Plan to Limit Some Drugs in Medicare Is Criticized
Source: New York Times
An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs...
The proposed rule, which would lift a requirement that insurers cover “all or substantially all” drugs in certain treatment areas, is just one of a series of changes to the drug program that are being opposed by the unlikely alliance. Even insurers and drug benefit managers, who have previously supported added limits on drug coverage, oppose the rule. They object to provisions including changes to so-called preferred pharmacy networks, where consumers are steered toward a limited network of pharmacies, and to reducing the number of plans that insurers can offer in any one region...
“We’ve been scratching our heads over this,” said John J. Castellani, the chief executive of the Pharmaceutical Research and Manufacturers of America, the drug-industry trade group. Medicare Part D, he noted, is the rare government program that not only gets high marks from consumers but also has cost taxpayers billions of dollars less than originally expected. “Why is the administration trying to make such extensive changes to a program that isn’t broken?”...
Under the proposal, Mr. Sperling said, a Medicare drug plan could have a list of preferred drugs with just two medications to treat schizophrenia. That is inadequate, he said, because antipsychotic drugs work in different ways in the body, and have different side effects. “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them,” he said.
Read more: http://www.nytimes.com/2014/02/22/business/plan-to-alter-medicare-drug-coverage-draws-strong-opposition.html
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pipoman
(16,038 posts)This type of policy is so incredibly anti Democratic it really makes me feel like my party has abandoned the base so completely that there really is no difference between us and the rethugs.
lostincalifornia
(5,095 posts)MUST prescribe generic lisinorpril this is not right. THIS panel is playing doctor, and it is outrageous.
This is why it is becoming more and more evident that the Democratic party really needs an active progressive group within the party that will not allow garbage like this to happen.
I will fight the administration on this tooth and nail. This is an intrusion of the government wanting to play doctor. There is a reason a person's physician prescribed a certain drug to a patient, and not a similar type drug in the same class. Perhaps it is because the drug their doctor prescribed them works.
durablend
(8,996 posts)Democrats propose this, Republicans go along then when it starts affecting people, the right will scream "LOOK! DEATH PANELS! DEMOCRATS VOTED TO KILL YOU!!". And they'll be right.
Is our side craven or just stupid?
lostincalifornia
(5,095 posts)I have no idea what the administration was thinking about when they proposed this. People can actually get hurt with some of these inane proposals.
It is just like the stupid recommendations that people should not be screened for Prostate Cancer, Breast Cancer, or Colon Cancer.
This is classic penny wise pound foolish crap.
If these policies are followed people are going to actually start to get injured or die
I am really disappointed in these things. This is NOT the way to save money, and in fact over the long term it could cost a lot more money
Sgent
(5,858 posts)are based on science.
They have been changed in colon cancer to favor colonoscopy over other forms of screening, because colonoscopy is so much better.
Mammograms and PSA (breast and prostate) unfortunately show no benefit and much harm when used as a screening technology. Although it should be pointed out that Medicare still pays for them due to politics.
Medicare has recently started covering CT Scan's for lung cancer screening in smokers, because the science shows that it works.
Enthusiast
(50,983 posts)
Sgent
(5,858 posts)not testing when there are symptoms:
Screening mammograms are no better at identifying lethal cancer than a clinical breast exam, but are much more sensitive -- meaning about 20% of events detected by mammograms were never going to be an issue.
So 20% of the people who underwent biopsy, lumpectomy, radiation, hormone treatment, etc. due to a positive result on a screening mammogram did so without evidence that the positive mammogram is likely to lead to a health problem. Each of those procedures carry risk, and radiation therapy and hormone treatment carry long term risk for other cancers and disease (heart disease, etc.). In addition, screening mammograms induce chest radiation, which can accelerate other problems.
Much of the same issues happen with the PSA. The PSA isn't specific enough to be used as a screening tool, and thus too many false positives result in biopsy's, which carry a very real risk of incontinence, impotence, and needing a colostomy bag.
None of the above applies to a symptomatic patient.
Enthusiast
(50,983 posts)against mammograms and PSA tests is because the insurance companies just do not want to pay for it. They could care less is you died tomorrow.
lostincalifornia
(5,095 posts)and because the American Cancer Society, AUA, and other groups are still using them, insurance companies are still paying for them.
What is changing is that if the screening finds something, and after other diagnostics it is determined to be a cancer, there are additional genetic tests and analysis that can be done to determine if treatment is immediately necessary or if Active Monitoring is an option.
The whole point is patients become more informed, and do not necessarily need treatment, but by not screening that is total ignorance
DesertDiamond
(1,616 posts)been around for years, mainly on the part of health activists.
Enthusiast
(50,983 posts)Sorry. 
lostincalifornia
(5,095 posts)has also been criticized, and flaws pointed out:
http://www.bostonglobe.com/lifestyle/health-wellness/2014/02/11/study-questions-value-mammography-reduce-breast-cancer-deaths/fQGBGHqCOZSKFRGhPgjULK/story.html
but of course most of the MSM do not detail the specifics of the study, just the conclusions.
Also, many of their conclusions are based on retrospective studies, which have major implications.
