Medicare Safeguard Leaves Taxpayers Pouring Billions Into Pharma’s Pockets
Medicare's catastrophic coverage was originally designed to protect seniors with multiple chronic conditions from the cumulatively high costs of taking many different pills, with the government paying 80 percent of the cost of drugs above a catastrophic threshold. But pricey drugs are stressing the system to its limits.
The Associated Press:
Pricey Drugs Overwhelm Medicare Safeguard
A safeguard for Medicare beneficiaries has become a way for drugmakers to get paid billions of dollars for pricey medications at taxpayer expense, government numbers show. The cost of Medicare's "catastrophic" prescription coverage jumped by 85 percent in three years, from $27.7 billion in 2013 to $51.3 billion in 2015, according to the program's number-crunching Office of the Actuary. Out of some 2,750 drugs covered by Medicare's Part D benefit, two pills for hepatitis C infection — Harvoni and Sovaldi — accounted for nearly $7.5 billion in catastrophic drug costs in 2015. (Alonso-Zaldivar, 7/25)
The Associated Press:
What Are The Top 20 Priciest Medicare Prescription Drugs?
A look at Medicare's top 20 priciest prescription drugs in 2015, ranked by their cost above the program's "catastrophic" coverage threshold. Medicare's catastrophic protection kicks in after a beneficiary has spent a given amount of their own money, $4,850 this year. The beneficiary pays only 5 percent, while their insurer pays 15 percent, and taxpayers cover 80 percent. Catastrophic spending is a large and growing share of total costs, threatening to make Medicare's popular prescription plan financially unsustainable. (7/25)
In other national health care news —
The New York Times:
U.S. Says Florida Network Defrauded Medicare And Medicaid Of Over $1 Billion
In the biggest health care fraud case the Justice Department has ever brought, prosecutors charged on Friday that the owner of a network of Florida nursing facilities orchestrated an elaborate scheme to defraud Medicare and Medicaid of more than $1 billion over the last 14 years. The case, featuring allegations of bribes to Miami doctors, hush money to witnesses, and laundering of huge profits through shell companies, shone a light on a lucrative Medicare black market that has surfaced in the last decade. (Lichtblau, 7/22)
Insurers Will Consolidate Even If Mega-Mergers Fail
But even if the federal government buries Anthem's $53 billion acquisition and Aetna's $37 billion purchase, the big five health insurers (which also include UnitedHealth Group) are likely to forge new transactions to scale up and improve their position at the bargaining table with consolidating hospitals and health systems. ... Centene Corp., Molina Healthcare and WellCare Health Plans, all publicly traded insurers, are logical targets because of their relatively smaller size. (Herman, 7/23)
Obama Signs Opioid Bil
President Obama signed a bill aimed at addressing opioid addiction Friday, though he called out Republicans for the measure’s shortcomings. Lawmakers in both parties reached a compromise over the bipartisan Comprehensive Addiction and Recovery Act, though Senate Democrats held out hope until the final hour that they could win more funding for treatment. (Neidig, 7/22)
The Washington Post:
Lifelong Care, Heartaches Ahead For Babies Born With Zika In The U.S.
At least 12 babies in the United States have already been born with the heartbreaking brain damage caused by the Zika virus. And with that number expected to multiply, public health and pediatric specialists are scrambling as they have rarely done to prepare for the lifelong implications of each case. Many of Zika’s littlest victims, diagnosed with microcephaly and other serious birth defects that might not immediately be apparent, could require care estimated at more than $10 million through adulthood. Officials who have been concentrating on measures to control and prevent transmission of the virus are now confronting a new challenge, seeking to provide guidance for doctors and others who work with young children with developmental problems. (Sun, 7/24)
The New York Times:
Uncle Sam Wants You — Or At Least Your Genetic And Lifestyle Information
Government scientists are seeking a million volunteers willing to share the innermost secrets of their genes and daily lives as part of an ambitious 10-year research project to understand the causes and cures of disease. Those selected to be members of the “precision medicine cohort” will be asked to provide a detailed medical history and blood samples so researchers can extract DNA. They will also be asked to report information about themselves — including their age, race, income, education, sexual orientation and gender identity, officials said. (Pear, 7/23)