Walmart drug program cheaper for many Medicare patients

https://www.nbcnews.com/health/health-news/walmart-drug-program-cheaper-many-medicare-patients-n893811

Grand Opening At A New Wal-Mart Store

Walmart’s $4 generic prescription drug program ends up being cheaper for some Medicare patients than their own health insurance, according to a new study released Monday.

It’s more evidence that patients cannot always rely on their health insurance to get them the lowest prices for their prescription drugs, said Dr. Joseph Ross of the Yale School of Medicine, who led the study.

“Patients were paying more out of pocket when they were using their insurance than when they went to Walmart,” Ross told NBC News.

The study, published in the Annals of Internal Medicine, documents that Walmart provides a better deal than the government’s health insurance plan for people over 65. And that is bad news for Medicare, because if people don’t take their drugs, whether for cost or for other reasons, they tend to get sicker and then end up costing even more to treat.

“Everyone’s talking about pharmacy costs these days,” Ross said. “We did this study in part because of all the discussion about pharmacy gag rules.”

Pharmacy gag rules prevent pharmacists from telling patients that they could save money on drugs, for instance by not using their health insurance.

Pharmacy benefit managers are the middlemen between drug companies and pharmacies, and some of those companies have agreements forbidding talk of discounts. But some states have also banned pharmacists from giving this information to customers.

According to the National Conference of State Legislatures, at least 22 states have some kind of gag rule legislation.

One way patients can get around this is to ask, but few people think to do so.

Ross and colleagues decided to see what would happen if Medicare patients just took advantage of Walmart’s program offering $4 generic prescription drugs.

They looked at Walmart’s generic list for drugs commonly used to treat heart conditions, including high blood pressure and high cholesterol.

“Next, we used Medicare prescription drug plan data from June 2017 to determine beneficiary out-of-pocket costs for the lowest-priced dose of each drug in each plan,” they wrote. They got data on more than 2,000 Medicare prescription drug plans, including Medicare Advantage plans.

Overall, 21 percent of the plans asked patients to pay more out of pocket for the drugs than they would pay if they just got them for $4 at Walmart, the team reported.

Medicare Advantage plans were the most expensive for patients, Ross said. And the higher-tier programs were the worst, he found.

“Twenty percent of the time, at least, we should go to Walmart,” Ross said.

It doesn’t help that Medicare is very complicated. Patients can choose from dozens of different plans, depending on where they live, and it can take a great deal of research to find out which plan is most likely to cover a particular person’s health conditions for the least amount of money.

“Each Medicare drug plan has its own list of covered drugs (called a formulary),” the Center for Medicare and Medicaid Services says on its website.

“Many Medicare drug plans place drugs into different ‘tiers’ on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less than a drug in a higher tier.”

Ross said it is time-consuming to compare one Medicare plan to another. But understanding one of the many plans tells people very little about what the others might offer.

“If you have read through the details and material for one plan, you have read through the details and materials for one plan. It’s very hard to compare,” he said.

In addition, any given plan may change the drugs that it covers and their prices throughout the year.

Ross said he studied Walmart because its $4 price for a 30-day supply of a generic drug seemed like the least expensive option, but other retailers also have inexpensive drug plans. Some grocery-based pharmacies even offer free drugs, such as antibiotics.

These offers get customers into the store, and the hope is that they’ll buy something else while they are there.

Ross said no patient should decide on a Medicare plan based solely on whether Walmart offers a better deal on prescriptions.

Switching plans might not be the best idea, because different plans provide different levels of coverage for doctor visits, medical procedures and other health needs.

“What we are showing is there may be some ways to save some money on some drugs by going to Walmart,” Ross said.

According to the Kaiser Family Foundation, about 90 percent of prescriptions filled in the U.S. are for generic drugs. Most people get health insurance through an employer, and the typical co-pay for a generic drug for a patient covered by employer-provided health insurance is $11, Kaiser found. For a brand-name drug, the average co-pay is $33.

Walmart is moving aggressively to get a big share of the U.S. health care market. Besides having large pharmacies, stores offer free health screenings and the company has said it intends to expand its locations of retail walk-in health clinics.

Walmart is also negotiating a closer partnership with health insurer Humana, including the possibility of buying it outright, according to CNBC.

The discount retailer’s $4 generic prescriptions beat Medicare’s co-pays 21 percent of the time, a study found.

 

 

 

Is it a gag rule after all? A closer look at changes to Title X funding regarding abortion.

https://www.washingtonpost.com/news/to-your-health/wp/2018/05/23/is-it-a-gag-rule-what-changes-to-family-planning-funds-and-abortion-referrals-might-mean/

The Trump administration has released the language of a proposed rule on federal family planning funding, and abortion rights activists are raising alarm about it.

When health officials revealed Friday that they would be filing a change to which clinics would be eligible for funding, they emphasized that it was not a “gag rule.” Instead, they said they were proposing to strip away a current mandate. It requires organizations that receive Title X funding to counsel women about abortion and provide them with referrals to abortion services. Under the new rules, a provider wouldn’t have to talk about abortion at all.

This was part of a plan that would require “a bright line of physical as well as financial separation” between Title X family planning programs and ones in which abortion is “supported or referred for as a method of family planning.”

“Contrary to recent media reports,” the White House said in a statement that day, “HHS’s proposal does not include the so-called ‘gag rule’ on counseling about abortion.” The statement contrasted the new rule with a Reagan administration policy in 1988 that banned any mention of abortion.

The Department of Health and Human Services declined to make the full proposed rule available last week, but it was posted on the HHS website Tuesday. It’s consistent with the message the administration provided Friday but is more explicit about what can and cannot be said.

Page 119 states that “A Title X project may not perform, promote, refer for, or support, abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion.”

The one exception is if a woman “clearly states that she has already decided to have an abortion.” In this situation, a doctor or other provider should provide “a list of licensed, qualified comprehensive health service providers (some, but not all, of which also provide abortion, in addition to comprehensive prenatal care.)”

So is it or isn’t it a “gag rule”?

HHS’s view is that there is a difference between counseling and referrals. Counseling — as long as it is not “directive” or expressing an opinion — is allowed. It stated that referrals for abortion are, “by definition, directive” and, therefore, not allowed under its new interpretation of a 2000 regulation that pregnancy counseling be nondirective.

Planned Parenthood, which serves about 41 percent of the patients who receive services through Title X, and other groups that support abortion rights, beg to differ. On Wednesday, Planned Parenthood started a #NoGagRule campaign that will include a rally in front of the U.S. Capitol at 5:30 p.m.

“This is one of the largest-scale and most dangerous attacks we’ve seen on women’s rights and reproductive health care in this country. This policy is straight out of the Handmaid’s Tale — yet, it’s taking effect in America in 2018,” Dawn Laguens, executive vice president for Planned Parenthood Federation of America, said in a statement that referenced Margaret Atwood’s dystopian novel.

Georgeanne Usova, legislative counsel with the American Civil Liberties Union, said the policy is “putting the health and lives of countless people at risk in service of this administration’s extreme antiabortion agenda.”

Likewise Jenn Conti, a fellow with Physicians for Reproductive Health, said the ” ‘gag rule’ is not only unconscionable, but it undermines medical ethics by allowing health-care professionals to withhold accurate and timely medical information from patients.”