Tag: Prescription drugs

The Five ‘Rights’ Rule for Taking Medications
We all know that both prescription drugs and over-the-counter medications can help keep us healthy. But, it is estimated that 50 percent of people do not comply with their medication regimens. About half of this non-adherence is intentional, because medications are expensive, (some are unaffordable), or they may have side effects that don’t feel good. People also may not understand their medication regimens and are therefore unable to follow them.

The number of medications we take has steadily increased over the past ten years. And, this can lead to harmful mistakes when it comes to taking our daily doses.

How can you make pill-taking safer for yourself and your loved ones at home? Hospital staff and ambulance workers frequently use the Five ‘Rights’ of medication management to help them give medications correctly.

Before taking or giving someone else a medication, you too should follow the Five ‘Rights’ rule to keep you and your loved ones safe at home. Check that these five things are right:
1. Right person (Is the right person taking the medication?)
2. Right medication (Is it the right medication?)
3. Right dose (Is it the recommended dose?)
4. Right route (Is this medication being taken in the right way? For example, orally?)
5. Right time (Is this medication being taken at the right time of day? Has the right amount of time elapsed between doses?)
To help ensure the people you love are safe and healthy, make sure you have a list of their medications and follow these other tips. Also, make sure the primary care doctor knows all the drugs they are taking, both prescription and over-the-counter to avoid risky drug interactions.
September 2, 2015
At 50, Medicare and Medicaid Face the Challenge of Pricey Drugs
Medicare and Medicaid turned 50 last week. Middle age. It’s fair to say both programs are feeling the years, even as they remain basically healthy. Together, the programs insure one in three Americans. Medicare was recently pronounced solvent until 2030. And Medicaid is poised to grow significantly in coming years as more states expand their programs under provisions of the Affordable Care Act, or as it’s often called, Obamacare.

The challenges to both programs are not going to let up, however. They are forecast to consume ever-larger chunks of the federal budget and state budgets—which of course means taxpayers are on the hook as baby boomers flood into Medicare over the next 10 years, and Medicaid expands.

Many conservative politicians don’t like the sounds of that and are again proposing reforms to both programs that would weaken the guarantee and scope of coverage and likely shift costs to the elderly (Medicare) and low-income people (Medicaid).

I suggest they instead support efforts to constrain health care spending overall, which is the root of the problem. There are hundreds of such efforts underway, with a push from Obamacare but also from innovations in every nook and cranny of the healthcare industry. And make no mistake, it’s an industry, very much driven by the profit motive in this country.

To wit, one emerging challenge deserves special attention: the increasing number of very expensive specialty drugs. For a detailed discussion, see this piece I wrote last month.

The gist is this:
- Specialty drugs accounted for 30% ($112 billion) of the $374 billion spent on prescription drugs in 2014, and they drove the bulk of the 13% increase in drug spending that year over 2013, according to IMS Institute for Healthcare Informatics. That leap in drug spending contrasted with low single digit increases for the previous few years.
- Specialty drugs range in price from $2,000 to $10,000 a month. One source pegs the average at around $36,000 a year. Most are made through bioengineering. They are often referred to as biologics. When there were just a few, it wasn’t a big deal. But now there are a couple dozen. Some treat rare diseases that afflict a small number of people, but an increasing number target cancer, multiple sclerosis, rheumatoid arthritis, immune system disorders, and even heart disease. Some 900 biologics are now in the research pipeline, according to a 2013 industry report. By some estimates, specialty drugs could comprise over 50 percent of all drug spending by 2020.
- Medicare (via Part D, Part B and Medicare Advantage) pays 25% to 30% of the nation’s prescription drug tab each year. Consistent with IMS’s finding for drug expenditure overall, Medicare drug spending leapt 12.6% from 2013 to 2014, the fastest rise in years. Almost all that increase stems from specialty drugs.
- One drug alone–Sovaldi for hepatitis C, at $84,000 for a 12-week course of treatment—cost Medicare $4.5 billion in 2014, becoming the single most expensive drug Medicare enrollees received.
- In a brief commentary this month in the journal Mayo Clinic Proceedings, 118 cancer doctors from leading cancer treatment centers called for immediate steps to lower the price of cancer drugs, the average price of which has increased to over $100,000 a year in 2012.
  - They wrote: “Drug companies keep challenging the market with even higher prices. This raises the question of whether current pricing of cancer drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear.” They also noted that the structure of both private insurance benefits and Medicare means some cancer patients needing a $120,000 drug can be saddled with out-of-pocket costs as high as $30,000.
It goes without saying that for lower and middle-income families, that’s simply untenable.

