Millions Lose Coverage as Affordable Care Act Changes Take Effect May 4th marks the oneyear anniversary of the U.S. House of Representatives passing the American Health Care Act (AHCA), a bill that would have put millions of Americans at risk of losing affordable health care. The bill would have ended Medicaid as we know it, eliminated the insurance
protections of the Affordable Care Act (ACA), raised premiums on older adults, and undermined Medicare. While AHCA ultimately failed to become law, efforts to unravel the ACA have continued. Late last year, Congress passed a tax bill that included a provision eliminating the ACA’s individual mandate, which was widely seen as the linchpin for the ACA’s individual market. In
addition, the Administration has taken several steps to reduce spending to support the ACA, including stopping cost-sharing reduction (CSR) payments that helped reduce premiums for consumers, ending most marketing and advertising for ACA markets, and changing ACA enrollment rules to make plans harder to buy and keep. We are starting to see the impact of these changes. This
week, the Commonwealth Fund’s Affordable Care Act Tracking Survey showed recent coverage declines among 19-to-64-year-olds. The survey’s focus is on adults who gained coverage through the ACA’s marketplaces and Medicaid...Read More
Kaiser Family Foundation Makes Predictions for Future of Medicare Drug Price Negotiation Under current law, Medicare is expressly prohibited from negotiating directly with drug manufacturers to set prescription drug costs for beneficiaries. Instead, each Part D plan must separately negotiate with each drug manufacturer. The belief supporting this scheme was that each plan, though the creation of distinct formulary structures, would have the ability to drive down prices for preferred medications. Then, beneficiaries could choose the plan that had the lowest cost for the drugs that they take. For many drugs, however, this arrangement means that the negotiating power of the Medicare population is diluted, split across different Part D plans that are in competition with each other and have no incentive to work together to
lower prices across the board. The idea of allowing Medicare to negotiate at least some drug prices for all beneficiaries has been promoted as an alternative since the inception of Part D, and enjoys widespread support across the political spectrum. The Kaiser Family Foundation released a new report looking at the history of this concept, including the dramatically different role that the federal government has in securing good prices for Medicare beneficiaries, compared to its active involvement in establishing drug prices for other government health programs, including Medicaid and the Department of Veterans Affairs (VA). The report outlines various bills that have been introduced in Congress since the enactment of the Part D benefit, and discusses how
enthusiasm for making this change tracks closely with the rate of increase in Part D drug costs. The report notes that with prescription drug spending growth on the rise, and strong public support for policymakers to take action to ensure the affordability of medications, interest in giving Medicare negotiating power has spiked in the past couple of years, and is increasingly a focus of this Congress and Administration.
As soon as next week, President Trump is expected to lay out new administrative actions on the issue. Medicare Rights will be monitoring these developments closely, for any implications the policy proposals may have for people with Medicare to limit the growth in drug prices that has moved too many medications out of the reach of average beneficiaries. Read the Kaiser Family Foundation report.
First drug priced at over $1 million may be on the horizon In the paradoxical world of drug pricing, the U.S.'s first price tag exceeding $1 million for a medicine is being contemplated as the nation's agita over the cost of prescription drugs climbs ever higher. New gene therapies that aim to cure hemophilia, a disease affecting the blood's ability to
clot, may carry prices of $1.5 million or more, analysts at Leerink wrote in a research note Monday. Gene therapies deliver a healthy copy of a gene to make up for a defective one that causes disease, aiming to cure — or at least significantly improve — the malady in just one treatment. Such therapies for hemophilia are in development at drugmakers
BioMarin, Spark Therapeutics, and UniQure. They're changing the way we think about delivery — and pricing — of medicine. The first gene therapy was approved in the U.S. in December, and received a price tag of $850,000in January. Called Luxturna, it treats a rare form of blindness and is made by Spark A price of $1.5 million or more
would set a new paradigm in the U.S. "It appears the seemingly impervious million-dollar threshold may be breached with hemophilia gene therapy, which could do so while still creating value for society by reducing the cost of factor replacement therapy," Leerink analysts Joseph Schwartz and Dae Gon Ha wrote in their research note. …...Read More
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