New Rules to Deprive Seniors of Drugs, Doctors
By Diana Furchtgott-Roth
Two provisions in lengthy proposed regulations
published by the Centers for Medicare and Medicaid Services in the
Federal Register on January 10 would deprive seniors of vital drugs and
make it more difficult for them to see their doctors.
These provisions should be changed before the regulations become final. Comments are due by March 7.
The
proposed regulations limit the drugs covered under Medicare's Part D,
the prescription drug component of the program, beginning in 2015.
Now
Part D plans have to include drugs within six drug classes, namely
antineoplastics, anticonvulsants, antiretrovirals, antipsychotics,
antidepressants, and immunosuppressants. CMS is proposing no longer to
require all drugs from the antidepressant and immunosuppressant drug
classes to be covered by Part D.
Seniors
would no longer necessarily have access to insurance for these drugs,
with serious consequences. Depression is the most frequent mental
health problem in the elderly, and lack of treatment can lead suicide.
Depressed patients can cause difficulties for family members and
caregivers.
Immunosuppressant
drugs are used in the case of a transplant, to prevent the body from
rejecting a transplanted organ. Cutting back on these drugs mean that
transplants would be more risky and less successful. This would decrease
life expectancy of seniors.
CMS
calculates that the savings from disallowing these drugs would be $720
million over the five-year period 2015 to 2019. That is $144 million a
year, two tenths of one percent of the $677 billion in net Medicare
outlays in 2019. In comparison, spending on HIV/AIDS remains untouched,
at almost $30 billion in 2014.
Reducing
access to major classes of drugs that were required from the beginning
of the Part D program would cut Medicare costs by shortening seniors'
lives, but it is not the direction in which our society wants to go.
Congress should demand a true cost-benefit analysis of trimming
antidepressant and immunosuppressant drugs, including a calculation of
the value of lives that could have been saved with the drugs.
As well as depriving seniors of drugs, CMS wants to deprive them of their doctors.
Doctors
are dropping out of Medicare due to low reimbursements and massive
paperwork. But under the proposed regulations, if seniors receive
prescriptions from doctors who do not participate in Medicare, these
prescriptions cannot be covered under Part D. This holds even if the
senior is paying for Part D.
Since
pharmaceuticals are often costly, this regulation, if made final, would
have the practical effect of requiring seniors to see doctors who are
enrolled in Medicare.
In
2012 another 9,500 doctors left Medicare, according to CMS. (Data are
not yet available for 2013.) This is happening as baby boomers are
turning 65 and signing up for Medicare and Social Security in record
numbers.
Doctors can be
"nonparticipating," where they file claims to Medicare but charge more
and bill patients for the difference. Doctors can also opt out of
Medicare entirely. They file no claims and patients pay out of pocket.
Under
the Affordable Care Act, physicians who order medical devices and home
health care must be enrolled in Medicare. The newly-proposed rules would
extend this to drugs and all other Medicare services.
Regulations
say that this is to prevent fraud and abuse, but the clear intention is
to prevent seniors from visiting physicians outside the Medicare
system. The government program is becoming increasingly unattractive to
both patients and providers, so CMS wants to make sure that no one
leaves.
Of course, if
seniors visited doctors privately, that would save Medicare the cost of
the visit. But CMS says that the proposal does not have any costs or
savings, because "we presume that if a beneficiary's prescriber is not
enrolled or does not enroll in Medicare, the beneficiary will find a new
prescriber who is enrolled, rather than go without needed medications.
Therefore, we do not estimate any savings from this proposal."
This
reasoning neglects the cost of a patient's time, a patient who might
not be able to find a convenient Medicare provider within a reasonable
period. It also neglects the peace of mind for those who have seen a
doctor for years and who will be forced to see a different one.
The
language in the CMS fact sheet announcing the proposed rule is
positively Orwellian and reflects the CMS mindset. On page 2 it reads,
"In order to ensure that beneficiaries have better access to health plan
services....CMS proposes that Prescription Drug Plan Sponsors offer no
more than two Part D plans in the same service area." It makes no sense
that to offer better access the number of Part D plans is being
limited.
The newly-passed
fiscal year 2014 budget cuts $10 million from the Independent Payment
Advisory Board, which was given the power under the Affordable Care Act
to disallow medical drugs, devices, and procedures that the Board deemed
too costly and therefore inefficient. But the new regulations show that
CMS has taken over the rationing role.
As
our economy grows and society gets wealthier, it is natural that people
want to spend more on health care, making their lives longer and more
comfortable. By reducing seniors' freedom to contract with private
doctors, and taking vital drugs out of the Medicare program, CMS is
being penny-wise and pound-foolish.
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