number of changes to Medicare prescription drug plans in 2014, and with 13 percent more stand-alone plan options available than last year, understanding the plans and shopping around for the right one might be warranted and might mean decreased costs for some Medicare Part D enrollees.  Premiums and out-of-pocket expenses aside, exploring different plans might also lead to increased convenience and quality in coverage.

Seniors can leverage a number of tools available, such as the government’s online plan finder and other resources to fully evaluate their options and select the right plan for them this year.

Survey: Medicare Rx program highly popular


The Medicare prescription drug benefit is still popular after all these years. Nine in 10 seniors with Medicare prescription drug coverage are satisfied with the program, and 97 percent said their coverage works well, according to a survey released by Medicare Today.

Among the survey’s other findings:

  • 96 percent said they felt “peace of mind” by having prescription drug coverage under Medicare, known as Part D.
  • 95 percent said their plan is convenient to use.
  • 84 percent said both their premiums and co-pays are affordable.
  • 88 percent said their Part D plan is meeting their expectations.
  • 72 percent said they are better off now than before they had Part D coverage.
  • And 89 percent would recommend the program to someone considering Medicare enrollment.

“Ten years after becoming law, it is clear that seniors remain happy with their Part D coverage and that the program is meeting their healthcare needs,” said Mary R. Grealy, chairman of Medicare Today and president of the Healthcare Leadership Council.

Not only are seniors happy with the Medicare prescription drug benefit, it is a good deal for them – and the system as a whole.

2011 study published in the Journal of the American Medical Association found that American seniors’ increased access to medicines via the Medicare prescription drug program led to reduced spending on post-acute care such as hospitals and nursing homes.

The study found that Medicare Part D enrollees who had inadequate prescription drug coverage or no prescription drug coverage prior to enrolling in the Part D benefit each saved an average of $1,200 per year, which resulted in savings of $12 billion in federal spending for non-drug costs in the Medicare program.

Medicare Part D: Don’t Mess with Success

American Pharmacists MonthIf imitation is the greatest form of flattery, then the federal government should be flattered that states have begun using the market-based structure of the highly successful Medicare Part D program as a model for their Medicaid programs.  Peter Pitts, a former associate commissioner with the Food and Drug Administration (FDA) and the president of the Center for Medicine in the Public Interest, addresses examples of states providing Medicaid services through private insurers in an op-ed appearing in The Philadelphia Inquirer.

It is the competition from private insurers in the Medicare Part D program that has contributed to reduced costs, and just as importantly, to healthcare that works for the seniors who rely on it.

Medicare Part D provides affordable outpatient prescription drug coverage for seniors and people with disabilities and has been hugely successful by many measures.  According to the Congressional Budget Office (CBO), the Part D program has cost the government 45 percent less than initially expected when Congress approved the Medicare Modernization Act of 2003.  Ninety percent of Part D beneficiaries are satisfied with the program.  And according to a study released earlier this year, improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with congestive heart failure and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare.

In his analysis, Pitts goes on to question why some politicians are now proposing changes to Medicare Part D to “substitute government price controls for the competitive marketplace that has been so effective in keeping costs down.”  We agree.  Medicare Part D is a federal program that has produced impressive, meaningful cost savings and greater access to the medicines that patients need – medicines that in some instances have likely prevented more significant and costly health issues.  The fact that Medicare Part D may serve as a model for some states to emulate in their Medicaid programs is just one more reason not to mess with success.

Congress Should Repeal IPAB

Congress should approve HR 452.

AstraZeneca is urging Congress to support legislation sponsored by Rep. Phil Roe that would repeal the Independent Payment Advisory Board (IPAB) established by the health reform law.

IPAB would have the authority to cut Medicare spending if spending exceeds specified targets. As created, implementation of IPAB’s recommendations is exempt from both judicial and administrative review and is fast-tracked through Congress.

IPAB’s virtually unchecked authority to cut Medicare spending represents a clear threat to patient care.

Without real congressional oversight, the board has the power to reduce Medicare spending at the expense of patients’ health and future breakthroughs in treatment.


A federal entity focused solely on cost-cutting measures is more likely to view innovative new therapies as problems instead of solutions.

