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Post by boca1girl on Feb 1, 2019 13:11:01 GMT -5
Feb 1, 2019 consumer.healthday.com/health-technology-information-18/press-medical-and-health-reporting-news-552/health-highlights-feb-1-2019-742264.htmlMedicare/Medicaid Drug Rebates Would be Banned Under Trump Administration Proposal A proposal to ban drug companies from giving rebates to pharmacy benefit managers and insurers in Medicare Part D- and Medicaid-managed care plans was announced Thursday by the Trump administration. Instead of those rebates, drug makers would be urged to provide discounts directly to pharmacy customers, and pharmacy benefit managers would receive a set fee, CNN reported. The proposal would be a major change and was welcomed by the drug industry, but criticized by insurers and pharmacy benefit managers. "If this rule goes into effect in its current form, it would be the largest change the administration has yet announced on drug pricing," Rachel Sachs, an associate law professor at Washington University, told CNN. Currently, pharmacy benefit managers negotiate rebates from drug makers to insurers in exchange for better coverage terms -- typically lower copays for brand-name drugs. The goal is to get insurers' enrollees to choose that cheaper brand-name medication over a competitor's version. Pharmacy benefit managers keep a part of the rebate, CNN reported. In 2016, insurers received $89 billion in rebates, lowering their spending on prescription drugs to $279 billion in 2016, according to estimates from the research and consulting firm Altarum. That doesn't include the portion of the rebate kept by pharmacy benefit managers, which is not made public, CNN reported. The proposal's impacts are uncertain. While Medicare and Medicaid patients with high drug costs would save money, there could be higher premiums for all beneficiaries. About 30 percent of Medicare Part D enrollees spend enough that their savings under the proposal would likely exceed any premium hikes, according to the Trump administration, CNNreported. And because the government provides various subsidies in the Part D program, federal spending could rise between $35 billion and $196 billion over 10 years, projections suggest. Another unknown is how the proposal will affect drug costs for the more than 150 million Americans who get their insurance through work, CNN reported. Drug makers are responsible for high drug costs and this proposal could boost patients' drug costs, according to the Pharmaceutical Care Management Association, which represents pharmacy benefit managers, and America's Health Insurance Plans, an industry group for insurers. "PBMs keep coverage affordable by negotiating rebates with drug-makers, which are used to enhance benefits and reduce beneficiary cost sharing and premiums," JC Scott, the association's president, told CNN. Drug makers say high drug prices are the fault of others. "This proposal would also fix the misaligned incentives in the system that currently result in insurers and pharmacy benefit managers favoring medicines with high list prices," Stephen Ubl, chief executive of PhRMA, a trade group for drug makers, told CNN. The proposal was panned by some Democrats. "The Trump administration's rebate proposal will increase government spending by nearly $200 billion and the majority of Medicare beneficiaries will see their premiums and total out-of-pocket costs increase if this proposal is finalized," Reps. Richard Neal of Massachusetts and Frank Pallone of New Jersey said in a statement, CNN reported. "While we agree that the cost of prescription drugs must be addressed, we are concerned that this is not the right approach," they said. Sent from my iPad |
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Post by seanismorris on Feb 1, 2019 13:15:27 GMT -5
I don’t know if this is the solution but it’s worth a shot, after the half assed plans put forth by both parties, it’s unlikely to make things worse.
If it makes the insurance companies squeal it’s probably a step in the right direction.
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Post by mnkdfann on Feb 1, 2019 14:06:02 GMT -5
Feb 1, 2019 consumer.healthday.com/health-technology-information-18/press-medical-and-health-reporting-news-552/health-highlights-feb-1-2019-742264.htmlMedicare/Medicaid Drug Rebates Would be Banned Under Trump Administration Proposal A proposal to ban drug companies from giving rebates to pharmacy benefit managers and insurers in Medicare Part D- and Medicaid-managed care plans was announced Thursday by the Trump administration. Instead of those rebates, drug makers would be urged to provide discounts directly to pharmacy customers, and pharmacy benefit managers would receive a set fee, CNN reported. The proposal would be a major change and was welcomed by the drug industry, but criticized by insurers and pharmacy benefit managers. I don't know enough about the topic to have an opinion about it being a good or bad thing for most individuals, but it looks to be yet another victory for BP. www.businessinsider.com/trump-administration-drug-rebate-proposal-could-benefit-pharma-2019-2The drug industry lobbying group PhRMA, which once ran an ad campaign to highlight that drug discounts don't always get passed down to patients, praised the new Trump administration proposal.
