Drug plan hit with backlash
http://thehill.com/policy/healthcare/275918-drug-plan-hit-with-backlash
The Obama administration’s aggressive move to rein in the cost of prescription drugs in Medicare has triggered a backlash, with some advocates warning the plan goes too far.
The administration is pursuing a pilot program that could squeeze the margins for doctors that prescribe high-cost drugs, potentially saving the government billions of dollars in the process.
It’s the first step of a model from the Centers for Medicare and Medicaid Services (CMS) that could be finalized as early as next month. The stark shift in doctor payments is slated to go into effect in some parts of the country this summer.
But the proposal is facing mounting opposition from groups that represent people with some of the costliest conditions to treat, including cancer, multiple sclerosis and rheumatoid arthritis.
“I think they are shocked by the pushback,” said the head of one advocacy group that recently met with the CMS. “They didn’t anticipate what was going to happen and now they are really backing up now going, ‘What do we do about this?’ ”
The Obama administration has defended the plan, calling it a serious attempt to deal with a decades-old problem. The current payment structure, the administration says, has resulted in doctors prescribing higher-priced drugs when cheaper, effective alternatives are available.
“The goal is to test whether alternative approaches will lead to better value,” Dr. Patrick Conway, chief medical officer at the CMS, told reporters when he announced the model last month.
The first phase of the administration’s plan is to rethink doctor payments, starting as early as this summer. The second phase, expected in 2017, will dole out doctor payments for certain drugs based on how effective those drugs have proven to be.
If the pilot model is shown to work after five years, it could be incorporated on a national basis.
But groups like the Biotechnology Innovation Organization and the American College of Rheumatology say the new payment formula has the potential to force smaller, rural healthcare providers out of business.
Dr. William Harvey, head of government relations for the American College of Rheumatology, said he has observed a “huge backlash” in large part because many doctor and patient groups felt they had been blindsided by the proposed shift.
“Everyone says, ‘No, no, no, this has to be repealed, we can’t have this at all,’ ” Harvey said, adding much of the chaos could have been avoided if CMS officials “would have had conversations with us.”
At least one group has met face-to-face with Medicare agency officials, and others say they have tried, though administration officials say their doors have been open throughout the process.
Conway, a practicing physician at the CMS, addressed the criticism during a Pew Charitable Trusts panel on the Medicare Part B proposal on Monday.
“We thought we expressed this well in the proposal, but we’ve heard from some patient groups, so I want to say this clearly: We hear you, and we will deeply engage patient and consumer communities in this model,” Conway said.
He stressed the agency had “received input prior to this proposal” and will have “the most public and engaged process that we can.”
Physicians are now reimbursed by Medicare based on the “average sales price” of a drug plus an additional 6 percent to cover storage and other expenses.
Officials at the CMS want to cut that formula to the average-sales price plus 2.5 percent, with an additional flat fee of about $16.
While the government says the 6 percent formula encourages the use of pricey drugs, Medicare doctors say they’re insulted by the implication that they’re prescribing medicine based on the costs.
The cost of Medicare Part B drugs has jumped by an average of 8.6 percent annually since 2007, and the total amount spent on drugs has doubled in the last five years. Those costs are expected to climb even higher as costlier drugs come to the market.
Most medical experts agree the Medicare’s reimbursement system is flawed. But critics of the CMS pilot program argue the administration is meddling in a system that’s more complex than just “average sales price.”
“It needs to be more comprehensive than just looking at the drug costs,” Stephen Grubbs, vice president of clinical affairs for the American Society of Clinical Oncology, said at a panel Monday.
Some healthcare observers have described the pilot as a “half-step” toward giving Medicare more control over drug pricing, a longtime goal of Democrats and patient advocacy groups.
Powerful groups like the AARP and the Center for American Progress have backed the administration’s attempts to alter the status quo of Medicare reimbursement.
“Frankly, we’re really glad to see it. It’s something we think has been a long time coming,” said KJ Hertz, a senior legislative representative at the AARP.