It is NOT a coincidence that the death rates from both prostate cancer and breast cancer have decreased
lostincalifornia
(5,095 posts)is the trend toward Active Surveillance, but I am sorry, anyone over 55 unless a family history, or other symptoms occur, who is not being screened for PCa is making the decision that it is better to live in ignorance. John Hopkins, Harvard, Mayo Clinic, and every other major institution does not agree with that conclusion. The AUA does not agree:
“The main point is that PSA testing for early detection of prostate cancer has an important role in maintaining the health of American men,” Wolf said. “Clearly, it has been overused in the past, but we feel it is a grave mistake to react to that overuse by completely getting rid of any early-detection efforts at all. We feel that a more balanced approach—selecting men at higher risk—is a more appropriate way to go.”
The issue is far from decided in regarding screening for PCa, though the bean counters and biostatisticians would like you to believe otherwise.
http://www.oncologypractice.com/oncologyreport/single-view/urologists-back-psa-screening-rail-against-uspstf-s-position/ae6807c2203aa24678b0222cd0aaa932.html
http://www.healthnewsreview.org/2012/05/reactions-to-uspstf-prostate-cancer-screening-recommendations/
The issue is what to do if something is found. That is where the changes have occurred. The technology is there to help determine if the tumor is aggressive or intermediate, or low, and whether active surveillance is prudent. I won't list the guidelines used, but they avoid unnecessary treatment, and treat when necessary. The U.S. Preventive Services Task Force (USPSTF) did not have one urologist on the committee that made that recommendation.
http://www.drcatalona.com/quest/quest_fall09_5.htm
In your view it may be settled, but not in the mind of most urologists today.
The mammography report is also flawed:
"“Mammography is an imperfect test at best, but at this point, it’s the best test we have,” said Dr. Ann Partridge, a breast oncologist at Dana-Farber Cancer Institute. She and others highlighted some potential methodological flaws of the Canadian study.
For example, Partridge said, technology has improved significantly over the past 30 years with X-ray machines and digitized film that yield clearer images.
Others have questioned whether the women in the Canadian study were properly randomized since a significantly higher number of women in the mammography group were diagnosed with advanced cancers during the first year or two of the study than those in the control group.
“This might have been due to chance,” Wender said, “but if the randomization wasn’t done perfectly, some women at higher breast cancer risk might have been put into the mammography group and this might have skewed the results.”
Some radiologists have sharply attacked the study investigators, accusing them of having a bias against mammography by designing a study in which the control group of women in their 50s received breast exams performed by skilled nurses every year instead of mammograms.
“The principal investigator set out to prove that all you needed to do was a physical examination,” said Dr. Daniel Kopans, director of breast imaging at Massachusetts General Hospital, in an e-mail responding to the new study finding. “The nurse examiners were highly trained while the radiologists and technologists [who performed the mammograms] had no training.”
http://www.bostonglobe.com/lifestyle/health-wellness/2014/02/11/study-questions-value-mammography-reduce-breast-cancer-deaths/fQGBGHqCOZSKFRGhPgjULK/story.html
Medicare still pays for PSA and mammograms, and it isn't due to politics. It is well know that catching cancer when it is localized is more easily controlled than when it has spread, and if knowing diagnostically someone has an Adenocarcinoma in its early stages, and determining whether Active Surveillance is a viable option.
Deaths from both Prostate Cancer and Breast Cancer have decreased because of early detection.
The point is, the patient/doctor needs to make these decisions, not some task force trying to save money for the government.
As for Colonoscopy you are correct, that is still recommended.
Sgent
(5,858 posts)There are multiple studies over large populations, with essentially the same results. Mammography increases 5 year survival, but only because the cancer's are caught sooner.
The reason that breast cancer mortality is down is due to better treatment, not screening beyond clinical breast exams.
I agree that risk stratification and watchful waiting can be useful for PSA, much like the new guidelines for CT screening in high risk smokers. But its not a useful test for all.
lostincalifornia
(5,095 posts)Last edited Sat Feb 22, 2014, 06:49 PM - Edit history (1)
Too much in a year, or psa values are consistently greater than 10 or greater than 6 if not accountable by bph, and a course of antibiotics does not resolve the issue. An MRI, color Doppler or a fusion of both technologies should be performed to determine if a biopsy is recommended. However, if a dre is positive even after negative diagnostics, it may still be advisable to do a biopsy.
As for the breast cancer the technologies has also greatly improved with 3d mammography and thomosynthesis. In addition it is recognized that breast density presents a real problem with mammography which is why women who have dense breasts may wish to consider MRI.
The study does not discuss radiologist guidelines or the supposed random groups Wher an older demographic could skew the results
I do not buy it. Like when they said proscar or avodart may prevent or slow low grade PCa but increases aggressive cancers. Not considering that the shrinkage of gland might in fact cause a cancer to be easier to detect due to less volume being biopsied, or other factors
The main point is that cancers detected early before they hae spread are more treatable than after
My family members will continue to have such screening done unless they don't want to even if I need to pay for it out of my own pocket
madrchsod
(58,162 posts)i really do`t give shit who is in power in washington dc. anyone who fucks around with medicare and social security by saying we need to cut back deserves what they get.
let the chips fall where they may
Yo_Mama
(8,303 posts)What we commonly see is that Medicare plans are too restrictive on these prescriptions already. I have people denied coverage for BP meds that are keeping them out of the hospital, because there is a generic - but the patient is either unresponsive to the generic or allergic to it.