"We applaud the Administration for taking steps to reform the rebate system to lower patients' out-of-pocket costs," Stephen Ubl, president and CEO of PhRMA, said in a statement.
Ubl went on to describe the move as fixing the "misaligned incentives" in the US drug system, and said it would help patient with persistent, chronic diseases like diabetes in particular.
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Post by brianrocco on Feb 1, 2019 14:21:19 GMT -5
My understanding is that the rebates paid to PBMs are used by the large drug manufacturers to restrict competition for their high volume branded drugs. The big insulin sellers are using rebates to PBMs to restrict insurance coverage of Afrezza. It seems to me that Afrezza would get better insurance coverage if all rebates were disallowed, not just for Medicare and Medicaid.
Perhaps Mannkind shareholders could help increase insurance coverage of Afrezza by explaining to their congressional representatives (particularly those on the House Committee for Government Oversight and the Senate Finance Committee that are looking into pharmaceutical pricing) how rebates are used to restrict competition from small and new competitors. However, I would be more comfortable if Sport or someone could check with Mike C. to see if he supported such efforts.
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Post by agedhippie on Feb 1, 2019 15:27:24 GMT -5
It would be interesting to see how this plays out. If rebates disappear then it all comes down to the discount. If the PBM gets a percentage of the discount there is still going to be an incentive for pharmas to keep prices high. If they don't get a percentage of the discount then the model flips and PBMs need to get low prices regardless of the apparent discount. It becomes no longer necessary to maintain high list prices. The businesses contracting them want the lowest cost so PBMs will have to compete on raw price.
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Post by mango on Feb 1, 2019 18:16:56 GMT -5
Feb 1, 2019 consumer.healthday.com/health-technology-information-18/press-medical-and-health-reporting-news-552/health-highlights-feb-1-2019-742264.htmlMedicare/Medicaid Drug Rebates Would be Banned Under Trump Administration Proposal A proposal to ban drug companies from giving rebates to pharmacy benefit managers and insurers in Medicare Part D- and Medicaid-managed care plans was announced Thursday by the Trump administration. Instead of those rebates, drug makers would be urged to provide discounts directly to pharmacy customers, and pharmacy benefit managers would receive a set fee, CNN reported. The proposal would be a major change and was welcomed by the drug industry, but criticized by insurers and pharmacy benefit managers. "If this rule goes into effect in its current form, it would be the largest change the administration has yet announced on drug pricing," Rachel Sachs, an associate law professor at Washington University, told CNN. Currently, pharmacy benefit managers negotiate rebates from drug makers to insurers in exchange for better coverage terms -- typically lower copays for brand-name drugs. The goal is to get insurers' enrollees to choose that cheaper brand-name medication over a competitor's version. Pharmacy benefit managers keep a part of the rebate, CNN reported. In 2016, insurers received $89 billion in rebates, lowering their spending on prescription drugs to $279 billion in 2016, according to estimates from the research and consulting firm Altarum. That doesn't include the portion of the rebate kept by pharmacy benefit managers, which is not made public, CNN reported. The proposal's impacts are uncertain. While Medicare and Medicaid patients with high drug costs would save money, there could be higher premiums for all beneficiaries. About 30 percent of Medicare Part D enrollees spend enough that their savings under the proposal would likely exceed any premium hikes, according to the Trump administration, CNNreported. And because the government provides various subsidies in the Part D program, federal spending could rise between $35 billion and $196 billion over 10 years, projections suggest. Another unknown is how the proposal will affect drug costs for the more than 150 million Americans who get their insurance through work, CNN reported. Drug makers are responsible for high drug costs and this proposal could boost patients' drug costs, according to the Pharmaceutical Care Management Association, which represents pharmacy benefit managers, and America's Health Insurance Plans, an industry group for insurers. "PBMs keep coverage affordable by negotiating rebates with drug-makers, which are used to enhance benefits and reduce beneficiary cost sharing and premiums," JC Scott, the association's president, told CNN. Drug makers say high drug prices are the fault of others. "This proposal would also fix the misaligned incentives in the system that currently result in insurers and pharmacy benefit managers favoring medicines with high list prices," Stephen Ubl, chief executive of PhRMA, a trade group for drug makers, told CNN. The proposal was panned by some Democrats. "The Trump administration's rebate proposal will increase government spending by nearly $200 billion and the majority of Medicare beneficiaries will see their premiums and total out-of-pocket costs increase if this proposal is finalized," Reps. Richard Neal of Massachusetts and Frank Pallone of New Jersey said in a statement, CNN reported. "While we agree that the cost of prescription drugs must be addressed, we are concerned that this is not the right approach," they said. Sent from my iPad Richard Neal and Frank Pallone both played large roles in Affordable Health Care for America Act. And bout everything in there came from CNN. Just sayin' 😐🤐 |
