In Louisiana, Medicare Advantage beneficiaries would face premium increases and benefit reductions of more than $120 per month, according to new data from Oliver Wyman. To protect the affordable, high-quality care that Medicare Advantage provides to millions of Louisianans, seniors from AHIP’s Coalition for Medicare Choices shared their Medicare Advantage stories with Louisiana Sen. Bill Cassidy and Rep. Steve Scalise, who recently signed bipartisan House and Senate letters to protect seniors.
Below are several Coalition members in Louisiana who would feel the impacts of additional cuts. Here’s why their Medicare Advantage coverage matters so much:
- Judy Kemp of Metairie, LA:
“I believe my plan helps me attain a better standard of living because its programs reduce stress and hassle. It covers everything! It is important to me that my plan and others like it are protected by Congress for my family and my health.”
- Velva Flot of Slidell, LA:
“I have been a Medicare Advantage beneficiary since 2005. I’m completely happy with the doctors, clinics, hospitals and labs associated with the program, especially since I have a chronic eye disease that requires regular visits.”
- Ricky Flot of Slidell, LA:
“As a member for 11 years, I can honestly say I have been thoroughly pleased with the service through Medicare Advantage. I have been able to stay with the same doctors and hospitals since I joined, which is important since I have a chronic illness. They have saved me a great deal of stress.”
- Evelyn Warnken of Metairie, LA:
“I have been a Medicare Advantage member for more than 10 years. It is important to me and my husband. It promotes family and good health.”
- Patricia Bedenbaugh of Metairie, LA
“I joined Medicare Advantage five years ago because I wanted prescription drug coverage. I am pleased with my doctors, the co-pay is affordable and I look forward to going to exercise classes when I am done with physical therapy for my knee. Before I hit the age of 65, my healthcare bill was more than $1,200 a month for me and my daughter, even though we had no preexisting conditions and took no medications. Medicare Advantage is a lifesaver for me now that I am retired.”
As CMS prepares to finalize payment rates for next year, a growing number of voices are asking the agency to protect seniors like those featured above and millions others from further cuts to their benefits. The voices of bipartisan majorities in Congress, providers, stakeholders, and seniors from across the country are warning of the consequences the proposed cuts would have for beneficiaries. Final payment rates will be released on April 6, 2015.]]>
The article ignores the real reason why some patients can’t afford the treatments they’re prescribed: astronomical prices set by pharmaceutical companies. With some specialty medications priced over $1,000 per dose and upwards of $100,000 per year (more than double U.S. median family income), clearly, the issue is price not coverage.
Just look at the growing body of evidence that demonstrates soaring prices of new treatments remain one of the leading drivers of rising health care costs. And they’re increasing at rates that are unsustainable and unaffordable.
Despite exorbitant prices, health plans provide prescription coverage to help ensure patients have access to medications that are safe, effective, and affordable. Value-based purchasing and benefit designs allow people to have treatments they would never be able to afford without coverage. Health plans typically pay more than 90 percent of the cost of specialty drugs – delivering financial and health protections to consumers when they need it most.
Yet, benefit design alone cannot address the outrageous increases in prescription drug prices. Skyrocketing drug prices have a harmful ripple effect throughout the health care system, raising monthly premiums and increasing health care costs for individuals, families, and employers. This is an oft-overlooked point, but a critical one. Affordable health care coverage requires affordable treatments.
So let’s focus on the issue that really matters: High drug prices that create a barrier to access and a financial burden for patients.]]>
AHIP’s Coalition for Medicare Choices (CMC) – more than 1.8 million seniors and counting – are writing letters and emails, making phone calls, attending events, and engaging on social media to urge policymakers to protect Medicare Advantage as lawmakers consider policies that could impact their coverage. Below are some of the most recent highlights from Facebook:
These seniors add to a growing number of voices urging CMS to protect seniors in Medicare Advantage, including a bipartisan group of more than 300 members of Congress and a broad array of providers and stakeholders.
For the third year in a row, Washington policymakers proposed new cuts to the Medicare Advantage program, threatening the affordable, high-quality care these millions of seniors rely on. Further cuts to Medicare Advantage means seniors will feel the effects through reduced benefits, fewer choices, and increased costs.