I have had to send off pages and pages of documentation to justify a potassium sparing diuretic for a patient with heart failure just out of the hospital.
You are not going to lower medical costs if these patients can't get the medication they need, and for older people it actually gets much more difficult to balance med benefit/harms.
It's already so bad that the Medicare D cos don't want to pay for enough diabetic test strips so that we can really control blood sugars without severe hypoglycemia. When these patients get blood clots, strokes or heart attacks, the system pays an awful lot for treatment, but it doesn't want to fund $15 extra a month to prevent those incidents? Older people frequently don't have the money to pay for such necessities out of pocket.
I am sad to say that I have seen NOTHING good from Medicare attempts to control costs. Maybe the medical device programs are working better, but the other initiatives seem to be insane.
lostincalifornia
(5,095 posts)
murielm99
(32,817 posts)will pay for my Armour Thyroid. Medicare does not acknowledge the existence of the drug. I pay for it myself. Synthroid, the drug they want me to take, messes me up.
Yo_Mama
(8,303 posts)They want only the artificial (levothyroxine), but it doesn't work well for all patients. And boy, if they have a bad reaction they REALLY have a bad reaction.
An article about the great controversy:
http://thyroid.about.com/b/2009/01/27/the-desiccated-thyroid-controversy-why-endocrinologists-dont-like-armour-thyroid.htm
madrchsod
(58,162 posts)i can not take a certain generic heart medicine. the only medicine that works is a non generic.
it boggles my mind why anyone in either party would want to fuck with a program that works. it`s either they are just plain stupid or there`s money involved.
INdemo
(7,024 posts)If it aint broke don't fix it. What the President is trying to do is something I would expect from a Republican..but even Republicans are against this idea, according to the article.
Has to be some sort of payback some where but even Pharmacy groups are against this idea..Im not sure all the facts are clear yet for whom ever wrote this article.
Yo_Mama
(8,303 posts)And do you know how much money is saved by you taking the medication that works? Plus think of all the money spent on trying to deny patients the meds they need!
This is utterly irrational. Patients will take the cheapest thing they can find that works. If it doesn't work, trying to make it work will balloon costs.
RKP5637
(67,112 posts)follow that trail into whose pockets it's going. R, D, I they all fuck up and often have ulterior motives. Some I trust more, some I trust less, but never to I blindly trust all of them, I don't care what F'en party they are labeled.
okaawhatever
(9,565 posts)negotiate for the price of drugs. As you may recall, Part D had a provision that the gov't couldn't negotiate for the price of drugs the way it does for the VA or military health care system. At the time everyone was upset that it was a big give away for big pharma. (I think it was). This is from wikipedia but the sources for info are good. Also, Part D has benefited lower income seniors, but the costs that have been tacked on to benefit pharma and higher income types (no income qualifications for the plan) makes the program unsustainable.
By the design of the program, the federal government is not permitted to negotiate prices of drugs with the drug companies, as federal agencies do in other programs. The Department of Veterans Affairs, which is allowed to negotiate drug prices and establish a formulary, has been estimated to pay between 40%[25] and 58%[26] less for drugs, on average, than Medicare Part D. For example, the VA pays as little as $782.44 for a year's supply of Lipitor (atorvastatin) 20 mg, while the Medicare pays between $1120 and $1340 on Part D plans.[26]
Although generic versions of [frequently prescribed to the elderly] drugs are now available, plans offered by three of the five [exemplar Medicare Part D] insurers currently exclude some or all of these drugs from their formularies.…Further, prices for the generic versions are not substantially lower than their brand-name equivalents. The lowest price for simvastatin (generic Zocor) 20 mg is 706 percent more expensive than the VA price for brand-name Zocor. The lowest price for sertraline HCl (generic Zoloft) is 47 percent more expensive than the VA price for brand-name Zoloft.
—Families USA, No Bargain: Medicare Drug Plans Deliver High Prices[26]
Estimating how much money could be saved if Medicare had been allowed to negotiate drug prices, economist Dean Baker gives a "most conservative high-cost scenario" of $332 billion between 2006 and 2013 (approximately $50 billion a year), and a "middle cost scenario" of $563 billion in savings "for the same budget window".[27]
Former Congressman Billy Tauzin, R-La., who steered the bill through the House, retired soon after and took a $2 million a year job as president of Pharmaceutical Research and Manufacturers of America (PhRMA), the main industry lobbying group. Medicare boss Thomas Scully, who threatened to fire Medicare Chief Actuary Richard Foster if he reported how much the bill would actually cost, was negotiating for a new job as a pharmaceutical lobbyist as the bill was working through Congress.[28][29] A total of 14 congressional aides quit their jobs to work for the drug and medical lobbies immediately after the bill's passage.
