Archives for June 2020

Protect Our Free-Market, Consumer-Based Medicare Part-D Plans

Author: Ron Hall

Over the past year, we have all learned the critical importance of maintaining the integrity of our prescription drugs supply chains.

With over 90% of prescription drugs now generic, the need to keep drug prices low has driven manufacturing and raw materials procurement to India and China.

Our experiences during the COVID-19 crisis prove the global supply chain is simply not reliable. It is too vulnerable to population health distortions, political pressure, and volatile market conditions.

The United States has the highest prescription drug costs in the world. Because of this, seniors are burdened. Most seniors like myself, live on fixed incomes and depend on Medicare Part D to control their costs. Almost 20% of Arizona’s population is over 65 and we all share responsibility for ensuring their needs are met.

In 2006, Congress created a prescription drug benefit known as Medicare Part D.  Today, it benefits Arizona seniors when they purchase a stand-alone prescription drug plan or enroll in a Medicare Advantage Plan, similar to an HMO. 

Every year, seniors can choose the Part D or Medicare Advantage Plan that best suits their individual needs. 

To attract seniors, plans must deliver on both price and service. Since low monthly premiums and co-pays appeal to seniors, plans have an incentive to negotiate with drug manufacturers.

Consumer choice and free-market competition, which are the backbone of Part D’s design, have resulted in a government benefit with impressive satisfaction rates above 90%. In addition, the cost to the Medicare Trust Fund and seniors, as measured by the average monthly premium, are substantially less than predicted when Part D became law. A claim few, if any, government benefit programs can make. 

At a time when we are depending on America’s innovative technologies and scientists to develop therapeutics and vaccines that treat or prevent COVID-19, we are reminded that many seniors also depend on lifesaving pharmaceuticals and must be able to afford them.

Congress is considering a few policy changes that don’t undermine the intent of Part D and Medicare Advantage plans – a free-market, consumer choice for all seniors.

These new policy changes include two bills; S. 3129 presented by Senator Mike Crapo and H.R. 19 from Congressman Greg Walden. They include provisions that cap annual out of pocket costs, allow deductible payments over 12 months, and drastically lower the price of insulin. They also make sure the savings, which plans negotiate with drug companies, are passed directly onto enrolled seniors.

Smart solutions to lowering drug costs must provide relief to seniors without throttling research and slowing the introduction of new therapies and cures. 

In the midst of the COVID-19 pandemic, we are proud of the thousands of Arizonans who work and contribute to the thriving biopharmaceutical and biotech industries across the state.

Within weeks of the COVID-19 outbreak, Arizona innovators and university partners began protective equipment while therapeutics and vaccines were fast-tracked into clinical trials.

The eyes of the world are focused on Arizona’s success in urgently deploying collaborative, pragmatic solutions that benefit Americans and protect public health.

Our quick actions have not only accelerated the sustaining economic value of innovation in our local communities but prove that onerous regulations and oppressive government oversight often inhibit access to essential needs and modern technologies.

This pandemic is teaching us a lot about what we must do to prepare for the future, but it is also reminding us of what we should NOT do.

I’m grateful we are focused on building a better Arizona, together.

Ron Hall is a medicare part-d patient and republican living in Congressional District 5.

President Trump worked with drug manufacturers to lower insulin co-pays to $35

Recently, under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. Across the nation, participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap. The model follows on the Trump Administration’s previously announced 13.5 percent decline in the average monthly basic Part D premium since 2017 to the lowest level in seven years.

Currently, Part D sponsors may offer prescription drug plans that provide lower cost-sharing in the coverage gap; however, when they do, the Part D sponsor accrues costs that pharmaceutical manufacturers would normally pay. These costs are then passed on to beneficiaries in the form of higher premiums. The new insulin model directly addresses this disincentive by doing two things: 1) allowing manufacturers to continue paying their full coverage gap discount for their products, even when a plan offers lower cost-sharing; and 2) requiring participating Part D sponsors’ plans, in part through applying manufacturer rebates, to lowering cost-sharing to no more than $35 for a month’s supply for a broad set of insulins.

Under President Trump’s leadership, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap. Both manufacturers and Part D sponsors responded to this market-based solution in force and seniors that use insulin will reap the benefits.

