Category / Uncategorized

by Jim Sorrentino

Help is Available for Seniors Struggling to Live Independently

The National Council on Aging (NCOA), is a tax-exempt non-profit organization that helps older adults and their caregivers, meet the challenges of aging, often on a fixed income, through services like BenefitsCheckUp®.

BenefitsCheckUp is a free online service that connects older adults with information on a variety of benefits they may need and qualify for including, assistance with the cost of housing & utilities, food, health care, and insurance, medications, Veteran benefits, transportation, and more.

For more info, call 1-800-794-6559 or go to https://www.ncoa.org

by Jim Sorrentino

Do you have Diabetes, use Insulin, and are on Medicare?

If the answer is yes, and you’re paying more than $35 a month for insulin, keep reading….

In 2021, Medicare introduced a pilot program called the Senior Saving Model  (SSM) with the aim of reducing the cost of insulin to people on Medicare and improving the quality of their health care.

Who is eligible for this discounted insulin program?

  • People that have diabetes and are prescribed insulin
  • People that are enrolled in Medicare Advantage (MA-PD) plans or Medicare Prescription Drug Plans (PDP) that agreed to participates in the SSM.
  • People that take insulin from manufacturers that participates in the SSM.

What insurance companies and plans participate in the SSM?

There are a variety of insurance companies that sell Medicare Advantage (MA-PD) and stand-alone Prescription Drug Plans (PDP) ranging from large for-profits such as United HealthCare, Humana & CVS to regional non-profits such as BCBS affiliates to small plans with limited subscribers.

To illustrate, in Rochester, NY with a metropolitan population of over 1 million, there are 22 Medicare Advantage plans offered by 5 major insurers: Excellus (BCBS), MVP, CVS/Aetna, United HealthCare, and Wellcare. These insurers sell 22 different MA plans, however, only 4 plans from Excellus and 4 plans United HealthCare participates in the $35/mo. insulin SSM program.

In addition, there are 19 prescription drug plans (PDP) offered in Rochester to individuals that choose to enroll in either Original Medicare or a Medigap plan. Not all PDP insurers participate in the SSM program and not all of their plans include the $35/mo. insulin.

Some insurers offer discounted insulin in their plans with higher monthly premiums. So, you need to carefully evaluate the total cost of each plan including the premium, deductibles, and the price of your prescriptions, with and without the discounted insulin. A plan with discounted insulin may not be the lowest total cost plan when you include the total costs of the plan and all of your medications.

What Insulin brands participate in the SSM program?

Insurers that participate in the SSM program are required to include at least one vial and one pen dosage form for each of the different types of Model insulins, where available and including – rapid acting, short-acting, intermediate-acting and long-acting – all for at a maximum $35 copay for a one-month supply.

Participating Insulin Manufacturers include:

  1. Eli Lilly and Company
  2. MannKind Corporation
  3. Mylan Specialty L.P.
  4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  5. Sanofi-Aventis U.S. LLC

How can you find out if your current plan or other plans available to you, participates in the $35/mo. SSM program and what specific insulins are included?

  • Call your plan’s member services (number is listed on the back of your card)
  • Ask your pharmacist
  • Call & ask Medicare at 800-633-4227
  • Check online at Medicare.gov/plan-compare. 

With the online http://www.medicare.gov/plan-compare, after you input all your medications, you will see an estimate of your total annual out-of-pocket expenses for each plan that you are considering, and for each of your medications and the pharmacy that you select.

Please keep in mind, the Medicare Open Enrollment period end on December 7th, for changes in MA-PD and PDPs that will become effective January 1,2022.

Best wishes

by Jim Sorrentino

Americans Favor Government Action to Lower Prescription Drug Costs

A national poll conducted by Kaiser Health News in August 2015, found that:

  • Over 70% of respondents  believe drug costs are unreasonable.
  • While the vast majority of Americans want lower costs, they differ significantly (based on their political ideology), on how prices should be established.
  • Seventy-six  percent of Republicans believe price changes should occur by the current marketplace competition.
  • By comparison, 57% of Democrat and 43% of Independent respondents support a role for the federal government in reviewing and approving drug prices (similar to what is done in Canada and Europe). Government involvement there has resulted in foreign drug costs being approximately 50% less than in the United States where pharmaceutical companies  establish their own prices.

    There is a consensus among respondents with 94% of Democrats and 84% of Republicans favoring a repeal of the 2003 federal law that prohibits Medicare, (with 55 million subscribers) from negotiating prices directly with drug companies.

Background

Canadian to Foreign Drug Price Ratios

The recent KHN poll is consistent with the growing revolt against the pricing practices of pharmaceutical companies which reached a tipping point when Gilead established the price for Sovaldi, a new drug formulation that is used for the treatment of Hepatitis C, at $1,000 a pill.  Other examples include Vertex’s Kalydeco $300,000 a year price to treat cystic fibrosis and Celgene’s Revlimid price of $150,000 year for the treatment of specific forms of cancer.

Prices for patented-protected drugs for life threatening and disabling diseases such as cancer, heart disease, multiple sclerosis, cystic fibrosis, diabetes, have been rising dramatically over the past decade with no end in sight.

According to Express Scripts, the number of people with prescription drug cost in excess of $100,000 a year in the US, tripled in 2014.

A Call to Action

Various stakeholders including insurance companies, pharmacy management companies, cancer treatment specialists and concerned citizens have begun to mobilize, educate their family, friends and colleagues and communicate their grave concerns and demand action by pharmaceutical companies and federal and state governments.

The Wall Street Journal (7.23.15) has reported that the federal government could save and reduce its deficit by an estimated $16 billion a year if Medicare was not prohibited by Congress from directly negotiate drug prices as they do for Medicaid and the VA. 

If you share these concerns over the astronomically high drug prices that few people can afford and that are bankrupting thousands of individuals and adding to public deficits, two actions you can take are:

1.Read and sign the Change.org Concerned Citizen’s petition protesting the high cost of cancer drugs at: http://chn.ge/1WHY7FD

2. Read and ask your Congressional House member and Senators to co-sponsor and vote for the:

To find out your elected representatives contact info go to: https://www.usa.gov/elected-officials

To subscribe to this blog for more articles on the political and economic dimensions of Medicare plans and policies and their impact on patients’ access to affordable and effective treatment go to http://healthplanadvisor.org.