In response, the Manhattan Institute, a free-market conservative think tank, which, according to the Capital Research Center, receives funding from a large number of private interests including pharmaceutical companies,[30] issued a report by Frank Lichtenberg, a business professor at Columbia University, that said the VA National Formulary excludes many new drugs. Only 38% of drugs approved in the 1990s and 19% of the drugs approved since 2000 are on the formulary. He also argues that the life expectancy of veterans "may have declined" as a result.[31]
Paul Krugman disagreed, comparing patients in the Medicare Advantage plans, which are administered by private contractors with a subsidy of 11% over traditional Medicare, to the VA system: mortality rates in Medicare Advantage plans are 40% higher than mortality of elderly veterans treated by the V.A., said Krugman, citing the Medicare Payment Advisory Commission.
*As to the Manhattan Institute (neo-conservative think tank) the other policies they promote are: Welfare Reform, they believe welfare is a detriment to the individual and society as a whole
Fracking: They are pro-fracking
School Vouchers: Their "research" was what helped influence the scotus vote on constitutionality of school vouchers.
freshwest
(53,661 posts)seniors couldn't afford the donut hole that has been eliminated. Single payer set ups have these debates all the time. It's called Democracy.
HockeyMom
(14,337 posts)or any Medicare Advantage Plan. Something I don't use? Last time I even took Tylenol, let alone any script, was over a year ago. Waste of money for me.
Is that one a beta blocker? My Plan D approved the brand name for mine.
madrchsod
(58,162 posts)i used to take a generic but cardiac arrest the generic did`t work.
OKNancy
(41,832 posts)I have part D. I don't take any prescriptions, so it is not something I face ( yet).
After reading the article, I'm not sure that the proposed changes are a bad thing. Sounds like the drug companies want to keep their monopoly.
Bluenorthwest
(45,319 posts)Anything?
OKNancy
(41,832 posts)maybe I should have written confused.
"I don't know"
I will certainly have to educate myself about the subject.
Yo_Mama
(8,303 posts)Just think about changing the rules on immune-suppressant drugs. The newer classes work far better, and the teams of medical personnel who manage transplant patients have a lot of experience and focus on managing rejection. The cost for even one patient who rejects a transplant when they wouldn't have otherwise can be two lives - that patient's and the patient who would have otherwise gotten the organ.
The only possible rationale for doing this would be to make transplant programs reject Medicare patients because they couldn't manage them properly afterwards.
If they wanted to manage drug costs, just make it legal to get the same drugs outside the US. But no, they take this ugly tack.
As for failing to fund schizophrenia drugs, that is brutal and cruel.
And then to round out the "benefits", once the patient is depressed because they are ill you stop them from getting adequate treatment for depression.
lostincalifornia
(5,095 posts)BP. They are telling people that to get reimbursed you need to use generic Lisinopril because that is a slightly cheaper ACE inhibitor to generic Accurpril. However, the problem is that for some people Accurpril is more effective than Lisinopril. What they are doing is bad medicine.
As for your premise about drug companies want to keep their monopoly, that is mostly bogus. Most of the drugs referred to are generic, so the large pharmaceuticals don't have the stake in this you are referring to. What we are talking about two different drugs of the same class, where depending on the person one may be effective, while another one isn't.
This is very bad medicine what they are trying to do, and they will deservedly get burned for it. It is NOT saving any significant costs. Especially since we are mostly dealing with generics anyway
Yo_Mama
(8,303 posts)But even for the non-generic hypertension meds, the savings from appropriate, effective medicine tailored to the individual patient are so huge versus non-effective therapy that this type of cost analysis is ridiculous. The theory behind this measure is that all patients will have equivalent efficacy on either drug, and this is just not true.
At most we are talking about price differences under a dollar a day for the accupril/lisinopril. If there is a patient who does much better with the more expensive prescription, the long term costs overwhelm the short-term savings. So you saved $89 dollars, but the patient is skipping doses due to bad reactions, and lands in the hospital or suffers organ damage!
Plus, when you have a patient with multiple conditions on multiple prescriptions, the interactions can force a change.
And then there is an issue of humanity, not just dollars. There is human suffering involved here.
This is the type of cost-saving measure thought up by soulless bureaucrats who may have an MD but who do not in fact treat patients!
lostincalifornia
(5,095 posts)because the editorial is claiming something very serious, and if it is not accurate then the Obama administration better speak to it now.
RiverNoord
(1,150 posts)it could be a nightmare, literally. In fact, the mental health-related medication changes would be terrible for many people on SSDI.
This proposal is very strange...
Yo_Mama
(8,303 posts)is the kindest thing I can think of to describe it. A more ACCURATE description would be "demonstrating depraved indifference to life".
I do have a musical comment for the author of this "modest proposal":
lostincalifornia
(5,095 posts)specific condition will not react the same way on two different people.
Congress had better overturn this. Better yet, the President should back off on this
starroute
(12,977 posts)Now I'm wondering if even the chains like CVS and Rite-Aid are going to survive, since the only preferred pharmacies around seem to be supermarkets and big-box stores.
George II
(67,782 posts)....within three miles of us, and we're not in a city. Double that three miles to six miles and you can add another Walgreens and CVS.
They're not all open because they're hurting.
anasv
(225 posts)The pharmacists there are great. More than once they have caught a new med being something I'll have a problem with, and they always find the cheapest option for buying meds. Usually that's my Plan D, but there are a couple of small oddball plans that are sometimes cheaper and that cost me nothing to be a member of. They knew about them, not me.
i could save a few dollars by going to a preferred pharmacy or doing mail order, but it is long term stupid for me to do that.
