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Valued Social Butterfly
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 11 of 15
answer: the health insurance companies!!!
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Valued Social Butterfly
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Sorry, @Centristsin2010, don't understand your cartoon's implications - definitely not fake news.

This is just part of the discussion going on within the Senate and House committees, HHS and the Administration looking into drug cost and how to keep them down - specifically those of Medicare Part D.

 

I guess you have no opinion ?????

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Valued Social Butterfly
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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I'm sure the fact that Congress , especially the GOP , have refused to stand up against those high prices has just a little to do with those high prices. Who do the Lobbyist's own ?

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Treasured Social Butterfly
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 14 of 15

Image result for greed


"FAKE 45 #illegitimate" read a sign at the Woman's March in Washington DC, January 21, 2017.
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Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISION?

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I would be interested in your views on this - since it does involve the Medicare Drug Coverage under which many of us participate and the cost of meds- beneficiary, the insurer and Medicare -, specifically in these (5) protected classes of Meds in the Med D program.

 

We all harp about the cost of meds but the case of these (5) protected classes of Meds in the Med D program - What are you willing to accept?

 

IMO, this is a program (Medicare Part D) which we all share in - beneficiary, the insurer and Medicare.  So the questions in the article proposed to the "experts" are actually good for us to answer also -

  1. Should we even have these (5) protected classes in the Medicare Part D program?  These are the classes of meds which Medicare Part D currently requires that “all or substantially all” drugs must be covered by all insurers.  These are some of the MOST expensive meds.  They also may be the ones which could extend life for only a matter of a few months at a tremendously high price.  And as we all know, we don't rate our meds in a good-better-best hiearchy.
  2. Should these protected class drugs be subject to insurers negotiations like the other classes in Med Part D and therefore some insurers will cover those where they get the best price and are listed on their formulary and other do the same with others in these drug classes? 
  3. Should these meds be subject to step therapy as a medically sound reasoning - meaning a beneficiary must use a lower cost treatment med before trying the higher cost treatment.
  4. Should these (Pharma donation subsidized) Patient Advocacy Groups have the right to lobby?
  5. Should some meds in these classes (and maybe others too) just NOT be on any Med D formulary if the price goes over a certain amount?
  6. Should there be a measure for the actual outcome of a Medication?  Meaning if it only extends life a few months without regard to quality of life and is tremendously expensive - should it even have been improved for distribution?
  7.  What do we need to do here with these (5) protected classes of medications in the Med D program where "all or substantially all" meds in these classes have to be covered to make negotiations happen ?  Negotiating from the standpoint that ALL of them have to be covered is NOT a strong place for negotiations.

 

KHN 03/04/2019 - Big Pharma Gave Money To Patient Advocacy Groups Opposing Medicare Changes

 

highlights from the above link ~

 

Dozens of patient advocacy groups . . . . .  recently appeared in national advertisements objecting to a Trump administration proposal that could limit drugs covered by Medicare providers.

 

But a Kaiser Health News analysis found that about half of the groups representing patients have received funding from the pharmaceutical industry. . . . . .

 

. . . . . As patient organizations gain ground lobbying Congress and the administration, experts have begun to question whether their financial ties could push them to put drugmakers’ interests ahead of the patients they represent.

 

The advertisement, which ran in national newspapers, attacked proposed changes to Medicare Part D’s “protected” drug classes, which require that “all or substantially all” drugs must be covered by all insurers. The medicines involved include oral cancer drugs, HIV medicines and antipsychotics.

 

The protection can have the effect of guaranteeing sales to Medicare patients no matter the price tag.

 

The proposed rule

  • would give insurers more opportunities to instead steer patients toward lower-cost therapies and generics using prior authorization or step therapy, in which patients must try cheaper drugs before they can switch to options that are more expensive. 
  • It would also allow protected drugs to be left off Medicare Part D formularies when price hikes exceed inflation or new formulations of drugs don’t offer a “significant innovation” over existing versions.

“It’s wrong and it will put patients’ lives at risk,” reads the ad paid for by the American Cancer Society Cancer Action Network above a list of 56 other patient advocacy groups who presumably agree. Underneath, a link directs readers to an online form to send pre-written emails to members of Congress and the administration.

 

========================

THE CONFLICT

The Government's Position:

The government proposal’s goal, however, isn’t to end coverage for drugs in protected classes, said Rachel Sachs, an associate law professor at Washington University in St. Louis who specializes in health care. Its goal is to give plans more leverage to bargain for better discounts. If there’s a chance an insurance plan won’t cover a drug, the provider has more negotiating power.

 

Pharma and ( many ) Patient Advocacy Groups Position:

It’s important to make sure cancer patients can get “cutting-edge” treatments, said Keysha Brooks-Coley, vice president of federal affairs for the Cancer Action Network. “This is really an access issue,” she said.

 

The lobby for brand-name drugmakers, the Pharmaceutical Research and Manufacturers of America, takes the same stance, according to its submitted comments on the proposal.

 

======================

 

But access to drugs means more than insurance coverage, said Karuna Jaggar, the executive director of Breast Cancer Action, a patient group that was not invited to be listed in the ad and hasn’t accepted corporate funding for two decades to avoid the appearance of bias. “If people can’t afford it, the reality is they cannot access it.”

 

Given the ad’s selective understanding of “access” to exclude cost and the patient groups’ industry ties, she asked, “Can we trust them?”

 

Although there are occasions when what’s best for patients is the same as what’s best for drugmakers, people should consider patient advocacy group statements with a “skeptical eye” if groups have financial ties to the pharmaceutical industry, said Matthew McCoy, a medical ethics and health policy assistant professor at the University of Pennsylvania.

 

Drugmakers and patient advocacy organizations have fundamentally different missions, he said. One wants to make money for shareholders. The other wants to serve patients. Since their goals will inevitably diverge, it’s important that patient groups aren’t swayed by their funders, he said.

 

It can be easy to view a pharmaceutical company as an ally when its contributions help keep the lights on, McCoy said. “I think we have a lot of evidence from research on financial conflicts of interest in other areas of health care to know that the influence often is unconscious to the people who are actually experiencing it.”

 

Still, Sachs said she can understand why patient advocacy groups oppose changes to the six protected classes, even if they lead to lower drug prices.

 

“The question is, what happens if negotiations between pharmaceutical companies and the Part D plans fail?” Sachs said. “In at least some cases, the Part D plan will be able to say simply it’s going to exclude you from coverage because of the price of the drug.”

* * * * It's Always Something . . . Roseanne Roseannadanna
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