Are these pricey medicines worth the cost? Do they yield good value? Are they fairly priced? Or are drug companies profiteering, as the cancer doctors imply. And, if specialty drugs are going to remain very expensive, how are we possibly going to afford them?

The answers to these questions aren’t yet clear. There’s emerging evidence that Sovaldi may be worth it, because it essentially cures hepatitis C. The same cannot be said of many cancer drugs. There’s not the space to discuss this at length here. It’s a complex issue that involves tough ethical issues, clinical judgments, patient preferences, and contradictory evidence. Suffice it to say that evidence grows steadily that too many new cancer drugs priced at $50,000 to $150,000 a year are buying most patients only a few extra months of life, on average, and those may not be months with good quality of life.

Solutions? See the cancer doctor’s recommendations. I concur with them.

Slightly elaborated here are my top 3:
1. Permit Medicare to negotiate prices directly with drug companies, now explicitly barred by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. As Medicare moves swiftly to pay providers based on the quality and value of their care, the same should hold for prescription drugs.
2. Authorize the Patient-Centered Outcomes Research Institute (PCORI) to evaluate the benefits and value of new drug treatments, and include price in their assessments. That’s now blocked by a provision in the Affordable Care Act, which gave birth to PCORI. Industry and their political allies insisted on the provision. It’s time to repeal it.
3. Allow people to import prescription drugs for personal use and give FDA the power to monitor the program and certify channels of purchase. An unenforced federal law blocks importation now. (I’d make this a pilot program for five years to immediately give consumers the option.)
The politics of such measures is difficult, to say the least. I’m hoping it emerges as an issue in the 2016 elections. A Kaiser Family Foundation poll of 1,200 adults released last month found that three-quarters of Americans think prescription drug costs are unreasonable, and they blame the drug companies.
August 5, 2015
Unite with doctors to advocate for lower cancer drug prices

Last week, in an article for Mayo Clinic Proceedings, a group of 118 distinguished doctors united to question the pricing of cancer drugs, which is “unsustainable,” and to call for a new pricing method. As this 60 Minutes report reveals, the drug companies set the price of cancer drugs as high as they can. And because of their market power, cancer drug prices have risen an average of $8,500 a year for the last 15 years, a five to ten-fold increase in the price of new cancer drugs over that period.

One in three Americans will have some form of cancer. And, even with insurance, they typically will end up bearing 20 to 30 percent of the cost of their cancer drugs. The insurers have no ability to rein in prices so insurers simply shift more drug costs to their members. People who need a new cancer drug easily could end up with out-of-pocket annual costs of $30,000 just for their cancer medication. Worse still, they might have to forego needed treatment. In 2014, the least expensive new cancer drug approved cost more than $120,000 a year.

American households have an average gross income of $52,000. And half of people over 65 have incomes under $23,500. When out-of-pocket costs for cancer medications are anywhere near $20,000 a year, most people will need to sell assets or take out loans to pay for the drugs; $20,000 represents half of the take-home pay of a typical working family and slightly less than the average income of older adults.

Not surprisingly, as many as one in five cancer patients today are not taking their cancer treatments or taking less than the amount they need. They and their families are suffering and some are needlessly dying. The doctors argue that something has to change.