George II
(67,782 posts)...she makes me go six miles to get our prescriptions. They call the doctor when the prescription needs a refill, they remind us by phone when our supply is almost up, and I spend maybe 60 seconds total getting our prescriptions.
But you're right, they're probably #3 in our area behind CVS and Walgreens. If any go under, it'll probably be a Rite Aid.
Enthusiast
(50,983 posts)Why are you lying about drug stores?
What is the motive behind such a lie?
You post some curious things and take some odd positions but this takes the cake.
George II
(67,782 posts)...using Microsoft Streets & Trips. My first post was just done off the top of my head, not measuring precisely.
But you're correct, the second Rite Aid is about 3-1/2 miles away, not 3. And in that 3-1/2 mile radius there is a fifth CVS and a third Walgreens, and even more in my original estimate of 6 miles.
Here's a link to the CVS stores near here, and it's missing a couple that are just outside the map area. Click on the fifth page and you'll see that there are a total of TWENTY FIVE CVS stores within 10.5 miles!
http://www.cvs.com/stores/store-locator-landing.jsp?_requestid=3600913
Why so "arrogant"?
George II
(67,782 posts)George II
(67,782 posts)(link doesn't save location, you have to type in "Cromwell, CT"
Enthusiast
(50,983 posts)Sorry for the overreaction. Funny that Canada would have more drugs stores than the USA considering that their drugs are not as profitable.
George II
(67,782 posts)....that's 45 total within about ten miles! And we have a Target and three WalMarts and a number of supermarkets with pharmacies too.
Prescription drugs are indeed a huge industry in the US.
PS - I won't even try to count up the number of Dunkin' Donuts within ten miles, but we have two within a quarter mile of each other on the SAME side of the street. Unbelievable.
anasv
(225 posts)and pharmacies everywhere: You must be a fellow Rhode Islander.
Within three miles of my rural Southern Rhode Island location, there are three riteaids, one walgreens, and one cvs. Two dunkin donuts.
Update: I see you're in Connecticut; Close enough
George II
(67,782 posts)...and then need prescription drugs to try to get healthy again!
I'm from NYC originally, nothing like what we have here in New England.
JoeyT
(6,785 posts)Even if it is a small one. Nearest one to my parent's house is 12 miles. The next is 20 miles. The closest place with more than one pharmacy to choose from is 38 miles. It has two.
So no, they might not survive fine.
George II
(67,782 posts)greiner3
(5,214 posts)The ones that fill a million scripts weekly.
This way is cheaper but I really, really like my pharmacist and have relied on her for a lot over the last 7 years.
Besides, she's cute as is the entire staff.
mimi85
(1,805 posts)They charge the highest prices of any pharmacy. A drug I've had to take for years cost me $15 in January and $66 in February. CVS said it was the insurance company (who is also on my shit list), but when I called both back and forth, it was finally shown to be CVS. Costco is the only place I'll go anymore. CVS is like a mile away which is the only reason I started using them to begin with - convenience. Well, those days are over!
tomp
(9,512 posts)...with multiple financial restrictions imposed coverage realities. it has gotten to the point where the restrictions determine the choice of medication available to the point where at times it becomes tantamount to prescribing by the insurance provider.
our health care system is a total travesty but nowhere more than in psychiatry. for the most part, the mentally ill do not get what the need, to the detriment of the patient and society, and to the intense frustration of providers.
valerief
(53,235 posts)like the U.S. does.
L0oniX
(31,493 posts)INdemo
(7,024 posts)I thought I did
lostincalifornia
(5,095 posts)people in Congress know you want this overturned.
woo me with science
(32,139 posts)Every. Single. Day.
Enthusiast
(50,983 posts)
SmittynMo
(3,544 posts)My wife and I are not medicare age yet. She has a health care plan at work. Recently the following happened. I have been on a drug for acid reflux, prescribed by my doctor. It works perfect. Out of pocket costs to me were about $5.00. The insurance company recently rejected my script saying that it was available over the counter. It is not the same name and there is no guarantee that it will work. It now costs me 25.00, over the counter. If I continue to use the drug that works, and now since the insurance company will not cover it, it's 25.00 also. So the insurance company is now playing doctor, to save them money. So in an effort of the insurance company to control my prescribed meds, I get screwed.
As for Medicare, I am very concerned for both of us when we get there. I'm sure they'll play doctor again.
Enthusiast
(50,983 posts)The insurance industry and the pharmaceutical industry make the rules. They are the only ones at the table.
Enthusiast
(50,983 posts)I'm pretty desperate. I would happily pay $25/month because my condition is so severe. Could you tell me what drug it is?
My condition comes and goes. I believe it is caused by other drugs.
SmittynMo
(3,544 posts)Have been using it for years. Works great. I take 1 after PM dinner. I think they want me to go on Zantac?
Enthusiast
(50,983 posts)I have the added complication of severe gluten intolerance. Some of these drugs use a gluten binder.