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Post by mango on Feb 1, 2019 18:33:44 GMT -5
Why was the Richard Neal quote included? "Over his two-decade career in the House, Neal has relied on support from the health care industry, receiving $950,000 from health professionals and associations and $750,000 from the pharmaceutical industry, according to data compiled by the Center for Responsive Politics. Neal also received $2.4 million from the insurance industry, which includes health insurers amongst other types of insurance companies, more than any other member of the incoming 116th Congress. Unlike the majority of House Democrats, Neal has never signed on as a cosponsor of H.R. 676, a Medicare for All bill that has been introduced in the House every session since 2003. In his interview with the Hampshire Daily Gazette, Neal said one of his health care priorities would be bringing back the tax penalty related to the individual mandate requiring all people to purchase or otherwise have health insurance. The insurance industry opposed the repeal of the individual mandate tax that was passed in 2017." readsludge.com/2018/12/05/richard-neal-medicare-for-all-block-progressive-health-care-bills-ways-means-committee/www.opensecrets.org/members-of-congress/summary?cid=N00000153&cycle=2018&type=I |
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Post by itellthefuture777 on Feb 2, 2019 11:53:31 GMT -5
Feb 1, 2019 consumer.healthday.com/health-technology-information-18/press-medical-and-health-reporting-news-552/health-highlights-feb-1-2019-742264.htmlMedicare/Medicaid Drug Rebates Would be Banned Under Trump Administration Proposal A proposal to ban drug companies from giving rebates to pharmacy benefit managers and insurers in Medicare Part D- and Medicaid-managed care plans was announced Thursday by the Trump administration. Instead of those rebates, drug makers would be urged to provide discounts directly to pharmacy customers, and pharmacy benefit managers would receive a set fee, CNN reported. The proposal would be a major change and was welcomed by the drug industry, but criticized by insurers and pharmacy benefit managers. "If this rule goes into effect in its current form, it would be the largest change the administration has yet announced on drug pricing," Rachel Sachs, an associate law professor at Washington University, told CNN. Currently, pharmacy benefit managers negotiate rebates from drug makers to insurers in exchange for better coverage terms -- typically lower copays for brand-name drugs. The goal is to get insurers' enrollees to choose that cheaper brand-name medication over a competitor's version. Pharmacy benefit managers keep a part of the rebate, CNN reported. In 2016, insurers received $89 billion in rebates, lowering their spending on prescription drugs to $279 billion in 2016, according to estimates from the research and consulting firm Altarum. That doesn't include the portion of the rebate kept by pharmacy benefit managers, which is not made public, CNN reported. The proposal's impacts are uncertain. While Medicare and Medicaid patients with high drug costs would save money, there could be higher premiums for all beneficiaries. About 30 percent of Medicare Part D enrollees spend enough that their savings under the proposal would likely exceed any premium hikes, according to the Trump administration, CNNreported. And because the government provides various subsidies in the Part D program, federal spending could rise between $35 billion and $196 billion over 10 years, projections suggest. Another unknown is how the proposal will affect drug costs for the more than 150 million Americans who get their insurance through work, CNN reported. Drug makers are responsible for high drug costs and this proposal could boost patients' drug costs, according to the Pharmaceutical Care Management Association, which represents pharmacy benefit managers, and America's Health Insurance Plans, an industry group for insurers. "PBMs keep coverage affordable by negotiating rebates with drug-makers, which are used to enhance benefits and reduce beneficiary cost sharing and premiums," JC Scott, the association's president, told CNN. Drug makers say high drug prices are the fault of others. "This proposal would also fix the misaligned incentives in the