Based on CMS’s estimates, beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model. With a robust voluntary response from Part D sponsors, CMS anticipates beneficiaries will have Part D plan options in all 50 states, the District of Columbia, and Puerto Rico, through either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with prescription drug coverage. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.

“President Trump has forged partnerships with pharmaceutical manufacturers and plans to deliver lower priced insulin to our nation’s seniors,” said CMS Administrator Seema Verma. “This market-based solution, in which insulin manufacturers and Part D sponsors compete to provide lower costs and higher quality for patients, will allow seniors to choose a Part D plan that covers their insulin at an average 66 percent lower out-of-pocket cost throughout the year.”

The Part D Senior Savings Model – which was announced on March 11, 2020 – is a voluntary model that tests the impact on insulin access and care by participating Part D enhanced alternative plans offering lower out-of-pocket costs, at a maximum $35 copay for a month’s supply, for a broad range of insulins.

Part D sponsors that participate in the model will offer beneficiaries Part D prescription drug plans that provide supplemental benefits for a broad range of insulins, including both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins. Participating pharmaceutical manufacturers will continue to pay their current 70 percent discount in the coverage gap for their insulins that are included in the model, and based on the model’s waiver of current regulations, those manufacturer discount payments will be calculated before the application of supplemental benefits under the model – which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries.

One in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For some of these beneficiaries, access to insulin is a critical component of their medical management, with gaps in access increasing risk of serious complications, ranging from vision loss to kidney failure to foot ulcers to heart attacks. Unfortunately, the costs of insulin can be a major barrier to appropriate medical management of diabetes.

A beneficiary’s out-of-pocket costs for insulin in Medicare’s Part D prescription drug benefit can fluctuate from one month to the next, in part due to the different rules applying for each phase of the Part D benefit. This can be challenging for beneficiaries when budgeting for their drug costs. These challenges can in turn lead to beneficiaries not being able to afford their medicine or resorting to medication rationing, resulting in worse health outcomes over time. The model aims to address this with stable, predictable costs for insulin that beneficiaries know up front by staying in or choosing a model-participating plan during open enrollment.

Part D sponsors that applied must submit their calendar year 2021 plan benefits to CMS by June 1, 2020 to designate their participation in the model. CMS anticipates releasing the premiums and costs for specific Medicare health and drug plans for the 2021 calendar year in September 2020, including final information on the model.

Beneficiaries will be able to find a Part D plan participating in the Part D Senior Savings Model in the 2021 plan year through the Medicare Plan Finder on Medicare.gov during the annual open enrollment period, which begins on October 15, 2020 and ends December 7, 2020. CMS will enhance the Medicare Plan Finder to include a filter to identify plans that will offer capped out-of-pocket costs for insulin in the model so beneficiaries can easily find those plans during open enrollment in the Fall. The Medicare Plan Finder, which was upgraded for the first time in a decade last year, is the most used tool on Medicare.gov and allows users to shop and compare Medicare Advantage and Part D plans.

The Part D Senior Savings Model builds on steps the Trump Administration has already taken to strengthen Medicare and improve the quality of care for patients with diabetes. CMS has taken the following actions to address the needs of beneficiaries with diabetes:

·        Providing coverage for therapeutic continuous glucose monitors (CGM) for patients who synchronize their insulin devices with their smartphones, when used in conjunction with a durable CGM receiver.

·        Allowing Medicare Advantage plans to offer a broader range of supplemental benefits tailored to a patient’s chronic disease. For an enrollee living with diabetes for example, a plan could provide transportation to a doctor’s appointment, diabetes education programs, or time with a nutritionist.

To respond to the coronavirus disease 2019 (COVID-19) public health emergency, CMS has taken additional actions to ensure that beneficiaries with diabetes have access to treatment and care by:

·        Implementing statutory requirements for Medicare Part D prescription drug sponsors and MA plans with a prescription drug benefit to allow enrollees to obtain prescription fills or refills of covered Part D drugs—including insulin—for up to a three-month supply in most instances.

·        Providing additional flexibility to Part D sponsors to give beneficiaries more options for delivery of their medications – including their diabetes supplies — such as mail or home delivery through retail pharmacies.  