Sgent
(5,858 posts)of Zantac. You can find ranitidine generic right next to Zantac in the drug store aisle (and it will be cheaper). If you look on the box of Zantac, the only active ingredient is ranitidine.
Enthusiast
(50,983 posts)According to my wife, this Ranitidine is what I have been taking—the one I find to be ineffective.
SmittynMo
(3,544 posts)I have a mild case of reflux. Yours must be more severe. Sorry.
Enthusiast
(50,983 posts)I'm still taking them. I appreciate the suggestion. I think the BP meds are taking a toll on the old digestive tract.
DJ13
(23,671 posts)The pharmacy recently stopped carrying the 500mg acetaminophen version, so my doctor prescribed the 300mg version as a substitute (same mg hydrocodone) .
Went to pay my share of cost ($1.20) and they said it was $77 because that version isnt covered by Medicare, only the 325mg version is covered.
Doctor rewrote the 'script.
$75.80 difference for 25mg less Tylenol is kinda stupid!
Assuming the current idiocy does not go through, you may be better off with Medicare. i curse United Healthcare, which was my employer's plan. I never could get coverage for two meds i needed. I wasted a year getting the run around from them and generating the damn paperwork they "needed." My Plan D approved both meds.
Hoyt
(54,770 posts)of patients to compromise, ensure that.
There are lots of drugs out there that do nothing more than older, cheaper standbys. But patients demand the newer drugs -- maybe you only have to take it once a day, rather than twice or some other slight inconvenience like that. Doctors don't care, they just want to get the patient out of the office.
The only way to control this is for Medicare or insurers to make intelligent choices on our part. Clearly, they can be wrong, but so is spending an extra $100 a month on a prescription with no real benefit over an older drug. In any event, I'd rather that extra $100 go to helping some poor kid get an education, job, etc.
Obama's proposal could force some competition into drug pricing. One reason Part D is costing less than expected is that the drug administrators are limiting some of these high cost drugs in favor of older, cheaper products. I'm fine with that.
Enthusiast
(50,983 posts)They could do something for us. Although that might kill some of us from shock.
They could negotiate drug prices. Or, even enact drug price controls. Then the GOP would whine. Let 'em squeal. It would make for good TV theater.
Hoyt
(54,770 posts)Enthusiast
(50,983 posts)Hoyt
(54,770 posts)"The administration predicted savings for both beneficiaries and the Medicare program if prescription drug plans could remove some currently covered drugs from their formularies. It could also give insurers additional tools to limit overuse of certain drugs, such as the prescribing of antipsychotic drugs to nursing-home patients with dementia, a common practice that is widely viewed as inappropriate. . . . . . ."
But, go ahead and believe the alliance financed and led by, you guessed it -- drug companies.
woo me with science
(32,139 posts)http://www.msfaccess.org/our-work/addressing-medical-challenges/article/1676
WOULD IMPACT PUBLIC HEALTH
http://www.exposethetpp.org/TPPImpacts_Public-Health.html
The TPP would provide large pharmaceutical firms with new rights and powers to increase medicine prices and limit consumers' access to cheaper generic drugs. This would include extensions of monopoly drug patents that would allow drug companies to raise prices for more medicines and even allow monopoly rights over surgical procedures. For people in the developing countries involved in TPP, these rules could be deadly - denying consumers access to HIV-AIDS, tuberculosis and cancer drugs.
The TPP would establish new rules that could undermine government programs in developed countries. The TPP would control the cost of medicines by employing drug formularies. These are lists of proven medicines that the government selects for use by government health care systems. Lower prices are negotiated for bulk purchase of such drugs and new medicines that are under monopoly patents are not approved if less expensive generic drugs are equally effective. Drug firms would be empowered to challenge these decisions and pricing standards. In the United States, these rules threaten provisions included in Medicare, Medicaid and veterans' health programs to make medicines more affordable for seniors, military families and the poor.
TPP would empower foreign pharmaceutical corporations to directly attack our domestic patent and drug-pricing laws in foreign tribunals. Already under NAFTA, which does not contain the new rules proposed for TPP, drug firm Eli Lilly has launched such a case against Canada, demanding $100 million for the government's enforcement of its own patent standards.
The TPP would also empower foreign corporations to directly challenge domestic toxics, zoning, cigarette and alcohol and other public health and environmental policies to demand taxpayer compensation for any such policies that undermine their expected future profits. Often initiatives to improve such laws are chilled by the mere filing of such an "investor-state" case. In other instances, countries eliminate the attacked policies. For instance Canada lifted a ban on a gasoline additive already banned in the U.S. as a suspected carcinogen after an investor attack by Ethyl Corporation under NAFTA. It also paid the firm $13 million and published a formal statement that the chemical was not hazardous.
Enthusiast
(50,983 posts)But Sherrod Brown sent me what I consider to be weasel words on fast track and TPP. It seemed he was of the opinion if we looked at the language carefully and got some environmental and worker's rights provisions it would be more palatable. I think he is giving the predators too much credit.
SmittynMo
(3,544 posts)It's like the republicants are running the drug companies. Cut, cut, cut. and screw you.
Sunlei
(22,651 posts)Insurance Corps probably get a kickback from the 'allowed pharmacies' and the Drug Corp. They over charge for many drugs in the restricted networks.
