Elections have consequences, and one positive consequence of the midterms is that the new House majority is serious about reducing drug prices for seniors. Last week, Democrats introduced legislation to allow Medicare to negotiate prices directly with pharmaceutical companies. This week, the new chairman of a key House committee, Rep. Elijah Cummings (D-MD), announced an investigation into skyrocketing drug costs.
“It’s time to provide much-needed relief to the American people. They should not have to decide between paying their bills or paying for their prescriptions. We need real and immediate action to lower drug prices in this country. The American people deserve that, and I will do everything I can to help deliver that for them.” – Rep. Elijah Cummings
Cummings has just sent letters to 12 large drug companies demanding details and documents about the companies’ pricing practices. They include industry giants like AstraZeneca, Eli Lilly, Johnson & Johnson, Novartis, Novo Nordisk, and Pfizer, whose profits and CEO compensations are – to say the least – quite healthy.
Despite tepid pleas from the Trump administration, Big Pharma hiked the prices of hundreds of medications at the beginning of the year. According to Cummings’ office, some 94% of the most often prescribed brand-name drugs more than doubled in price between 2005 and 2017.
Meanwhile, the percentage of Medicare Part D beneficiaries who paid at least $2,000 out-of-pocket for prescriptions nearly doubled from 2011 to 2015.
Seniors living on fixed incomes are the least able to afford rising drug prices. The average Medicare beneficiary has about $25,000 in annual income, which is only 200% of the federal poverty level. Too many seniors still must choose between groceries and prescription drugs – or cutting pills in half to save money.
This is not lost on Congressman Cummings and like-minded elected leaders on Capitol Hill. Rep. Cummings and Senator Bernie Sanders (I-VT) rolled out an ambitious package of bills last week that could make a serious dent in drug prices:
- The Prescription Drug Price Relief Act, which would peg the price of prescription drugs in the United States to the median price in five major countries: Canada, the United Kingdom, France, Germany and Japan;
- The Medicare Drug Price Negotiation Act, which would direct the Secretary of Health and Human Services (HHS) to negotiate lower prices for prescription drugs under Medicare Part D;
- The Affordable and Safe Prescription Drug Importation Act, which would allow patients, pharmacists and wholesalers to import safe, affordable medicine from Canada and other major countries.
If enacted, these bills would save Americans and the federal government billions of dollars in prescription drug costs. In fact, Stat news reported that the government could have saved more than $14 billion on the 50 most frequently prescribed medications in 2016 if Medicare were able to negotiate prices with Big Pharma like the Department of Veterans Affairs does.
There are myriad other proposals to bring down drug prices, recapped nicely by Dylan Scott in Vox earlier this week. These include measures to expedite the production of lower-priced generic drugs, cap patients’ out-of-pocket costs, allow the government to manufacture certain medications, and reform the U.S. patent system. “The current proposals on the table range from the realistic to the purely aspirational,” Scott observes. “Drug prices are a thorny problem. What we do know for sure is people want something done.”
While the government shutdown rightly dominates the headlines, there is activity on Capitol Hill to address another urgent issue: rising prescription drug prices. At the beginning of the year, the Wall Street Journal reported that more than three dozen pharmaceutical companies hiked the prices of hundreds of medicines, despite the Trump administration’s pleas that they be lowered. Rising drug prices continue to pummel the pocketbooks of seniors living on fixed incomes. Too many older Americans are still having to choose between groceries and medicine – or cutting pills in half.
But the tide may be turning. Champions of seniors are assuming powerful committee chairmanships in the House of Representatives. Momentum is building for legislation – some of it solidly bipartisan – that would help bring prescription drug prices under control. In other words, the new Congress may begin to stand up to Big Pharma:
Hope is strong among health-care advocates and lawmakers that 2019 could be the year Congress and the executive branch finally make significant moves against the powerful prescription drug industry, after long acknowledging a need for action but doing little about it. – Washington Post, 1/7/19
Members of the new 116th Congress are introducing bills to bring seniors some relief at the pharmacy counter. On Thursday, Senator Bernie Sanders (I-VT) and Congressman Elijah Cummings (D-MD) unveiled legislation that would, among other things, direct the Medicare program to negotiate prescription drug prices with pharmaceutical companies. (The U.S. Veterans Administration has been doing it for years.) Congressional Democrats estimate that these negotiations would save Medicare beneficiaries at least $15 billion a year.