system that currently result in insurers and pharmacy benefit managers favoring medicines with high list prices," Stephen Ubl, chief executive of PhRMA, a trade group for drug makers, told CNN. The proposal was panned by some Democrats. "The Trump administration's rebate proposal will increase government spending by nearly $200 billion and the majority of Medicare beneficiaries will see their premiums and total out-of-pocket costs increase if this proposal is finalized," Reps. Richard Neal of Massachusetts and Frank Pallone of New Jersey said in a statement, CNN reported. "While we agree that the cost of prescription drugs must be addressed, we are concerned that this is not the right approach," they said. Sent from my iPad Angers me that PBM force Americans to less clinically effective drugs..even when insured..they deserved a swift kick in the nutz |
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Post by mnholdem on Feb 2, 2019 17:07:27 GMT -5
What angers me more is that sufficient clinical trial evidence exists that Short Term Intensive Insulin treatment is proven to result in a nearly 50% drug-free remission of diabetes and, yet, the ADA and AACE still place insulin last in the Diabetes Standard of Care (which virtually guarantees the destruction of insulin-procing beta cells) rather than the first treatment for early diagnoses of Type 2 diabetes.
It’s not just the Big Pharma companies that should be grilled.
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Post by nylefty on Feb 2, 2019 18:28:59 GMT -5
There continues to be a lot of confusion on this board about Medicare. It covers prescription drugs that are administered in doctors' offices or hospitals, but it does not cover drugs that Medicare recipients get at pharmacies or by mail order. However, Medicare does have some rules for the commercial supplemental plans that are offered to Medicare recipients. If you go to Medicare.gov you'll see that Medicare requires those supplemental plans to cover at least two drugs in "the most commonly prescribed categories and classes," and that's where we have a problem. However, I've been on Medicare for twenty years and my supplemental plan (for GE retirees) does cover Afrezza (with a prior authorization requirement) -- but you'd never know that by looking at FormularyLookup.com, since the GE plan for its retirees is not listed among the Medicare plans there. I don't know how many GE retirees are covered under this plan, but it's got to be in the many, many thousands (I worked for NBC, which at the time I retired was owned by GE). Here's what Medicare.gov says: Most Medicare drug plans have their own list of covered drugs, called a formulary. Plans cover both generic and brand-name prescription drugs. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need. All Medicare drug plans generally must cover at least 2 drugs per drug category, but plans can choose which specific drugs they cover.
The formulary might not include a specific drug you use. However, in most cases, a similar drug should be available. If you or your prescriber (your doctor or other health care provider who’s legally allowed to write prescriptions) believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception.
A Medicare drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.
Plans may immediately remove drugs from their formularies after the Food and Drug Administration (FDA) considers them unsafe or if their manufacturer removes them from the market. If you’re currently taking these drugs, you’ll get information about the specific changes made afterwards.
For other changes involving a drug you’re currently taking that will affect you during the year, your plan must do one of these:
Give you written notice at least 60 days before the date the change becomes effective (for 2019 and beyond, at least 30 days); or
At the time you request a refill, provide written notice of the change and a 60-day supply of the drug (for 2019 and beyond, at least a month’s supply) under the same plan rules as before the change.
For 2019 and beyond, plans meeting certain requirements also can immediately remove brand name drugs from their formularies and replace them with new generic drugs, or they can change the cost or coverage rules for brand name drugs when adding new generic drugs. If you’re taking these drugs, you’ll get information about the specific changes made afterwards.
You may need to change the drug you use or pay more for it. You can also ask for an exception. Generally, using drugs on your plan’s formulary will save you money. If you use a drug that isn’t on your plan’s drug list, you’ll have to pay full price instead of a copayment or coinsurance, unless you qualify for a formulary exception. All Medicare drug plans have negotiated to get lower prices for the drugs on their drug lists, so using those drugs will generally save you money. Also, using generic drugs instead of brand-name drugs may save you money.
www.medicare.gov/drug-coverage-part-d/what-drug-plans-cover |
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