The doctors offer several possible solutions, including Medicare drug price negotiation, which is the top policy priority for Americans. They also suggest legislation that would prevent pharmaceutical companies from paying generic drug companies to delay putting generic drugs in the market at lower prices and/or that would allow Americans to import drugs from abroad at lower prices. Click here to read their other proposed solutions.

If you agree that we need federal action to stop these high cancer drug prices, email [email protected] or click here, and we will add your name to the campaign list. In the meantime, if you’d like some tips for keeping your drug costs down, click here.

July 28, 2015
If your Medicare drug plan refuses to cover your medications, take these five simple steps
Too often, pharmacists are unable to fill prescriptions for people with Medicare because their Part D plan says the drugs are not covered. If you need the medications, you should appeal. The drug plan may improperly believe that a less costly medication will meet your needs. Or, the drug plan might apply inappropriate limits on your medication or not implement proper Medicare policy. Here are three things to think about when choosing a Medicare Part D drug plan.

Almost four out of five people who appeal get their drugs covered. To file an appeal, you will need to follow a five-step process, whether you have a stand-alone Part D plan or you get your drug coverage through a private Medicare Advantage plan. Along the way, the drug plan might agree to cover your drug.
1. If your pharmacist tells you that your Medicare Part D drug plan will not cover a drug you need, you will get a “Medicare Prescription Drug Coverage and Your Rights Notice.”
2. Call the Part D plan and find out the reason for the denial. Unfortunately, the pharmacy cannot tell you the reason for denial. If it’s because the drug prescribed is not on the drug plan’s list of covered drugs, its “formulary,” ask your doctor if there’s another drug you can take that is on the formulary. If it’s because you must first try another drug or meet some other requirement, speak with your doctor.
3. If you need the drug prescribed, you will need a denial letter from the drug plan. You can only appeal the drug plan’s refusal to cover a prescription if you have this letter. To get the letter, file a request for drug coverage, an “exception request” (or an expedited exception request if you need the drug urgently), along with the letter from your doctor explaining the need for the drug, with your Part D plan. Your Part D plan will let you know how to file this request. And, the drug plan might decide to cover your drug after it receives your exception request.
4. If your Part D plan denies your exception request, it will send you a Notice of Denial of Medicare Prescription Drug Coverage. The Part D drug plan’s denial letter should explain the reason for denial. Get your doctor to explain in writing why the drug prescribed is medically reasonable and necessary and why no other drug will meet your needs. In a 2013 audit, CMS found that more than half of the health plans audited had issued inappropriate denials.
5. If necessary, file an appeal with the Part D plan, including the letter from your doctor; file an expedited appeal if you need your drug immediately.
So long as your drug is medically necessary, you are very likely to win the appeal. The delay you might face in getting needed medications is a problem that the Center for Medicare and Medicaid Services is now looking to address.

Of course, even with drug coverage your out-of-pocket costs can be sky high since Congress allows the drug companies to charge whatever they want and they often have the power to set prices. And the health plans simply raise copays to offset rising costs. They have no ability to rein in prices. It’s no surprise that 576,000 Americans had drug bills over $50,000 in 2014.

For more information on Medicare Part D appeals, visit Medicare Interactive.
July 26, 2015
576,000 Americans with annual drug bills over $50,000 in 2014

How much is too much to expect Americans to pay for prescription drugs? Unlike just about every other country, which negotiate drug prices, in the United States, Congress permits drug companies to set prices sky high. Not surprisingly, a new Kaiser Family Foundation poll shows that about three-quarters of Americans believe drug prices are not reasonable.

Since insurers must cover medically reasonable and necessary drugs, regardless of the price, drug companies focus on profits and seem not to concern themselves with whether needed drugs are affordable. For example, two new FDA-approved drugs to treat heart disease by lowering LDL cholesterol levels and protect against heart attacks are expected to cost between $7,000 and $12,000 a year. And, Sovaldi, a new drug to treat hepatitis C costs $84,000 for a 12-week treatment. Of note, insurers do not generally cover the full cost of these drugs; patients usually spend thousands of their own dollars in copays and coinsurance for them.

