Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Is this cost-saving Medicare proposal doomed?

Martha Rosenberg
Policy
January 3, 2019
Share
Tweet
Share

The Trump administration has proposed that insurance plans providing drug coverage to Medicare beneficiaries will no longer be forced to cover six hitherto “protected” drug classes. The classes — which include drugs for psychiatric conditions, cancer and immune diseases –– are among the priciest of all drugs and account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.

Under the proposal, Medicare plans could “exclude from their formularies protected class drugs with price increases that are greater than inflation, as well as certain new drug formulations that are not a significant innovation over the original product,” says Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.

In 2014, the Obama administration sought the same “price relief” for Medicare but was defeated by drug industry lobbyists. At the time, 100 pills of the “protected” psychiatric drug Abilify cost $1,644, 100 pills of the “protected” psych drug Geodon cost $958, 100 pills of the “protected” psychiatric drug Invega cost $1,789 and 100 pills of the “protected” psych drug Seroquel cost $2,000. Since then, even pricier psychiatric drugs have emerged as well as six-digit cancer drugs.

The Obama proposal was roundly defeated by drug industry-funded groups like the National Alliance on Mental Illness (NAMI). NAMI received $23 million in just two years from drug makers and is heavily financed by them.

The proposal “undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said NAMI lobbyist Andrew Sperling, one of many voices that defeated the proposal. “You get much better outcomes when a doctor can work with patients to figure out which medications will work best.” He might have added, as long as the taxpayer pays.

Such drug industry tactics are well known. “When insurers balk at reimbursing patients for new prescription medications, these groups typically swing into action, rallying sufferers to appear before public and consumer panels, contact lawmakers and provide media outlets a human face to attach to a cause,” writes Melissa Healy of the Los Angeles Times about this well-known Pharma tactic to loot Medicare dollars.

The six protected drug classes are not the only example of lobbyist-initiated regulations which protect nothing more than drug industry profits and its expensive psychiatric drugs, many of which have cheaper alternatives. In Texas, a Medicaid “decision tree” called the Texas Medical Algorithm Project was instituted that literally requires doctors to prescribe the newest psychiatric drugs first. It was, not surprisingly, funded by the Johnson & Johnson linked Robert Wood Johnson Foundation.

Drug industry lobbyists are already berating the new Trump Medicare proposal on behalf of the “sickest, most vulnerable Medicare beneficiaries” who they say will be hurt if taxpayers won’t fund its four- and five-digit priced drugs. Yet few to none of the newer psychiatric drugs show clear improvements over cheaper ones, and they all lack the safety profiles of older drugs that are widely in use. In fact, some drug safety groups recommend waiting several years to take a new drug — until its safety has been demonstrated through longer and wider use.

Will this cost-saving Medicare proposal be defeated as it was in 2014?

Martha Rosenberg is a health reporter and the author of Born With a Junk Food Deficiency.  

Image credit: Shutterstock.com 

Prev

68 laws of the ER

January 3, 2019 Kevin 7
…
Next

Average physicians are extraordinary

January 3, 2019 Kevin 3
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
68 laws of the ER
Next Post >
Average physicians are extraordinary

ADVERTISEMENT

More by Martha Rosenberg

  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • How drug companies turned “depression” into a billion-dollar industry

    Martha Rosenberg

Related Posts

  • Medicare’s historic proposal to change how it pays physicians

    Bob Doherty
  • Instead of Medicare for all, how about Medicare for more?

    Brian C. Joondeph, MD
  • Expensive Medicare patients aren’t who you think

    Peter Ubel, MD
  • The cost of avoiding cost: a medical student’s perspective

    Palak Patel
  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • The conservative appeal of Medicare for all

    Peter Ubel, MD

More in Policy

  • How fragmented records and poor tracking degrade patient outcomes

    Michael R. McGuire
  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Is this cost-saving Medicare proposal doomed?
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...