The Trump administration has proposed that insurance plans providing drug coverage to Medicare beneficiaries will no longer be forced to cover six hitherto "protected" drug classes. The classes----which include drugs for psych conditions, cancer and immune diseases----are among the priciest of all drugs and account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.
Under the proposal, Medicare plans could "exclude from their formularies protected class drugs with price increases that are greater than inflation, as well as certain new drug formulations that are not a significant innovation over the original product," says Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.
In 2014, the Obama administration sought the same "price relief" for Medicare but was defeated by Pharma lobbyists. At the time, 100 pills of the "protected" psych drug Abilify cost $1,644, 100 pills of the "protected" psych drug Geodon cost $958, 100 pills of the "protected" psych drug Invega cost $1,789 and 100 pills of the "protected" psych drug Seroquel cost $2,000. Since then, as Pharma makes the taxpayer funded Medicare its ATM, even pricier psych drugs have emerged as well as 6-digit cancer drugs.
The Obama proposal was roundly defeated by Pharma funded front groups like the Depression and Bipolar Support Alliance, Mental Health America, the National Alliance for Research on Schizophrenia and Depression and the National Alliance on Mental Illness (NAMI). NAMI, perhaps the best known group, received $23 million in just two years from Pharma and draws as much as 75 percent of its donations from drug companies.
The proposal "undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries," said NAMI lobbyist Andrew Sperling, one of many Pharma voices that defeated the proposal. "You get much better outcomes when a doctor can work with patients to figure out which medications will work best." (As long as the taxpayer pays.)
The six protected drug classes are not the only example of regulations which "protect" nothing more than Pharma profits and its expensive psychiatric drugs, many of which have cheaper alternatives. In T exas, a Medicaid "decision tree" called the Texas Medical Algorithm Project was instituted that literally requires doctors to prescribe the newest psychiatric drugs first. It was--surprise--funded by the Johnson & Johnson linked Robert Wood Johnson Foundation.
Already Pharma and its many phony "patient" groups are bellowing about how the "sickest, most vulnerable Medicare beneficiaries" will be hurt if taxpayers won't fund its 4 and 5 digit priced drugs. Yet few to none of the newer psych drugs show clear improvements over cheaper ones and they all lack the safety profiles of older drugs that are widely in use.
"When insurers balk at reimbursing patients for new prescription medications, these groups typically swing into action, rallying sufferers to appear before public and consumer panels, contact lawmakers, and provide media outlets a human face to attach to a cause," writes Melissa Healy of the Los Angeles Times about this well known Pharma tactic to loot Medicare dollars.
Will the Trump administration cave to Pharma like the Obama administration did?
(Article changed on November 28, 2018 at 15:51)