To much control from the Insurance Corps. We should never have 'for profit' companies in charge of our healthcare.
Hoyt
(54,770 posts)You can always pay more in premiums and get access to all the pharmacies and providers you want. I'm fine with using the mail order pharmacy myself, that saves even more.
Sunlei
(22,651 posts)They also get people on unnecessary medications to make more profit because those medications have huge profit margins.
We need to cut these middlemen out and the Gov should pay Doctors and pharmacies directly. Medications should be priced 20% above wholesale price.
Not $800 dollars for a bag of fluids that wholesales for $4.00.
They need to limit the hospitals and pharmacies to the 20% profit the Insurance Corps are supposed to use.
Enthusiast
(50,983 posts)Price controls! It is not at all unreasonable. The consumer is being stretched to the breaking point.
Hoyt
(54,770 posts)The insurer likely pays the hospital $7 - $15 at best. The rest is written off. Hospital charges mean almost nothing if you are insured. If you are not and don't negotiate with them, they'll try to collect the $800.
As to paying 20% above wholesale price for drugs, that's more than Medicare and insurers pay now.
I doubt that any hospital or pharmacy makes 20% profit, however you figure profit -- based on revenue, costs, investment, etc. In other words, you'd be paying too much.
Sunlei
(22,651 posts)"Obamacare" law is supposed to limit insurance corps to 20% profit from the premium. That rule started last year.
Hospitals, drug corps and some pharmacies & some Doctors make a huge profit. Much, much, much! more than 20%!
And when these Doctors/drug corps/pharmacies/insurance corps can get 'free' Federal dollars they harm people with the unnecessary but profitable, healthcare & price gouge even more.
Hoyt
(54,770 posts)As to providers pushing unneeded (medically unnecessary) services, that's another thing that insurers and Medicare try to prevent. Of course, providers and patients gripe about that too.
Sunlei
(22,651 posts)We Americans are so screwed by the for-profit insurance corps. They aren't providers, they are for-profit middlemen.
Hoyt
(54,770 posts)Executive pay comes out of the 20%. Read the bill, it spelled out clearly for those who really care about the truth.
ProSense
(116,464 posts)Reposted from GD: http://www.democraticunderground.com/10024544733
By KATIE THOMAS and ROBERT PEAR
An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia.
Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs...Even insurers and drug benefit managers, who have previously supported added limits on drug coverage, oppose the rule.
http://www.nytimes.com/2014/02/22/business/plan-to-alter-medicare-drug-coverage-draws-strong-opposition.html
Is this how a distortion starts? I ask because the media was able to successfully spin Medicare savings from reducing overpayment to insurers in Medicare Advantage as cuts.
The current rule appears to be about implementing the process of negotiating drug prices. The NYT article quotes people from across the spectrum, but the concerns appear more rooted in fear of change than the actual effects of the policy. I mean, how will negotiating drug prices limit choice?
By Elise Viebeck
Republican committee leaders are pushing the Obama administration to call off proposed changes to the Medicare prescription drug program, arguing the overhaul would jeopardize seniors' plans and raise premiums.
The charges pertain to recent regulations proposed by the Centers for Medicare and Medicaid Services (CMS). The rules would allow the agency to participate in negotiations between insurance companies and pharmacies in Medicare Part D for the first time out of concerns over cost and access.
Supporters of the change argue the CMS needs new authority to ensure the market for prescription drugs in Part D works for patients. But Republicans said the proposal will allow the agency to unnecessarily interfere with existing drug plans, potentially forcing millions of seniors out of their coverage.
"Despite the program's far-reaching success, CMS is proposing to fundamentally undermine the program and jeopardize the prescription drug plans that million [sic] of seniors rely on for their health and peace of mind," the members wrote.
- more -
http://thehill.com/blogs/healthwatch/medicare/198800-gop-slams-proposed-changes-to-medicare-part-d
The proposed rules would empower the agency to participate in Part D negotiations between insurance companies and pharmacies for the first time out of concerns about cost and access.
The regs would also open plans' preferred networks to a wider range of pharmacies, limit plan bids within a region and remove "protected class" designations for certain types of drugs.
The CMS argues the changes are necessary to save money, hold plans and providers to account, and enhance consumer choice within Part D.
But despite praise from some quarters of the healthcare world, most of the reaction from business groups, insurers and drug companies has been negative.
http://thehill.com/blogs/healthwatch/politics-elections/198816-gop-debuts-new-campaign-attack-line-on-medicare
Pharmaceutical Research and Manufacturers of America (PhRMA) stated yesterday that it is opposed to the proposed rule on Medicare Advantage and Part D that CMS released in early January because it could disrupt care for millions of beneficiaries.
The Part D program is already working well, making the proposed rule unnecessary and harmful. Quite simply, it is a solution in search of a problem, says PHRMA senior vice president Matthew Bennett, adding: “Since 2006, the Part D program has developed a strong track record of success. Currently, total Part D costs are 45% - or $348 billion - lower than initial projections for 2004-2013. Additionally, average beneficiary premiums are stable at $31 per month in 2014 - less than half the level originally projected. And several surveys have found that 90% or more of Part D beneficiaries are satisfied with their coverage.”