·        Expanding telehealth so that people with diabetes, nationwide, can still maintain access to their doctor.

·        Expanding access to therapeutic continuous glucose monitors for patients with diabetes as determined medically appropriate by practitioners. Previously, patients were required to meet certain clinical criteria to qualify for coverage of a therapeutic continuous glucose monitor under Medicare. During the COVID-19 public health emergency, CMS will not enforce the clinical indications in Local Coverage Determinations for therapeutic continuous glucose monitors in an effort to give practitioners the flexibility to allow more of their diabetic patients to better monitor their glucose and adjust insulin doses from home. 

More information on the Part D Senior Savings Model can be viewed at: https://innovation.cms.gov/initiatives/part-d-savings-model

To read a New England Journal of Medicine perspective on Medicare Part D and insulin affordability, please visit: https://www.nejm.org/doi/full/10.1056/NEJMp2001649

NTU Poll: Arizona Taxpayers Oppose Wasteful Spending on Anti-Tech Battles

Even as some elected officials insist on continuing probes of America’s tech sector, solid majorities of voters think those investigations are a poor use of time as well as tax dollars. That’s just one warning in a new survey released today from National Taxpayers Union (NTU) asking Arizona concerning the economy, technology, and how Arizona’s Attorney General should invest limited taxpayer resources. The survey of 500 likely Arizona voters was conducted by the respected firm Fabrizio, Lee & Associates, which has advised a number of campaigns, over May 12-17.

NTU conducted this survey amid an increased interest by Congress, the Department of Justice, and State Attorneys General in pursuing antitrust investigations and lawsuits against several American tech companies. For more than 25 years, NTU has warned policymakers about the lasting negative impact of antitrust investigations on economic innovation, consumer welfare, and the development of technologies that make government more efficient, effective and responsive to taxpayer needs. The organization has likewise voiced concerns over taxpayer resources being directed toward such often- destructive litigation, whether the issues have been software “tying,” search regulation, or the latest accusations of excessive market power in advertising. Throughout this time, NTU research and analysis has made the case for a light-touch approach toward competition regulation in order to safeguard consumers and taxpayers.

On the most important priority for the state’s top prosecutor, the largest groups of voters suggested a focus on combating human trafficking (22%) and price gouging (18%), while the share focused on investigating companies for antitrust violations (3%) fell below the margin of error. Among GOP voters, the gap between the top answer (human trafficking) and bottom answer (antitrust) was even wider, at 27% and 2%, respectively. The survey also examined fraud, elder abuse, criminal prosecutions, and other issues. “Arizona voters expect officials to be mindful of taxpayer dollars, and the office of Attorney General is no exception,” said Pete Sepp, President of NTU. “Especially in today’s budgetary environment, limited resources need to stay focused on serious threats to consumers’ pocketbooks, but all too many Attorneys General across the country have instead been focused on grabbing headlines with issues that rank low in importance with most Americans.”

Asked where they would least like to see the State Attorney General spend tax dollars, among the most common answers were suing drug manufacturers over addiction to pain killers (20%) and investigating companies for antitrust violations (17%). In general, tech companies were viewed positively by Arizona voters (37% favorable, 9% unfavorable), with individual companies viewed favorably by as much as 75% of respondents.

“States face massive budget shortfalls as the result of COVID-19 shutdowns and those will have to be made up either with service cuts or higher taxes,” Sepp observed. “Both are unpalatable to American voters, particularly if their future is shortchanged so that their Attorney General can tilt at far away windmills which have at best tenuous links to the state.”

The survey also found that respondents were sensitive to the state budget crunch caused by COVID-19. A large majority of Democrats (75%), Independents (68%), and Republicans (64%) all indicated that spending tax dollars to investigate tech companies is a “minor priority” or “not a priority at all” given the financial strain caused by coronavirus.

“At a time when European competition regulators are effectively creating trade barriers to our firms abroad, we can’t afford to squander public resources here at home on politically driven campaigns against American businesses large and small,” Sepp concluded. “The Attorney General is there to defend the public, not attack the businesses that are meeting unique challenges and delivering for Americans during the pandemic.”

Detailed results are available here.