Wednesday, April 16, 2014
YOLO COUNTY NEWS
99 CENTS

Proposed Medicare drug change stirs access worries

WASHINGTON (AP) — In a move that some fear could compromise care for Medicare recipients, the Obama administration is proposing to remove special protections that guarantee seniors access to a wide selection of three types of drugs.

The three classes of drugs — widely used antidepressants, antipsychotics and drugs that suppress the immune system to prevent the rejection of a transplanted organ — have enjoyed special “protected” status since the launch of the Medicare prescription benefit in 2006.

That has meant that the private insurance plans that deliver prescription benefits to seniors and disabled beneficiaries must cover “all or substantially all” medications in the class, allowing the broadest possible access. The plans can charge more for costlier drugs, but they can’t just close their lists of approved drugs, or formularies, to protected medications.

In a proposal published Friday in the Federal Register, the administration called for removing protected status from antidepressants, antipsychotics, and immunosuppressant drugs. The proposal said that status it is no longer needed to guarantee access, would save millions of dollars for taxpayers and beneficiaries alike, and could help deal with the problem of improperly prescribed antipsychotics drugs in nursing homes.

But advocates for patients are strongly criticizing the idea, saying it could potentially limit access to critically needed medications for millions of people.

“We are disturbed by this,” said Andrew Sperling, legislative advocacy director for the National Alliance on Mental Illness. “This is a key protection. It’s a cornerstone of what has made the benefit work for people with mental illness.”

Sperling said that patients with mental health issues often have to try a variety of drugs before they find the right one for their condition. He questioned whether the change would help crack down on the problem of improperly prescribed antipsychotics, saying it amounted to a blunt instrument.

The National Kidney Foundation also voiced worries. Legislative policy director Tonya Saffer said transplant patients often depend on combinations of medication, so having the broadest possible choice is crucial.

“Covering all immunosuppressant drugs is very important for the patient and very important to protect the transplanted organ from rejection,” Saffer said.

The proposal could lead to “patients having to go through multiple channels to try and get a drug,” which would put patients at risk, she added.

In the proposal, the administration said the new policy was developed after careful consultation with a broad range of experts. The three other types of drugs that have protected status — for cancer, HIV/AIDS and preventing seizures — would remain protected. If adopted in the coming months, the new policy could take effect as early as 2015.

The administration estimates it could save the taxpayers a total of $720 million by 2019. Beneficiaries may also be able to save. That’s because the drug plans can drive a harder bargain for manufacturer discounts when a drug is not protected.

“The circumstances that existed when this policy was originally implemented have changed dramatically in the more than seven years the program has been in operation,” the Centers for Medicare and Medicaid Services said in its proposal.

“We are concerned that requiring essentially open coverage of certain classes and categories of drugs presents both financial disadvantages and patient welfare concerns … as a result of increased drug prices and overutilization,” the proposal added.

A leading industry analyst said the proposal would represent a significant change for Medicare’s prescription benefit, which is highly popular with beneficiaries.

“It is a weakening of a patient protection,” said Dan Mendelson, CEO of Avalare Health, a market analysis firm.

“I’m not sure that Medicare saves money from this kind of a change,” he added. “Other elements of the program may have a cost increase if people are not using medications in the right way.”

————

By Ricardo Alonso-Zaldivar

The Associated Press

LEAVE A COMMENT

Discussion | No comments

The Davis Enterprise does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

News

 
Frank, Peterman, Davis Bicycles! get us from here to there

By Special to The Enterprise | From Page: A1 | Gallery

Local professor subdues unruly man on flight

By Adrian Glass-Moore | From Page: A3

 
Family fiction in miniature showcased at bookstore event

By Special to The Enterprise | From Page: A3 | Gallery

Meditation, Buddhism classes offered

By Enterprise staff | From Page: A4

 
Seniors can get tips for getting around town

By Enterprise staff | From Page: A4

School has garden plots for rent

By Enterprise staff | From Page: A4

 
Sugar overload, on ‘Davisville’

By Enterprise staff | From Page: A4

Rotarians, students, teachers, parents collaborate on planter boxes

By Enterprise staff | From Page: A4 | Gallery

 
Yolo Crisis Nursery is in crisis; please help

By Special to The Enterprise | From Page: A4

Check out the night sky

By Enterprise staff | From Page: A5 | Gallery

 
Hop to it: Easter Bunny meets Davis history tour

By Enterprise staff | From Page: A5

Garden doctor: Veggie gardening available year-round

By Special to The Enterprise | From Page: A5

 
Animal expert explains dogs’ thinking

By Special to The Enterprise | From Page: A5

Central Park Gardens to host Volunteer Orientation Day

By Enterprise staff | From Page: A7 | Gallery

 
Are we there yet?: Self-reflections of a would-be stage mom

By Tanya Perez | From Page: A8Comments are off for this post

.

Forum

Still supporting this guy

By Special to The Enterprise | From Page: B5

 
Urban forest under siege

By Special to The Enterprise | From Page: A6

Drought care for our trees

By Letters to the Editor | From Page: A6

 
Tom Meyer cartoon

By Debbie Davis | From Page: A6

.

Sports

UCD staff allows 19 hits in Causeway rout

By Bruce Gallaudet | From Page: B1 | Gallery

 
DHS softball struggles in nonleague outing

By Spencer Ault | From Page: B1 | Gallery

Devils open Boras Classic by splitting games

By Enterprise staff | From Page: B1 | Gallery

 
 
JV/frosh roundup: DHS sweeps a trio of baseball games

By Enterprise staff | From Page: B2 | Gallery

Baseball roundup: River Cats get by Grizzlies at Raley

By The Associated Press | From Page: B3

 
Giants beat L.A. in 12

By The Associated Press | From Page: B3

Sports briefs: Stanford sends Aggies home with a lacrosse loss

By Enterprise staff | From Page: B8 | Gallery

 
.

Features

 
.

Arts

Craft Center exhibit explores ‘Possibilities’

By Special to The Enterprise | From Page: A9

 
RootStock to host wine themed plein aire exhibit

By Enterprise staff | From Page: A9

The California Honeydrops to bring danceable groove to The Palms

By Enterprise staff | From Page: A9 | Gallery

 
See Flower Power exhibit at Gallery 625

By Enterprise staff | From Page: A9 | Gallery

Red Union Blue inks record deal

By Landon Christensen | From Page: A9 | Gallery

 
.

Business

.

Obituaries

.

Comics

Comics: Wednesday, April 16, 2014

By Creator | From Page: B6