New Drug Spending Tool May be Helpful for Researchers and Policymakers— Not Much Help for Consumers This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboar d allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard. The Administration’s recent
focus on drug pricing is bringing attention to this important issue, and to tools and data that may help address the high cost of prescription drugs. However, while the Dashboard provides insights into drug pricing and the effects on the Medicare and Medicaid programs, it may be more helpful to researchers and policymakers than to people with Medicare. The prices the Dashboard shows are the “list prices,” which are the prices drug manufacturers request prior to any rebates or negotiations; they are not the prices people with Medicare actually pay. The
Dashboard does not show the consumer prices or indicate which plans will cover which drugs on their formularies. This information is important from a beneficiary perspective because it gets at the actual costs they will face when they pick up their medications at the pharmacy. The Dashboard is also limited in that it does not capture and show how much each Medicare beneficiary will ultimately pay for each drug. Such costs are difficult to estimate, as they are dependent on a number of highly specific, individualized factors, including the beneficiary’s
prescription drug needs and their plan’s deductible and formulary tiering. However, the lack of this information makes the tool of very limited use for consumers. At Medicare Rights, we welcome a focus on transparency in the Medicare program and see the Dashboard as a step in the right direction for future actions that will reduce drug costs and increase the affordability of prescriptions for all. While the Dashboard tool cannot show which drugs are the best value, people with Medicare and others may find the information interesting and informative. Access the Drug Spending Dashboard.
Beneficiary Advocates Urge Centers for Medicare & Medicaid Services to Correct Inaccuracies in Medicare & You Handbook for 2019 This week, the Medicare Rights Center, the Center for Medicare Advocacy, and Justice in Aging sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), on May 15, 2018, objecting to serious inaccuracies in the draft Medicare & You Handbook for 2019, and urging CMS to rectify the errors prior to disseminating the Medicare & You Handbook. Medicare & You is the official government publication designed to provide beneficiaries with factual information about the Medicare program, their choices for obtaining coverage, and the benefits they can expect. Unfortunately, the draft 2019 Handbook includes inaccurate descriptions of the differences between Original Medicare and private Medicare Advantage plans. Without fair and accurate information, older adults, people with disabilities and their families cannot make informed choices about their health care coverage. The letter to Ms. Verma voiced the three organizations’ concerns that the draft 2019 Handbook
distorts and mischaracterizes essential facts on which beneficiaries rely to make decisions about their coverage. First, it does not adequately inform beneficiaries of the significant limitations on choices of health care providers if they choose a Medicare Advantage plan rather than Original Medicare. In addition, it presents prior authorization in Medicare Advantage plans as a “right” that is not available in Original Medicare, rather than acknowledging that it is a requirement, an extra step mandated for Medicare Advantage members before they are permitted to access care. Further, the draft 2019 Handbook inaccurately implies that Medicare Advantage is the less expensive option for all beneficiaries. This sweeping generalization ignores the many variables that people with Medicare must consider in evaluating and selecting coverage that is most affordable and best suited for their needs. In a written statement,
Medicare Rights President Joe Baker stated, “From the Medicare Rights Center’s experience assisting people with Medicare and their families, we know how challenging it can be for beneficiaries to make the best coverage decision for their unique circumstances. The Medicare & You Handbook must support this decision-making process by accurately describing the rules, restrictions, and benefits of both Original Medicare and Medicare Advantage. Regardless of the coverage they ultimately select, all people with Medicare deserve the opportunity to make an informed choice. We commend CMS for incorporating many of the language changes we suggested in prior years, and urge the agency to address our concerns with the draft 2019 Handbook prior to its publication.” Also in the statement, Medicare Rights’ partners at the Center for Medicare Advocacy and Justice in Aging said the following:
Judith Stein, executive director of the Center for Medicare Advocacy, noted, “These can literally be life and death decisions. CMS has a duty to provide complete, unbiased information to help beneficiaries make the best choice for their Medicare coverage. Regrettably, the current version of Medicare & You does not fully and fairly inform people of the pros and cons of Original Medicare vs. Medicare Advantage. The draft Handbook needs to be corrected before it is published and sent to beneficiaries.” Kevin Prindiville, Executive Director of Justice in Aging stated: “Several proposed changes in the Handbook distort basic facts about how Medicare Advantage and Original Medicare work. People with Medicare rely on Medicare & You for accurate and objective information. If these changes were adopted, beneficiaries would not have the information they need to make fully informed decisions about their Medicare coverage.” Read the letter here.
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