As if its failed attacks upon Medicaid and Medicare were not enough (recurring in its latest budget proposal), the Trump administration is now looking to raise drug prices for older Americans.
Under a February scheme unveiled by Health and Human Services Secretary Alex Azar, who had even raised prices on insulin while an Eli Lilly executive, Medicare Part D premiums would rise an estimated 8 to 22 percent. The proposal does this by eliminating drug rebates, something the rulemaking notice concedes could result in higher premiums for all beneficiaries “with only some experiencing lower out-of-pocket costs.”
This comes on top of an earlier proposed Trump rule allowing Medicare Advantage plans to use “step therapy.” That is just a fancy way of saying that insurers can second-guess your doctor’s prescriptions. In the interests of honesty, we can refer to it as “drug rationing.” As that rulemaking notice states, “we are proposing to permit MA plans to require an enrollee to try and fail an off-label medically-accepted indication.” Because insurers know best, right?
Of course, the consequences of failed medication through this nickel-and-diming can include death. Buried on page 36 of that rulemaking notice are concessions that it “may cause a worsening of conditions leading to increased medical costs” and that “enrollees become discouraged when step therapy is used” and fails.
The real point of all of this appears to be to confer further riches upon drug companies and Medicare Advantage insurers, with ending the drug rebates adding up to $196.1 billion in federal spending by 2029, according to the Trump administration’s own figures. The Pharmaceutical Research and Manufacturers of America expressed its immense satisfaction with the proposal, which should worry anyone on Medicare.
As to the step therapy drug rationing, Medicare Advantage insurers already use their enormous political clout to crowd out the more efficient, traditional fee-for-service – as has been well-documented – but no political favor is ever, ever enough in fattening their bottom lines. Over 90 patient advocacy groups have signed a letter expressing concerns, and asking that “Medicare beneficiaries should know in advance of enrolling whether an MA plan uses restrictive step therapy and understand what impact it may have on access to needed treatments.”
Such transparency is not too likely. While the far-right ideologue who runs Medicare for the Trump administration regularly engages in Twitter attacks upon foreign health care systems that allegedly “ration and restrict care,” she is fine with the insurers that she favors doing the same. As a private consultant, she was paid $1.2 million to privatize Iowa’s Medicaid program, with diabolical results.
How much more suffering will the 65-and-older population have to endure under the Trump administration’s social science experiments? Rather than ship more taxpayer money to insurers and drug companies, after tax cuts already created a terrifying deficit, a far better approach would be to actually shore up the existing Medicare program; regardless of what one thinks of the “Medicare-for-All” approach, the U.S. House version would provide funding for long-term care. In a state where Medicaid rates for nursing home care went up only 17 cents per resident per day this year, federal help – not more federal harm – would sure be useful.
All of these issues should be addressed by the presidential candidates currently swarming our state. With the nation’s second-oldest population, and an especially elderly population receiving long-term care, we have a lot of older voters who need to hear more than empty blandishments.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)