A recent report by Express Scripts details the problem of rising drug costs, reporting that “An estimated 576,000 Americans spent more than the median household income on prescription medications in 2014,” up 63 percent from 2013. And,140,000 people had drug costs of $100,000 or more, three times the number of people with these costs in 2013; slightly more than half of these people were baby boomers, between 51 and 70.

About ten percent of Americans, millions of people, report that they have trouble affording their drugs, according to the Kaiser poll. And, many of them say they are not filling prescriptions or cutting their pills in half to reduce their costs at the expense of their health. No wonder that government drug price negotiation is the top national policy priority for Americans today.

Here are six tips for keeping your drug costs down if you have Medicare.

June 19, 2015
Trans-Pacific Partnership-Related Bill Contains A Medicare Poison Pill

New disturbing information has surfaced that the House Republicans’ trade adjustment assistance bill, which supports the Trans-Pacific Partnership (TPP) trade deal, contains a Medicare poison pill.

The bill includes $700 million in Medicare cuts at the end of a 10-year budget period to cover the cost of trade adjustment assistance for displaced workers, Americans who will lose their jobs because of lower cost imports. Please let members of Congress know that they should not support the bill in its current form.

Covering the cost of assistance for displaced workers is important. But, in the words of several groups representing older Americans, including the Medicare Rights Center and The Alliance for Retired Americans, “Medicare should not be used as a piggy bank every time the government needs funding for other purposes.”

Older adults with Medicare are already experiencing an insecure retirement. And, as currently written, if the bill is passed, it is the people with Medicare and their health care providers who are on the line.

The bill is up for a vote this week, and there’s a huge effort underway to halt passage of the bill. We need to fight the Medicare cuts in the trade adjustment assistance bill, just as we need to ensure that the TPP does not further drive up the price of prescription drugs in the United States.

The Medicare cuts in the trade adjustment assistance bill supporting the Trans-Pacific Partnership set a dangerous precedent, allowing Congress to treat Medicare like its own personal piggy bank. Please sign the CREDO petition to stop this attack on Medicare.

May 18, 2015
New data on Medicare drug spending reveals Nexium is the biggest coster

New 2013 data on Medicare drug spending from the Centers for Medicare and Medicaid Services tells important story about drug costs and drug use among people with Medicare. You can learn about physician prescribing habits by specialty and geography. There’s also data on the top prescribed drugs based on claims submitted and the top prescribed drugs based on cost.

The data clearly show that the use of generic drugs is up. A 2014 Congressional Budget Office report on falling Medicare drug costs recognizes this increase in generic drug use; it stems in part from a loss in patent protection for several commonly prescribed high-cost drugs. In the top five medical specialties with the highest total prescription drug costs, more than three quarters of drugs prescribed are generic. And of the top ten prescribed drugs based on claims submitted, all ten are generic.

More than three of four drugs dispensed to people with Medicare were generic. People living in Texas, Hawaii and Alaska used slightly fewer generics than people in most of the rest of the country.

The top prescribed drug based on cost is Nexium. Almost 1.5 million people with Medicare Part D were prescribed Nexium costing more than $2.5 billion. But, Advair is not far behind.

