Keeping you updated on the latest Medicare and Part D news

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Increases in Prices of Anticancer Medications Negating Savings for Part D Beneficiaries

New research has found that the steady increase in the price of targeted oral anticancer medications (TOAM) is washing out the potential for savings that patients would experience in their out-of-pocket (OOP) payments following closure of the Medicare Part D coverage gap.  TOAM OOP costs are relatively moderate for privately-insured patients, but impose a much greater financial burden on Part D beneficiaries.  As the coverage gap gradually closes under ACA provisions, the study finds that Part D beneficiaries’ OOP costs for TOAMs has fallen by about 20 percent.  However, the inflation in monthly regimen prices for TOAMs was found to be three times that of the medical care component of the consumer price index.  The authors of the study fear that the continued inflation in TOAM prices could negate any savings that beneficiaries will experience from the coverage gap closure.

Recommendations include allowing Part D plans to have two specialty tiers, as opposed to the current one specialty tier policy, with patient cost sharing capped on the preferred specialty tier.  They also note that the current specialty tier should be reserved for competitor drugs with high prices.





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Opioid prescription patterns linked to likelihood of long-term use

A recent study has found that opioid days supply and the number of prescriptions in the first episode of opioid use can greatly affect the likelihood a patient will become an opioid chronic user.  The study examined a random sample of opioid-naive adults without cancer that received a prescription for opioid pain relievers.  Starting with the third day, the risk of becoming a chronic opioid user grows with each day additional day supply provided to patients.  Prescribing opioids is increasingly becoming a complicated decision for doctors to make.

FIGURE 1. One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply* of the first opioid prescription — United States, 2006–2015

	The figure above is a line chart showing 1- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply of the first opioid prescription in the United States during 2006–2015.

* Days’ supply of the first prescription is expressed in days (1–40) in 1-day increments. If a patient had multiple prescriptions on the first day, the prescription with the longest days’ supply was considered the first prescription.


FIGURE 2. One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of prescriptions* in the first episode of opioid use — United States, 2006–2015

	The figure above is a line chart showing 1- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of prescriptions in the first episode of opioid use, in the United States during 2006–2015.

* Number of prescriptions is expressed as 1–15, in increments of one prescription.


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Risk of chronic opioid use in elderly impacted by prescribing doctor

A recent study has found a link between chronic opioid use in Medicare beneficiaries and “high-intensity” prescribers, doctors that prescribe opioids for one in four patients they treat.  Beneficiaries with a high-intensity prescriber were 30% more likely to become a long-time opioid user.  Study authors conclude that their results are indicate that a single opioid prescription can affect the chances of long-term use and additional adverse health outcomes among elderly patients though additional research is needed.

The New England Journal of Medicine

New York Times


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Tom Price confirmed as HHS secretary

Tom Price was confirmed overnight by the US Senate to become the next secretary of health of human services.  The vote along party lines was largely expected and one of Mr. Price’s first responsibilities will be to head President Trump’s push to dismantle the Affordable Care Act.  Mr. Price is expected to work to limit the growth of Medicare and Medicaid.  Details regarding possible changes to the programs, which insure more than 100 million Americans remain unclear, but Democrats are worried about what they see as the secretary’s desire to dismantle Medicare.  A 2009 op-ed article penned by Mr. Price included the following, “Nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.”

New York Times

Tom Price op-ed

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Medicare may be permitted to negotiate prescription drug prices under Trump administration

There has been much confusion about the Trump administration’s vision for heath care in America.  Repeated calls to replace the Affordable Care Act and promises to not dismantle Medicare on the campaign trail are still fresh in American’s minds though Trump has provided few details or proposals. President Trump proposed often that Medicare should be able to leverage its buying power to negotiate better drug prices.  Trump presented this idea often on the campaign trail and recently said the following during a January 11 news conference:

I think a lot of industries are going to be coming back. We have to get our drug industry coming back. Our drug industry has been disastrous. They’re leaving left and right. They supply our drugs, but they don’t make them here. To a large extent. And the other thing we have to do is create new bidding procedures for the drug industry because they’re getting away with murder.
Pharma, pharma has a lot of lobbies, a lot of lobbyists and a lot of power. And there’s very little bidding on drugs. We’re the largest buyer of drugs in the world, and yet we don’t bid properly. And were going to start bidding and were going to save billions of dollars over a period of time.

Medicare is currently not permitted to participate in the negotiation of drug prices between pharmaceutical companies and insurance companies that provide Part D prescription drug plans.  Many experts believe negotiating the prices of prescription drugs could save Medicare billions though the only government report on the subject, completed in 2007 by the Congressional Budget Office, found the effects would be insignificant.

Trump has seemed to walk back some of his previous campaign rhetoric on this subject and recently told a group of pharmaceutical executives that he would “…oppose anything that makes it harder for smaller, younger companies to take the risk of bringing a product to a vibrantly competitive market.  That includes price fixing by the biggest dog in the market – Medicare – which is what’s happening.”  White House spokesman Sean Spicer has since clarified that Trump does support Medicare negotiating prescription drug prices.

NPR story by Allison Kodjak

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CMS reports that Medicare Part D rebates to insurers not passed onto government, beneficiaries

CMS reported this week that despite pharmacies and drug companies paying higher rebates to insurers over time, the savings are infrequently passed on to government health programs and beneficiaries.  The growth in rebates from drug makers to insurers has far outpaced the growth in Medicare Part D drug costs since 2010, the CMS report shows. This has helped private insurers in Part D keep costs down, but it is not translating to lower costs for consumers. In some cases, it has resulted in more drug costs being shifted to the government.

The full report can be found here.