On the House side, Congressman Lloyd Doggett (D-TX) will re-introduce similar legislation. (With the Democratic takeover of the House, Doggett is expected to become chairman of the influential House Ways and Means health subcommittee.) His bill would allow the Secretary of Health & Human Services to directly negotiate prices for prescription drugs. If negotiations were to fail, Doggett’s bill would empower the HHS Secretary to issue a competitive license allowing other manufacturers to produce the drug for Medicare.
The Hill reports that the new House leadership, including Speaker Nancy Pelosi and House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) support allowing Medicare to negotiate prescription drug prices.
Momentum also appears to be gathering for legislation affecting generic drugs. Big pharmaceutical companies have long engaged in anti-competitive behavior to keep lower cost generic drugs off the market. The bipartisan CREATES Act would make it harder for brand name drug-makers to impede cheaper generic competition. According to The Hill, the CREATES Act enjoys the support of many Republicans, including Senator Chuck Grassley (R-Iowa), the new chair of the Senate Finance Committee.
While Senator Grassley is on the wrong side of the Medicare price negotiation issue, he has joined forces with Democratic Senator Amy Klobuchar (D-MN) on the Preserve Access to Affordable Generics Act. The bill would prohibit “pay-for-delay” deals where pharmaceutical companies pay producers of generic drugs to delay rolling out those medications.
On the other end of Pennsylvania Avenue, President Trump (who said in 2017 that drug companies were “getting away with murder”) has proposed some administrative measures to lower drug prices. Unfortunately, most of these have been weak tea – and seemingly designed not to offend Big Pharma. Instead of waiting to see if the Trump administration will do more than nibble around the edges of the problem, many in the new Congress appear ready to try to alleviate the pain of soaring prescription drug prices.
In the waning hours of 2018, President Trump signed into law a bipartisan bill to boost federal efforts to address the Alzheimer’s epidemic that impacts some 5.7 million Americans and their families. The BOLD Infrastructure for Alzheimer’s Act provides $100 million in new funding and “restates priorities” in the fight against a disease that’s aptly been called “The Long Goodbye.”
The BOLD Act was cosponsored by Senators Tim Kaine (D-VA), Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Catherine Cortez-Masto (D-NV):
“The… Act will improve early detection and diagnosis, provide assistance for caregivers and educate the public on Alzheimer’s disease and brain health. This bipartisan legislation is the first step in addressing [this] ongoing public health crisis…” – Sen. Catherine Cortez-Masto, BOLD Act co-sponsor
The National Committee, which fights for the financial and health security of America’s seniors, endorsed the bill to confront Alzheimer’s (whose victims are mostly over 65 years of age).
“The BOLD Act would create a public health infrastructure to implement effective interventions to combat Alzheimer’s disease and related dementias including prevention, early detection and diagnosis and treatment.” – National Committee letter endorsing BOLD Act, 5/2/18
While it’s commendable that a bipartisan group of Senators sponsored the bill and that President Trump signed the BOLD ACT into law, defeating the Alzheimer’s epidemic will require much, much more. One-hundred million dollars in new spending over 5 years is a small step forward, and advocates for Alzheimer’s victims are right to celebrate. But federal funding for Alzheimer’s research continues to fall short of what is needed to invest in an aggressive and intensive research strategy to develop effective treatment and, hopefully, a cure.
Estimated federal spending on Alzheimer’s research was some $1.8 billion in 2018, compared to President Trump’s demand for $5.6 billion for his border wall. His administration’s Fiscal Year 2019 budget called for a freeze in biomedical research. A significant shift towards disease research priorities is urgently needed.
Alzheimer’s is a fatal scourge deserving considerably higher funding. It is the 6th leading cause of death in the United States, felling more Americans than breast and prostate cancer combined. A startling one in three seniors dies with Alzheimer’s or other form of dementia. By 2050, the disease is expected to claim 14 million victims – almost three times the number of Alzheimer’s patients today.