Some critics of the proposal, like Harvey, said the potential longer-term effect of making Medicare more sustainable is one reason some of the bigger healthcare groups have showed a “hesitancy to speak so vociferously” against the experiment.
Even big-name cancer groups, like the American Cancer Society, have not yet released public comments about the proposal. A representative for the group declined to comment for this story.
The backlash against the proposal began before its public release. A draft of the proposal had been leaked weeks earlier, and some of the concerned groups said officials had assured them that it was not final version.
But when it was released, some close observers said the final copy strongly resembled that draft.
The policy was officially released in mid-March, sending shockwaves across doctor and patient groups.
A day after it was released, CMS acting Administrator Andy Slavitt came face-to-face with drug executives at the annual policy conference of the Pharmaceutical Research and Manufacturers of America (PhRMA).
Seated before 100 drugmakers, PhRMA board member and Merck CEO Kenneth Frazier asked Slavitt about “the elephant in the room.”
“As you can imagine, people have a great deal of concern about the proposal,” Frazier said.
Slavitt pitched the idea as a way to increase access to life-saving medicine.
“There is nothing that we propose to do, or should do, in any way, that prevents a patient from getting a prescription medicine that they need,” Slavitt told the drugmakers.
Filed under: General Problems
It’s the same old tale…a few (or a lot) bad apples….you know the rest. Many people do not know the standard in most Dr office’s is to charge double for everything pretty much. On the bad apples who are greedy and use the more expensive medication or the most they can get away with…do this for greed period! And pick the most expensive meds for you unless forced not too .Someone has to pay for their luxury items. Question for you…when you were in college or even shortly after graduation and you received pre–approved credit cards in the mail..where they all unlimited funds? No? Mine either. Need a mortgage? Did you just have to sign on the doted line right out of school? Again me either. So you may not want to be so harsh on the idea of curbing the cost you or your insurance has to pay for meds. Can it work against you? Yes! But only because the system has been abused for so many years. Are their good doctors who charge double and STILL give you the exact med you need?? ABSOLUTELY!! And those are the doctors this is probably going to hurt the most and you as their patient, for they haven’t been playing Dr with your health using greed as their guide from the get-go. So they don’t have the huge everything & the huge savings as a cushion. Life is really not fair to the good people, a lot of times : /
In other words, the US government is telling us our lives aren’t worth much once we turn 65. What does this mean for Oncologists and cancer patients? Cancer drugs can be extremely expensive. This is just disgusting!
Pretty much..Rahm Emanuel’s brother Ezeikeal who is a doctor and also one of the major architects of Obama care said that essentially age 75 is the cut off age of one’s contribution to society (I’m paraphrasing EVERYTHING HE EVER SAID IN A NUTSHELL) So basically IMO it is his belief we should stop further treatments to prolong life after age 75. And this where the “death panels” come in….where Medicare is wanting to pay your doctor to to discuss with you your final wishes and be certain there are things like living wills and DNR orders in your chart. God forbid you still want to to have a hip replacement at the age of the 80 when you are a very active person with probably many years of healthy active years left. My grandma died at 94 still living in her own house and pretty independent…..strong Irish stock
“The Obama administration has defended the plan, calling it a serious attempt to deal with a decades-old problem. The current payment structure, the administration says, has resulted in doctors prescribing higher-priced drugs when cheaper, effective alternatives are available.”
I’m all for using an established agent to treat a particular disease state, if it’s the best choice. I’m all for saving money in these situations, but not at the expense of someone’s life or sacrificing their quality of life. I can tell you that these “cheaper, effective alternative” qualities are not the primary sentiments driving this agenda and the quoted statement above is yet one in and endless lexicon of bureaucracy-speak prevarications. It’s all about “saving” money…I put the word “saving” in quotes as I do not believe that the “saving” has anything to do with being accountable, good stewards of the tax-dollars that are applied to these programs. Call me a cynic, along with any four-letter modifier of choice in the same breath. I sincerely believe that when president Obama and his chorus of sycophants on Capitol Hill, at least one as a member of the SCOTUS and those in the MSM collaborated to ram this broken-from-day-one, ACA “health plan for all” on us, they vastly understated the costs and the need to soak the middle class for more tax revenues. I say the middle class, because if one runs the numbers, even if the rich were subjected to a 95% deduction-free tax rate, the amount of revenue from * “soaking the rich” would be a drop in the bucket where covering the real cost of the ACA is concerned.