That, of course, is not the case, and it is a shortsighted approach to cost control. New medicines can be part of the solution to our health care problems, as research shows that medicines can hold down costs in other health care areas.

IPAB sets a bad precedent by allowing for a board’s decisions to essentially go into effect without oversight. The manner in which IPAB was designed makes it nearly impossible for Congress to override IPAB recommendations.  Even more disconcerting is the fact that the implementation of IPAB decisions cannot be challenged in court, therefore Americans will have no way to appeal the board’s decisions.

Simply put, IPAB wrongly puts control over Medicare in the hands of unelected, unaccountable federal officials.

Repealing IPAB would ensure that seniors and Congress continue to have control over Medicare. For that reason, Congress should approve HR 452.

Update: The House Ways and Means Committee just passed by voice vote legislation to repeal IPAB. Earlier this week, the House Energy and Commerce Committee passed the IPAB repeal bill by voice vote as well. Action by the full House of Representatives is expected the week of March 19.

Filling the donut hole: why it matters

A new study of the Medicare prescription drug benefit found that patients who enter the “donut hole” or coverage gap are twice as likely to discontinue their medications as they are to switch to more affordable or generic medications.

The study conducted by researchers from Harvard University, Brigham and Women’s Hospital and CVS Caremark suggests that Medicare Part D enrollees who have to bear the full cost of their medications are less likely to take their medicines as prescribed by their health care professionals.

“The resulting decrease in medication adherence could ultimately result in higher medical costs as a result of adverse health events,” said Jennifer M. Polinski, lead author of the study.

Annual excess health care costs due to medication non-adherence in the U.S. are estimated to be as much as $300 billion annually, according to CVS Caremark.

But there’s good news.

Efforts are underway to help those in Medicare Part D get the medicines they need, even as they go through the coverage gap.

As part of its support for health care reform legislation, the pharmaceutical industry agreed to cut out-of-pocket costs on brand name medicines by 50 percent for Medicare patients who reach the coverage gap.

And there’s growing evidence that seniors access to prescription medicines through Medicare Part D is improving health outcomes and lowering costs.

Earlier this year the Centers for Medicare & Medicaid Services (CMS) posted data that shows beneficiaries in the Medicare prescription drug program are accessing the medicines they need and saving money as they reach the coverage gap in the Part D benefit design.

American seniors’ increased access to medicines via the Medicare prescription drug program led to reduced spending on post-acute care such as hospitals and nursing homes.

AstraZeneca also provides support to Medicare patients who need help paying for our medicines through our prescription savings programs. Click here to learn more about this program and whether AstraZeneca may be able to help you or your family save on your prescription drug costs.

Savings for seniors in Medicare Part D

study published in today’s Journal of the American Medical Association found that American seniors’ increased access to medicines via the Medicare prescription drug program led to reduced spending on post-acute care such as hospitals and nursing homes.

Medicare Part D enrollees who had inadequate prescription drug coverage or no prescription drug coverage prior to enrolling in the Part D benefit each saved an average of $1,200 per year, which resulted in savings of $12 billion in federal spending for non-drug costs in the Medicare program,according to the Associated Press.

“Expanding the Medicare program to incorporate a drug benefit increased the use of prescription drugs, lowered out-of- pocket costs and improved adherence to prescriptions,” study lead author Dr. J. Michael McWilliams told Bloomberg.

In the study, the authors concluded, “In concert with previous studies, these findings suggest that increased medication use and adherence achieved through expanded drug coverage for seniors have been associated with decreased spending for non-drug medical care.”

The study offers further proof that the current Medicare Part D program is working and working well.

Today, more than 29 million Medicare beneficiaries are enrolled in a Part D plan, and 90 percent of all beneficiaries have comprehensive drug coverage. Polls have consistently shown that Medicare Part D enrollees are overwhelmingly satisfied with their coverage.

And, as we wrote about here, the Centers for Medicare & Medicaid have shown that seniors are saving money as they reach the coverage gap in the Medicare Part D design.

Prescription medicines play an essential role in disease management and prevention. AstraZeneca believes the Medicare Part D program is a model for how the private sector and public sector can work together to provide critical access to medicines that improve our nation’s health.

To read PhRMA’s view, click here.

-By Laura Woodin