The disease also poses a direct threat to Medicare and Medicaid. In 2018, the two programs spent an estimated $186 billion caring for beneficiaries with Alzheimer’s and other dementias – representing nearly 70 percent of total costs. “By 2050, combined Medicare and Medicaid spending on patients with Alzheimer’s is expected to quadruple to $750 billion (in today’s dollars),” according to the nonprofit Alzheimer’s Impact Movement. This is an enormous financial burden for Medicare and Medicaid, which seniors’ advocates are already fighting to strengthen in the face of conservatives’ demands for benefit cuts.
The nearly six million Americans suffering from Alzheimer’s, along with their families and caregivers, rightly expect an increased funding commitment from the federal government. The beginning of the 116th Congress – with its fresh faces and new leadership – presents an opportunity to build on the BOLD Act and put more brain power into the fight. It’s time for our national leadership to muster the political will to defeat Alzheimer’s before the grim estimates for the future become reality.
It’s unfortunate that in a desperate attempt to fill the White House chief of staff position vacated by General John Kelly, President Trump turned to an avowed ‘entitlement reformer.’ The new acting chief of staff, Mick Mulvaney, is an outspoken fiscal hawk committed to cutting Social Security and Medicare. This should be of concern to seniors and their advocates.
Vox called the former South Carolina Congressman, current director of the Office of Management and Budget, and temporary head of the Consumer Financial Protection Bureau “a very ideologically orthodox conservative who hates the idea of spending money on domestic social assistance programs.”
As budget director, Mulvaney pressured the president to cut Social Security and Medicare – despite Trump’s campaign promise “not to touch” either program. In fact, the budgets Mulvaney submitted to Congress on behalf of the Trump administration called for some $500 billion in cuts to Medicare and $64 billion to Social Security Disability Insurance (SSDI).
According to news reports, Mulvaney convinced the President to accept the cuts to SSDI by telling him that the federal disability program was “welfare.” The president reportedly responded, “OK. We can fix welfare.”
In 2017, Mulvaney told the moderator of CBS Face the Nation that SSDI is not really Social Security:
“Let me ask you a question, do you really think that Social Security Disability Insurance is part of what people think of when they think of Social Security? I don’t think so… It’s a very wasteful program and we want to try and fix that.” – Budget Director, Mick Mulvaney, CBS Face the Nation, 3/19/17
That same month, Mulvaney boasted that he had begun preaching the gospel of “entitlement reform” to the White House:
“I’ve already started to socialize the discussion around here in the West Wing about how important the mandatory spending is to the drivers of our debt. I think people are starting to grab it.” – Mick Mulvaney on Hugh Hewitt radio program, March, 2017
Never mind that tax expenditures (including the Trump/GOP tax scam) are the biggest drivers of the debt, not Social Security and Medicare Part A, which are fully self-funded.
When challenged to explain how his position was consistent with President Trump’s campaign vows, Mulvaney fudged. He suggested that Trump’s promise to protect Social Security and Medicare can be interpreted to allow any measure that helps both programs meet their obligations — “even and especially if those obligations are reduced.” According to Mulvaney’s contorted logic, we must cut Social Security and Medicare in order to save them.
The new acting chief of staff’s enmity for programs that help seniors extends beyond Social Security and Medicare. The budgets Mulvaney authored would have reduced federal home heating assistance and grants that support Meals on Wheels for needy seniors.
“Meals on Wheels sounds great,” said Mulvaney during a 2017 press conference, “[But] we’re not going to spend [money] on programs that cannot show that they actually deliver the promises that we’ve made to people.” The millions of seniors who receive hot meals every day from Meals on Wheels might disagree that the program doesn’t deliver on its promises.
Mulvaney’s fox-in-the-henhouse tenure as head of Trump’s Consumer Financial Protection Bureau (CFPB) cemented the perception that he is no champion of retirees or working people. Vox reported that “Mulvaney’s CFPB pulled back on its investigation of the data breach at Equifax, which exposed the personal information of 145.5 million U.S. consumers to hackers.” Meanwhile, according to the New York Times:
“Mr. Mulvaney…has dropped several of the agency’s lawsuits against predatory payday lenders and has taken a softer stance toward the industry than his predecessor did.” – New York Times, 6/05/18
This is not the man that seniors want whispering in the President’s ear. Given that President Trump tends to act on the last thing he’s heard, Mulvaney’s repeated entreaties may be more effective than when he was budget director. The good news is that Mulvaney is reportedly the one who insisted his title be ‘Acting’ Chief of Staff – and that he doesn’t intend to fill the role for more than six months. For the sake of older Americans, let’s hope that’s accurate.