To learn more about the Medicare Advantage program and the importance of protecting seniors in the program, visit www.medicarechoices.org.]]>
S. 829, Charles Grassley, to amend title XVIII of the Social Security Act to refine how Medicare pays for orthotics and prosthetics and to improve beneficiary experience and outcomes with orthotic and prosthetic care, and for other purposes.
S. 836, John Barrasso, to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act.
S. 839, Susan Collins, to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes.
S. 843, Sherrod Brown, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.
S. 844, Edward Markey, to repeal the medical device excise tax, and for other purposes.
S. 849, Johnny Isakson, to amend the Public Health Service Act to provide for systematic data collection and analysis and epidemiological research regarding Multiple Sclerosis (MS), Parkinson’s disease, and other neurological diseases.
H.R. 1526, Mark Meadows, to amend title XVIII of the Social Security Act to modify policies relating to payment under the Medicare program for durable medical equipment, orthotics and prosthetics, and prosthetic devices, and for other purposes.
H.R. 1530, Glenn Thompson, to amend title XVIII of the Social Security Act to refine how Medicare pays for orthotics and prosthetics, to improve beneficiary experience and outcomes with orthotic and prosthetic care, and to streamline the Medicare administrative appeals process, and for other purposes.
H.R. 1533, Alma Adams, to amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes.
H.R. 1537, G.K. Butterfield, to amend the Federal Food, Drug, and Cosmetic Act to reauthorize a program of priority review to encourage treatments for rare pediatric diseases, and for other purposes.
H.R. 1538, Steve Cohen, to extend the principle of federalism to State drug policy, provide access to medical marijuana, and enable research into the medicinal properties of marijuana.
H.R. 1547, Erik Paulsen, to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act.
H.R. 1552, Louise Slaughter, to amend the Federal Food, Drug, and Cosmetic Act to preserve the effectiveness of medically important antimicrobials used in the treatment of human and animal diseases.
H.R. 2, Michael Burgess, to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program, and for other purposes.
H.R. 1559, Christopher Smith, to amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of an initial comprehensive care plan for Medicare beneficiaries newly diagnosed with Alzheimer’s disease and related dementias, and for other purposes.
H.R. 1560, Devin Nunes, to improve cybersecurity in the United States through enhanced sharing of information about cybersecurity threats, and for other purposes.
H.R. 1570, Gus Bilirakis, to provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes.
H.R. 1571, Joe Courtney, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes.
H.R. 1576, Michael Burgess, to require a study by the Government Accountability Office (GAO) to assess the Food and Drug Administration’s current regulatory pathway for reviewing generic versions of nonbiologic complex drug products, and for other purposes.
H.R. 1578, John Delaney, to establish the Commission on Long Term Social Security Solvency, and for other purposes.]]>
Health plans are committed to preventing diabetes in a number of ways, including targeting prediabetes. About 86 million Americans have prediabetes, and CDC research estimates that 11 percent of them will develop type 2 diabetes within three years.
AHIP is working with four participating health plans that have launched the National Diabetes Prevention Program (National DPP) in Florida, New Mexico, New York, California, and Colorado. These plans are improving the health of their communities by reducing the risk of type 2 diabetes for people with prediabetes.
With the National DPP available to their members, EmblemHealth, Florida Blue, Molina Healthcare, and DenverHealth are reinforcing healthy lifestyle changes like physical activity, mindfulness, and healthy eating. And they’re meeting members where they are in their communities, worksites, schools, and physician offices – an important element to help people stick with the program and protect their health.
To meet the needs of diverse and often underserved populations, the health plans offer trained lifestyle coaches, classes in multiple languages, and retail centers, among other prevention and wellness resources. What EmblemHealth, Florida Blue, Molina Healthcare, and DenverHealth have found is that participants are engaged and achieving real results: For example, all participants at EmblemHealth had a 55 percent decrease in average blood glucose levels at week 16.
These innovative and collaborative efforts around diabetes prevention hold special significance on this day. Today and all year round, individuals can learn their risk by taking the Diabetes Risk Test.]]>
These members of Congress join a broad array of providers and stakeholders who are all standing up to protect the benefits that Medicare Advantage provides – better value, higher quality, and improved access to care for millions of beneficiaries. Strong support for protecting the Medicare Advantage program is especially critical in New York, Texas, and Louisiana, where recently proposed cuts would hit seniors the hardest – with higher costs and fewer benefits – according to a new state-by-state analysis from Oliver Wyman.
