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Bipartisan Opposition To Obama Limiting Access To Life-Saving Drugs For Seniors

- May 6, 2016

The Obama Administration Has Rolled Out A Proposed Rule Change That Will Limit Medicare Doctors' Use Of Prescription Drugs By Reducing Payments

The Obama Administration Rolled Out A Change To Medicare Aimed At Reducing The Fees Paid To Doctors For Administering Expensive Drugs. "Specialty physicians and other health-care providers have launched efforts to derail a federal proposal to test whether paying doctors less for drugs administered under a Medicare program reduces spending, one day after the Obama administration released the plan. The administration says the proposal will help patients and won't deny anyone access to drugs. But the reaction Wednesday suggested a major fight ahead, as specialty doctors, drug-industry groups and Republican lawmakers described the plan as ill-conceived." (Stephanie Armour, "Health-Care Providers Aim To Fight Medicare Drug Plan," The Wall Street Journal, 3/9/16)

The Rule Would Tie Payments To Doctors Based On The Drug's Effectiveness. "Concerns also are surfacing about a second stage of the proposal that would test alternative payments for drugs, including payments based on a treatment's effectiveness. For example, CMS suggested the use of reports from a nonprofit group, the Institute for Clinical and Economic Review, known as ICER." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

CMS Would Determine The Doctors' Payments For Certain Drugs Based Off Of Reports Provided By Non-Profit Groups, Like The Institute For Clinical And Economic Review, Detailing The Cost-Effectiveness Of The Drugs. "For example, CMS suggested the use of reports from a nonprofit group, the Institute for Clinical and Economic Review, known as ICER. Those reports analyze the cost-effectiveness of drugs, and some incorporate a metric known as Quality-Adjusted Life Year, or QALY, which quantifies the health benefit and quality of life derived from a particular treatment. The findings have been used by some insurers in coverage and reimbursement decisions." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

  • Some Of These Reports Use A Quality-Adjusted Life Year Metric Which Values The Individual Patient's Quality If Life When Determining The Cost-Effectiveness Of An Expensive Drug . "Those reports analyze the cost-effectiveness of drugs, and some incorporate a metric known as Quality-Adjusted Life Year, or QALY, which quantifies the health benefit and quality of life derived from a particular treatment. The findings have been used by some insurers in coverage and reimbursement decisions." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

Republicans And Democrats Have Slammed The Proposed Rule, Saying It Will Limit Seniors' Access To Life Savings Drugs

Tricia Neuman, A Senior Vice President At The Kaiser Family Foundation On Opposition To The Rule: "This Seems To Be An All-Out War." "'They may have underestimated the strength and power of the opposition to the changes,' said Tricia Neuman, a senior vice president at the Kaiser Family Foundation. 'This seems to be an all-out war, so it's hard to know how it will play out.'" (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

Senate Finance Chairman Orrin Hatch Said The Proposal Would Limit Access To Medications For Seniors . "The proposal would limit access to some medications, said Senate finance panel Republicans, led by Chairman Orrin Hatch (R., Utah), in an April 28 letter to CMS. "We urge you to withdraw the proposed rule immediately as it would severely disrupt care for vulnerable beneficiaries," the letter said." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

  • "Dozens Of House Republicans Are Demanding The Proposal Be Withdrawn…" Dozens of House Republicans are demanding the proposal be withdrawn, and Democrats on the Senate Finance Committee are raising concerns with the Centers for Medicare and Medicaid Services, which administers the program. The pushback is growing in advance of a May 9 deadline for public comments." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

Democrats On The Senate Finance Committee Also Expressed Concern With The Rule. "Democrats on the committee, including Sen. Ron Wyden of Oregon, said in an April 27 letter that 'we have heard numerous concerns from patients, providers, and other stakeholders.' They called for precautions such as real-time monitoring of any barriers to drug access." (Stephanie Armour, "Lawmakers Criticize Medicare Plan For Costly Drugs," The Wall Street Journal, 5/5/16)

Former Democratic Congressman Dan Maffei, Who Voted For Obamacare, Slammed The Rule In A "US News & World Report" Op-Ed

Admitting That He Voted For Obamacare In 2010, Former Democratic Congressman Dan Maffei (D-NY) Accused The Administration Of Rationing Health Care When It Comes To Prescription Drugs. "The Affordable Care Act recently passed its sixth birthday, and while voting for it contributed to my 2010 loss, I could not be prouder to see it increase access to care and patient choice while lowering overall costs. Before the health care law, insurance company bureaucrats, rather than doctors and patients, made too many health care decisions. Thanks to the law, insurance coverage restrictions based on preexisting conditions have gone the way of the dodo bird. Yet, when it comes to prescription drugs, the health insurance industry has evolved a new way of rationing health care." (Dan Maffei, The New Health Care Rationing," US News & World Report , 5/5/16)

Maffei Describes How The Institute For Clinical And Economic Review Is "Becoming A De Facto Arbiter For The Nation's Medicine Chest." "How do payers justify these hurdles? One way is to strategically deploy allies in the health care nonprofit world to camouflage their decisions under the cloak of economic analysis. A key example is the Institute for Clinical and Economic Review, which recently began conducting analyses to determine whether a new drug's benefit is worth its cost. It has found most of the drugs it has reviewed to be too expensive, giving insurance companies and pharmacy benefit managers an excuse to restrict them. Ed Silverman, who writes 'The Pharmalot View" column for STAT said, the institute "is becoming a de facto arbiter for the nation's medicine chest.'" (Dan Maffei, The New Health Care Rationing," US News & World Report , 5/5/16)

The Institute For Clinical And Economic Review Has Deep Ties To The Insurance Industry And Cannot Be Trusted To Provide Objective Analyses Of A Drug's Cost-Effectiveness, According to Maffei. " While the institute claims independence, its funding tells a different story. The lion's share comes from health insurance companies and their trade associations, pharmacy benefit managers and their associated foundations. Foundations run by current and former insurance company executives are still vehicles for industry money. In 2013, the Blue Shield Foundation of California accounted for about two-thirds of the institute's total funding. The institute's ties to the insurance industry go deeper. Its president worked for the industry's Washington lobbying group, and its board is mainly current and former insurance company executives with a few advocacy groups represented. Board representation is guaranteed for the Blue Shield of California Foundation." (Dan Maffei, The New Health Care Rationing," US News & World Report , 5/5/16)

"Unless The Proposed Rule Can Be Stopped.. [It] Would Truly Be Flying In The Face Of The Affordable Care Act's Patient Protections." "The institute is clearly not independent or objective and yet the federal Centers for Medicare and Medicaid Services released a proposed rule last month that says it's considering, among other things, adopting the institute's methods. That further confuses the public as to what The Institute for Clinical and Economic Review is and, unless the proposed rule can be stopped (public comments are due May 9), would truly be flying in the face of the Affordable Care Act's patient protections." (Dan Maffei, The New Health Care Rationing," US News & World Report , 5/5/16)


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