During the Medicare open enrollment period that ends today, the Trump administration once again asked beneficiaries to choose plans without the benefit of accurate, unbiased information. Throughout this period and the year preceding it, the Centers for Medicare and Medicaid Services (CMS) has unabashedly steered seniors toward private Medicare Advantage plans, while downplaying traditional Medicare.
Case-in-point: The New York Times reported that CMS has been sending emails to millions of beneficiaries encouraging enrollment in Medicare Advantage. The emails uncannily resemble advertising from big insurance companies. Effectively, that’s what they are.
“Get more benefits for your money,” says a message dated October 25. “See if you can save money with Medicare Advantage,” said another sent a week later. The messages – “paid for the by the U.S. Department of Health and Human Services” – urge beneficiaries to “check out Medicare Advantage” and point to an online tool to compare different options. – Robert Pear, New York Times, 12/1/18
CMS’ online plan-finder tool is similarly skewed toward private plans. The questions in the tool’s questionnaire seem to have been selected so that the inevitable answer to the beneficiaries’ needs is… drumroll, please… Medicare Advantage!
The enrollment information on Medicare.gov in general is also biased, largely by omission.
The website features a list of Medicare options, with Medicare Advantage plans at the top. “Original Medicare” is absent from the list. A new beneficiary could be forgiven for not even knowing that original Medicare exists. This is confusing – and misleading.
Unlike Advantage plans, original Medicare does not limit patients to a fixed network of providers, giving patients access to the best doctors and hospitals. Original Medicare covers beneficiaries when they are traveling. And, in combination with a supplemental Medigap policy, original Medicare insulates patients against high out of pocket costs. This bedrock health insurance program has served hundreds of millions of seniors for more than 50 years – with low overhead and no profit motive.
Yet, in its public outreach, CMS almost exclusively touts the benefits of private Medicare Advantage plans. These plans can have certain advantages for some beneficiaries, especially younger and healthier ones. Medicare Advantage plans often include prescription drug coverage, whereas subscribers to original Medicare must enroll under a separate plan (Part D) for that. Medicare Advantage can include extra goodies – including gym memberships and transportation to doctor visits – not covered in the traditional plan.
But the administration rarely mentions the downsides of private plans, which are considerable. Medicare Advantage patients are restricted to a limited network of providers, and may not be covered when traveling. They may encounter coverage limits and denied claims – and experience long delays in appealing claims.
The Trump administration hides the fact that your out-of-pocket costs for in-network care alone in a Medicare Advantage plan can top $6,700 a year. Or that you could wind up paying the entire cost for everything but emergency care if you need treatment while you’re away from home. Or, that the quality of care their providers offer can be poor. – Richard Eskow & Diane Archer, Common Dreams, 12/6/18
These issues may not matter as much to healthier patients, but everyone gets sick at some point. Beneficiaries with acute or chronic conditions often find it difficult to get quality care under Medicare Advantage. But if they try to switch midstream to original Medicare, they may not be able to obtain Medigap insurance to supplement it.
Our organization has partnered with the nonprofit Center for Medicare Advocacy to provide retirees (and near-retirees) with accurate, unbiased information about the two main Medicare options so that they can make a fully informed choice. Appropriately enough, the name of the initiative is the Medicare Fully Informed Project. One of the most compelling features of this project is a “Corrected Medicare & You Handbook,” including ‘red pencil’ notes correcting some of CMS’ misleading or incomplete language in its main consumer publication for Medicare.
There is little mystery as to why CMS is tipping the playing field toward Medicare Advantage. The Trump administration and its CMS chief, Seema Verma, have demonstrated a decidedly pro-corporate tilt in matters where the public interest should be the paramount concern.
Don’t let the insurance industry or the Trump administration deceive you. Don’t let them corporatize Medicare. Instead, let’s de-corporatize everyone else’s health care—and become a healthier, more humane nation. – Richard Eskow & Diane Archer, Common Dreams, 12/6/18
The National Committee does not oppose Medicare Advantage. For some beneficiaries, it may be the most practical choice – at least while they are relatively young and healthy. But we do believe that the playing field between private plans and original Medicare should be level. The Trump administration owes that to the tens of millions of Americans who rely on Medicare for health security in old age.