S. 754, Richard Burr, to improve cybersecurity in the United States through enhanced sharing of information about cybersecurity threats, and for other purposes.
S. 763, Jack Reed, to amend title XII of the Public Health Service Act to reauthorize certain trauma care programs, and for other purposes.
S. 768, David Vitter, to amend title XVIII of the Social Security Act to provide Medicare beneficiary access to eye tracking accessories for speech generating devices and to remove the rental cap for durable medical equipment under the Medicare Program with respect to speech generating devices.
S. 775, Bill Cassidy, to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans.
S. 776, Pat Roberts, to amend title XVIII of the Social Security Act to improve access to medication therapy management under part D of the Medicare program.
S. 786, Kirsten Gillibrand, to provide paid and family medical leave benefits to certain individuals, and for other purposes.
S. 799, Mitch McConnell, to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome.
S. 800, Mark Kirk, to improve, coordinate, and enhance rehabilitation research at the National Institutes of Health.
S. 804, Susan Collins, to amend title XVIII of the Social Security Act to specify coverage of continuous glucose monitoring devices, and for other purposes.
S. 810, Orrin Hatch, to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and improve Medicare payments for physicians and other professionals, and for other purposes.
H.R. 1387, Renee Ellmers, to amend the Internal Revenue Code of 1986 to provide for the determination of the employer mandate under the Patient Protection and Affordable Care Act without regard to alien agricultural seasonal workers.
H.R. 1400, Morgan Griffith, to amend title XIX of the Social Security Act to transition the Medicaid thresholds applied for determining acceptable provider taxes, and for other purposes.
H.R. 1411, Tim Ryan, to provide for a grants program to develop and enhance integrated nutrition and physical activity curricula in medical schools.
H.R. 1416, Renee Ellmers, to prevent application of sequestration to payment for certain physician-administered drugs under part B of the Medicare program in fiscal years 2016 and 2017, and for other purposes.
H.R. 1417, Pedro Pierluisi, to amend title XVIII of the Social Security Act to provide parity to Puerto Rico hospitals with respect to inpatient hospital payments under the Medicare program.
H.R. 1418, Pedro Pierluisi, to amend part B of the title XVIII of the Social Security Act to apply deemed enrollment to residents of Puerto Rico and to provide a special enrollment period and a reduction in the late enrollment penalties for certain residents of Puerto Rico.
H.R. 1419, Xavier Becerra, to amend title II of the Social Security Act to improve the Social Security Administration’s ability to fight fraud, prevent errors, and protect the Social Security Trust Fund, and for other purposes.
H.R. 1420, Bill Pascrell, to direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to establish a surveillance system regarding traumatic brain injury, and for other purposes.
H.R. 1423, Phil Roe, to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans.
H.R. 1427, Tom Reed, to amend title XVIII of the Social Security Act to specify coverage of continuous glucose monitoring devices, and for other purposes.
H.R. 1439, Rosa DeLauro, to provide paid family and medical leave benefits to certain individuals, and for other purposes.
H.R. 1446, Robert Hurt, to amend the Patient Protection and Affordable Care Act to provide privacy protections that enable certain individuals to remove their profiles from the healthcare.gov website, and for other purposes.
H.R. 1453, Devin Nunes, to amend title XVIII of the Social Security Act to modernize payments for ambulatory surgical centers under the Medicare program, and for other purposes.
H.R. 1455, Steve Stivers, to require the Food and Drug Administration to expedite review of pharmaceuticals that are approved for marketing in the European Union.
H.R. 1470, Michael Burgess, to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and improve Medicare payments for physicians and other professionals, and for other purposes.
H.R. 1458, David McKinley, to amend title XVIII of the Social Security Act to provide bundled payments for post-acute care services under parts A and B of Medicare, and for other purposes.
H.R. 1462, Katherine Clark, to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome.
H.R. 1468, Christopher Smith, to galvanize United States Government programs in support of brain health for global victims of autism, hydrocephalus and Alzheimer’s and other forms of dementia, and for other purposes.
H.R. 1469, James Langevin, to improve, coordinate, and enhance rehabilitation research at the National Institutes of Health.
H.R. 1479, Kevin Brady, to amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas.