The people that presume to rule over us know that they lied and they know that there is about to be a huge and immediate problem with coming up with the money to perpetuate the lie. They can’t tax the middle class anymore right now as it’s an election year.
They have to keep sealed the top that is presently ready to blow off the fetid, fermenting vat of bovine excrement that they “fed” us. We were “fed” this unholy goulash of lies and prevarications in order to get us to go along with what was and is essentially an unfundable** mandate. The financial shortfall is about ready to erupt like Vesuvius…the panic and urgency is on account of the present danger of the truth coming out too soon and that cannot be allowed to happen because…wait for it… it’s an election year. So they need to find a way to cut costs and to do it now.
Q: What’s is generally the most expensive, costly portion of the modern American Health Care model?
A: The medications.
Q: What medications can they cut that will result in huge savings and yet not affect so many people that the MSM will have to report it and create the very kind of negative attention they need to avoid for the next six months?
A: Part B office administered medications***. These drugs are generally the new ones, that for various and sundry reasons, are given in the health care provider’s office. Examples are, they have to be administered by the physician or a trained and licensed staff member, require specialized storage conditions, e,g, temperature between monitored storage between 34 degrees and 42 degrees Fahrenheit, have to be prepared for use right before administration, are injectable and sometimes that injection is into a particular body structure, may have an adverse effect profile that require a period of post-observation monitoring for safety purposes before the patient is able to go home, et.
So they looked at various Part B, office administered drug benefits that cost the proverbial arm and a leg, ran the numbers and and gleefully exclaimed, “Eureka, we’ve found it…it’s Gold…Yaayy, we’re saved…at least until the end of November!” They trot out some person with the right letters behinds their name (’cause in an expertocracy, one has no credibility without the right alphabet soup recipe trailing their name, don’cha know) and at the physicians they point the accusatory finger and covertly imply that this reduction in reimbursements is being done because of the “gratuitously greedy, damnable physicians who are just screwing over everyone in the country by abusing the reimbursement system set up at the generous and good-hearted bequest of our beloved Uncle Sam to care for the widders an’ orphans…(pauses to take a breath).. their Gulfstream private Jet and their McLaren…’cause everyone knows that was the reason they went into medicine”. That would seem to be the takehome message.
Why am I reasonably sure of this? Look at the timing and look at how quickly this is being implemented. Look at the defense being given that the necessary consultations have already been done, the implication that thinking has been done and this is the decision, effective immediately. The implied claim is, “Of course, it’s about the heart and soul of fiscal responsibility.” There is also a conciliatory “we really care about you sick people and all y’all are on our minds in this” thrown in there.
That sense of the warm human “We care about you”, really reduces down to…
Roses are Red
Violets are Blue
The State and its agents
Don’t give a damn about you
I wonder what would happen if on November 8th, 2016 if every vote cast was for someone besides the incumbent, or in the case where the current incumbent were not running, if someone from the opposite party, not the current incumbent’s, was voted for?
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In the interest of full disclosure, I’m not a physician. I’m a pharmacist. It’d be in my best interest for the physician to write a prescription and have me fill it. That’s not what matters to me. I’m for what is in the best interest of the patient. So are the majority of the docs getting the shotty end of the stick in this Richard move by the Obama Administration.
*That’ “soak the rich…make’em pay their fair share” is another discussion for another day. I will say that for my own part, I’ve run the numbers and the folly of the rich solving all the problems by paying a significantly higher tax burden is patently obvious.
** I said unfundable…as the ACA cannot be funded near anything even approaching what is required by the status quo of the situation.
***Additionally, these Part B benefit office administered medications, often times, are the absolute best choice for a particular individual’s illness and are the fifth, sixth, ninth, etc. in a long line of other agents that preceded them. The doc is actually assuming additional liability with these as many are biologics.