Would unlawfully interfere in a competitive, market-based program that is working
He continued: “Despite Part D’s success, the proposed rule represents a fundamental shift in CMS’ administration of Part D and would erode key features at the core of the program’s competitive structure – to the detriment of beneficiaries. The proposed changes would restrict patient access to needed medications, limit beneficiary choice of affordable plan options, and unlawfully interfere in a competitive, market-based program that is already working. Not only are these changes unnecessary; they could increase costs for both beneficiaries and taxpayers.”
“In light of Part D’s track record, PhRMA urges CMS to withdraw the proposed rule which, as written, would undermine Part D and harm beneficiaries who rely on the program for affordable access to comprehensive prescription drug coverage,” Mr Bennett concluded.
http://www.thepharmaletter.com/article/phrma-opposes-proposed-rule-on-us-medicare-advantage-part-d
National Center for Policy Analysis (Koch funded) is against it.
Most Popular Seniors’ Medicare Drug Plans May Be Banned by CMS: 14 Million Could Lose Medicare Part D in 2015: NCPA Study
http://www.prweb.com/releases/2014/02/prweb11601939.htm
National Center for Policy Analysis
http://www.rightwingwatch.org/content/national-center-policy-analysis
Here is the rule: http://www.gpo.gov/fdsys/pkg/FR-2014-01-10/pdf/2013-31497.pdf
From the PDF:
Interesting mention of "rebates." Medicaid has one of the best rebate drug policies.
<...>
The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.
The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html
The ACA increased Medicaid's drug rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html
<...>
Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).
- more -
http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates
Sunlei
(22,651 posts)I'm all for our Federal Gov. going after the drug corp. price gouging.
lostincalifornia
(5,095 posts)However, it fails to recognize, that these different drugs of the same class may and can react differently with different people.
It saves very little since in most cases we are talking about generics.
Those,explanations are sorry excuse for a bad decision
The president screwed up on this one. There is a reason this has bipartisan support against this, because it IS bad medicine
I have seen the list and recommendations for some of these, and it is simply looking for cheaper alternatives, between generics in most cases of the same class of drugs. to save pennies not dollars
If they really wanted to save consumers money they would cover pharmaceuticals from Canada from accredited pharmacies in Canada, as an example
ProSense
(116,464 posts)Mr. Castellani’s organization was one of more than 200 groups that signed a letter this week asking that the rule be withdrawn. Earlier this month, Republican and Democratic members of the Senate Finance Committee warned that the proposal could “diminish access to needed medication” without saving much money.
Here's one of the reasons, from the letter:
http://www.hlc.org/blog/wp-content/uploads/2014/02/Comment-Ltr-as-of-2-19.pdf
Now, I can't imagine any progressive making that case.
lostincalifornia
(5,095 posts)ago suggesting that she change the generic meds she is taking to some other generic meds of the same class. Now, perhaps this isn't the same thing, but I will tell you it isn't Medicare's responsibility to tell someone which drugs they should be taking, just because they are in the same class. I can understand encouraging patients to use generics over brand names if available, but I will not buy into them suggesting they use for example lisinopril generic over accupril generic.
Regardless, I will pay for the most effective drug, even if it is out of my own pocket, but for those who don't have the means, that is who will be hurt by this
If the editorial in the New York Times is NOT accurate, then the Obama administration better speak to it, and pretty quick. Tomorrow is the Sunday talking heads sounds like a good time to do it.
Hoyt
(54,770 posts)The best thing Obama could do is to tell everyone to go screw themselves and why, and quit. People want something done, and don't even recognize when the Obama Admin has taken a positive step.
freshwest
(53,661 posts)freshwest
(53,661 posts)good post
kickysnana
(3,908 posts)About every few months we hear of someone here or a relative dying because they could not get the drug they needed due to insurance interference including Medicare.
Guess that will happen more often now.
JDPriestly
(57,936 posts)Every case is different. The doctor is trained to respond to unusual as well as typical medical problems. It should be the doctor's decision and the doctor's alone about how much of a medication he prescribes. This should at least apply when the medication is not a controlled substance or dangerous. But the pharmacy at my HMO has already told me that I have to wait at least three months to renew a prescription. Normally that is fine. But I am in an abnormal situation. I am very disappointed about this. It is causing me to have sleepless nights. And no, the medicine is not a sleeping pill or a controlled substance. It is not something dangerous. It simply works for my very severe condition and so far I haven't found anything else that does.
Enthusiast
(50,983 posts)in dealing with your condition, JD. I have "issues" that I'm dealing with too. It's exhausting.
Hoyt
(54,770 posts)they should reconsider. Have you tried appeals? They do work.
JDPriestly
(57,936 posts)
dipsydoodle
(42,239 posts)and has done so for years - not a recent event.
Hoyt
(54,770 posts)ensure viability of the system.
dipsydoodle
(42,239 posts)Yes - keeping the system viable for the general benefit of the many.
proverbialwisdom
(4,959 posts)Drugged as Children, Foster-Care Alumni Speak Out
Use of Powerful Antipsychotics on Youths in Such Homes Comes Under Greater Scrutiny
By LUCETTE LAGNADO
Updated Feb. 23, 2014 2:44 p.m. ET