H.R. 1494, Jeff Fortenberry, to amend the Internal Revenue Code of 1986 to permit rollovers from retirement plans to health savings accounts.
H.R. 1499, Ron Kind, to provide for the publication by the Secretary of Health and Human Services of physical activity recommendations for Americans.
H.R. 1500, John Kline, to ensure that certain TRICARE program beneficiaries may enroll in TRICARE Prime regardless of the location of their residence.
H.R. 1502, John Lewis, to amend title XIX of the Social Security Act to extend for 5 years payment parity with Medicare for primary care services furnished under the Medicaid program, and for other purposes.]]>
“This year marks the 20th anniversary of the debut of The American Journal of Managed Care (AJMC), and provides us with an opportunity to congratulate the team and reflect on what has happened over these 2 decades. When the Journal began, health insurers were implementing solutions to bring double-digit increases in healthcare costs down, and around AJMC‘s 10-year anniversary, the economic and social consequences of the large number of uninsured Americans took center stage.
“As we look at the current landscape, the development of state-of-the-art tools for consumers and new benefit choices have been well-documented in these pages. These innovations are powering the evolution of patient-centered care, and health plans are at the heart of this innovation story.
“Today, health plans are employing a multi-faceted approach to care coordination and disease management. With detailed data analysis, health plans are working with clinicians to identify gaps in care and to provide personalized support for patients managing chronic conditions. These efforts complement new benefit structures and payment arrangements that promote disease prevention and consistent monitoring so that patients receive the appropriate care at the right time. The results of these reforms are clear: better health outcomes for patients, more efficient care delivery, and improved value overall.”
You can read the entire guest commentary here. For more information and resources on health plan innovations that are transforming health care, visit the online innovation hub.]]>
Unfortunately, the same can’t be said for some drug companies, which continue to try to prevent less costly biosimilar versions of their products. Case in point: Janssen, a unit of Johnson & Johnson, has sued Celltrion and Hospira in the hopes of delaying or blocking the U.S. launch of a biosimilar of its autoimmune drug Remicade, as BioCentury recently reported.
Remicade was originally approved in 1998, and since then, it’s become one of the best-selling drugs with more than $8 billion in worldwide sales in 2013 alone. Things were a lot different back when Remicade first entered the market:
Now, Barack Obama is finishing his second term as president and the nation has a $564 billion deficit. A first-class stamp costs $.49, a gallon of gas costs an average of $2.42, and Google is now a multinational corporation.
Another big change since then: A vial of Remicade now costs about $1,500, or $33,600 for a year’s worth of treatment, according to a report from Zacks Small-Cap Research.
Despite all this, J&J is still trying to prevent meaningful competition from biosimilars. It’s a display of the abusive monopolistic pricing that accompanies market exclusivity, and it will only get worse if lawsuits succeed in preventing patient access to biosimilars.]]>
The enthusiastic group shared cookies, coffee, and personal stories about why they love Medicare Advantage and the need for policymakers to protect their benefits from any further cuts. As evidence shows, further cuts to the program will hurt the more than 16 million seniors and individuals with disabilities enrolled in MA through reduced benefits, fewer choices, and increased costs. The CMC’s 1.8 million seniors are writing letters and emails, making phone calls, attending events, and engaging on social media to stand up for the Medicare Advantage program.
Coalition member Carol Berman, a Medicare Advantage beneficiary for 15 years, told CQ Roll Call that the Food Truck is “a way to draw attention to Medicare Advantage,” and added that “this is the time of the year when they’re going to decide whether to cut it short, so it’s critical.”
CMC seniors even had a chance to meet with Sen. Orrin Hatch(R-UT) Sen. Mark Warner (D-VA) and Sen. Rob Portman (R-OH) in between stops!
As you can see from the MA Food Truck visitors, bipartisan majorities in both the House and Senate support Medicare Advantage, and join a broad array of providers, stakeholders, and seniors from across the country who are warning of the consequences new proposed cuts would have for beneficiaries.
It’s as simple as this – Medicare Advantage coverage means better care, greater choice, and higher quality for millions of beneficiaries nationwide, and cutting the program threatens these important benefits. To learn more about Medicare Advantage seniors and the importance of protecting the benefits they rely upon, visit www.medicarechoices.org.]]>