May 15, 2015
Health caring for mom: Three ways to let your mom know you love her on Mother’s Day
Mother’s Day is the time to show your mom some serious love. But how? Most of us love flowers and chocolate. So, consider getting mom a little of both. What we really treasure, though, is the priceless gift of time together and conversation. And there are few things more important to talk about than your mom’s health. So here are a few priceless gifts for mom on her special day:
1. Make sure your mom is safe and healthy. Talk to her about all of the drugs she’s taking, both over the counter drugs and painkiller prescriptions. If your mom has a chronic condition like asthma or diabetes, find out whether her primary care doctor is doing a good job of coordinating her care. Click here to learn how your mom’s primary care doctor can help her. And, if your mom wants to stop smoking, lose weight or change another unhealthy behavior, here are some tips for motivating her to do so.
2. Talk to your mom about planning for her future health care needs. Who would she want to take care of her when she cannot take care of herself? Would she like to remain at home as long as possible? What are the tradeoffs she would like to make? And, make sure your mother has a reliable health care proxy and a living will. (You should have those too!) Click here for free help with these advance directives.
3. Double check that your mom is getting the preventive care services she needs. She should get regular pap tests, pelvic exams and breast exams. If she’s over 60, she should get a shingles vaccine. Medicare and most insurance cover all these tests in full. Next time she’s headed to the doctor, consider tagging along. Mom, like all of us, could use a health care buddy to ask the questions she might not ask.
These are important conversations. Most of us know we should talk to our mothers about their health, but we never quite get around to having the actual conversation. Why not use Mother’s Day as a reason to get serious about your mom’s health? Just talking to your mom about these issues can be healthy for her.
May 7, 2015
Insurers may be ready to support negotiated drug prices

Cancer drug prices keep rising, up from an average of $129 a month in 1975 to an average of over $10,000 a month in 2010. These drugs are increasingly unaffordable, even with insurance, because the insurance companies keep hiking up the copays. In a new twist designed to keep prices sky high and generate greater revenues, the drug companies are attacking health insurers and allying with cancer groups to advocate for lower copays. It could be the drug companies’ undoing; insurers may be ready to support negotiated drug prices.

You would think the drug companies would be embarrassed by the obscene cancer drug prices they are charging. (Express Scripts says that almost one-third (32 percent) of all health insurer spending on drugs came from one percent of prescriptions for costly specialty drugs.) You would want these drug companies to charge US residents what they charge residents of every other wealthy nation. Instead, they are effectively arguing that everyone with health insurance should pay higher premiums and deductibles.

If insurance companies were to reduce copays for cancer drugs, there’s no question they would simultaneously increase premiums, deductibles and perhaps copays for other services. More people might be able to afford cancer drugs. But, fewer people would be able to afford insurance premiums, deductibles and other health care services.

Right now, four states limit drug copays to no more than $150 a month. And, with Pfizer’s lobbying support, many other states are considering similar limits. But, as Karen Ignagni, head of the health insurers’ trade association explains, “it’s a shell game that’s being played on consumers.” Patients, state governments and employers all end up paying higher health care costs as a result of these caps.

To date, the health insurance industry has not shown any willingness to ally with patients to push for negotiated drug prices. Rather, the drug companies and the health insurers have been allies. Perhaps, the drug companies’ behavior will finally move the insurers to do right by patients, take on the drug companies and argue for drug price negotiation. It’s about time they did. If they do, we would have the drug companies to thank!

April 9, 2015
Government drug price negotiation is top policy issue for a strong majority of Democrats and Republicans

A new poll of likely voters shows that allowing government drug price negotiation ranks as the top policy issue for Americans. A Medicare buy-in for all ranks eighth and expanding Social Security benefits ranks 13th. Based on poll results, economic security issues are of paramount concern to Americans.

More than three quarters of likely voters, 79 percent, support government negotiation of drug prices. Almost 90 percent of Democrats (89 percent) support government drug price negotiation and more than three-quarters of Republicans (76 percent). Of note, the question posed concerned lower drug prices for people with Medicare and Medicaid and not everyone in the country. Every other wealthy nation negotiates drug prices for all its residents.

Seven out of ten likely voters (71 percent) support giving all Americans the choice of buying into Medicare as a way to drive competition in the health insurance marketplace. More than three quarters of Democrats (77 percent) support this policy, along with a healthy majority of Republicans (63 percent).

Seven out of ten likely voters (70 percent) also support expanding Social Security by having wealthy Americans pay Social Security contributions throughout the year, like everyone else. Eighty-five percent of Democrats support this policy, as do a 62 percent of Republicans.

April 2, 2015