What Are the Top 20 Priciest Medicare Prescription Drugs?

 

High Drug Costs

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.

Nondiscrimination And Chronic Conditions — The Final Section 1557 Regulation

http://healthaffairs.org/blog/2016/07/20/nondiscrimination-and-chronic-conditions-the-final-section-1557-regulation/

Blog_Burwell2

Before the Affordable Care Act (ACA), those with serious or chronic health conditions were often denied health insurance coverage or paid high prices for substandard plans with coverage exclusions. Many went uninsured and untreated. For them, the ACA’s new coverage opportunities and protections against discriminatory practices by health insurers serve as an essential lifeline.

Under the ACA, insurers can no longer charge higher premiums or deny coverage for people with pre-existing conditions. However, some insurers have tried to circumvent ACA protections by designing benefits that discourage enrollment by persons with significant health needs.

NHeLP and The AIDS Institute filed a landmark complaint with the Department of Health and Human Services’ Office for Civil Rights after four Florida insurers placed all HIV medicines, including generic drugs, on the highest cost sharing tiers. Researchers found that this practice—called “adverse tiering”—is widespread. A New England Journal of Medicine study found that one-in-four insurers placed all drugs to treat HIV in the highest tiers. Another study in Journal of the American Medical Association found that up to 15 percent of plans in the federal marketplace lack in-network physicians for at least one specialty, making access to care significantly more expensive for those with specialized care needs.

The Department of Health and Human Services (HHS) recently finalized regulations for the cornerstone non-discrimination provision of the ACA — Section 1557. For the first time, the provision applies civil rights protections against discrimination on the basis of race, ethnicity, national origin, sex, age, and disability specifically to health programs and activities administered by or receiving federal funding.

Health advocates and patient advocacy organizations lauded the final regulations for Section 1557, which expressly prohibit insurers from employing plan benefit designs or marketing practices that discriminate.

Hospitals oppose potential rebirth of ‘public option’ coverage

http://www.fiercehealthcare.com/finance/hospitals-chafe-against-potential-rebirth-public-option-coverage?mkt_tok=eyJpIjoiTXpVMk1HRm1NRE5pWW1JMSIsInQiOiIrM3BwTVBRRXorTzl3NjQxOWNPOUh1UUxUT0ZcL2xNTGdleWQzKzRFRzIwZzhHYTg2T0c3TWlZV1BjUEsxd0JBRmNJaGk0WU9NMTRvWmFyZndPVit2SzZmUDFxM1dWSm1OV2l4Rnd1YlBMWTQ9In0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Pillar of building etched with the word insurance

Under pressure from onetime rival Bernie Sanders and the liberal wing of her party, Hillary Clinton has pushed for a “public option” form of coverage in the state and federal health insurance exchanges.

The decision is considered to be a middle ground option away from Sanders’ primary campaign push for single-payer coverage. The proposal was recently endorsed by President Barack Obama.

However, the public option has drawn fire from the hospital sector, which fears it would depress the payments it receives to provide care. As a result, the American Hospital Association and the Federation of American Hospitals reached out last week to the Democratic Platform Drafting Committee.

Reflections on 17 Years in California Health Policy

http://www.chcf.org/articles/2016/07/reflections-17-years?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t

California Health Care Foundation - Health Care That Works for All Californians

California’s individual health insurance marketplace today bears little resemblance to that of the mid-2000s. Since 2014 Californians have been able to purchase individual coverage without regard to their medical history. They can switch plans and carriers during annual open enrollment periods. Consumers face strong incentives to obtain coverage: They incur tax penalties if they remain uninsured, and all who are lawfully present and meet income standards are eligible for subsidies through Covered California. As a result, a greater share of Californians is now covered through the individual market than is uninsured (14% versus 11%, according to one national survey). While affordability concerns remain, early data show that Californians who bought insurance through the individual market spent significantly less than those buying before the ACA. And the percentage of Californians with individual coverage spending more than 10% of their household income on health care costs also went down.

Health plans that attract the working uninsured

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/health-plans-attract-working-uninsured?cfcache=true

Baby-Hand-Holding

http://files.kff.org/attachment/supplemental-tables-the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform

 

Americans’ Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction

http://www.commonwealthfund.org/publications/issue-briefs/2016/jul/affordability-and-network-satisfaction

For people with low and moderate incomes, the Affordable Care Act’s tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law’s cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.

The Fundamentally Different Goals of the Affordable Care Act and Republican ‘Replacement’ Plans

http://blogs.wsj.com/washwire/2016/06/07/the-fundamentally-different-goals-of-the-affordable-care-act-and-republican-replacement-plans/?utm_campaign=KFF-2016-June-Drew-ACA-GOP-alternatives&utm_medium=email&_hsenc=p2ANqtz-9Uqf60gdSQ_FC57uSLNkYvFicHfqEALEVvadSgR8xY01bL5QFOrYsCgcl6KB_N5PVHy5G8fwynf8MEywb7m1kUxPljFQ&_hsmi=30331935&utm_content=30331935&utm_source=hs_email&hsCtaTracking=7825060e-e865-4738-ba5a-68a31a8904b6%7C192993c0-5763-4c2a-b289-c32fd7a5274a

Rep. Pete Sessions and Sen. Bill Cassidy introduced legislation last month calling for replacing elements of the Affordable Care Act. A House task force established by SpeakerPaul Ryan is expected to follow with more health-care proposals. These Republican health plans are generally referred to as “replacements” for the ACA–in the spirit of “repeal and replace”–as though they would accomplish the same objectives in ways that conservatives prefer. But the proposals are better understood as alternatives with very different goals, trade-offs, and consequences. Whether they are “better” or “worse” depends on your perspective.

To boil down to the most basic differences: The central focus of the Affordable Care Act is expanding coverage and strengthening consumer protections in the health insurance marketplace through government regulation. By contrast, the primary objective of Republican plans is to try to reduce health-care spending by giving people incentives to purchase less costly insurance with more “skin in the game,” with the expectation that they will become more prudent consumers of health services. They also aim to reduce federal spending on Medicare and Medicaid and the federal government’s role in both programs. Elements of the ACA were designed to reduce costs, such as the law’s Medicare payment reforms, and elements of Republican plans such as tax credits aim to expand access to insurance, but the primary aims of the ACA and the Republican plans differ.

The Next Big Debate in Health Care

http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/?utm_campaign=KFF-2016-Drew-WSJ-June-30-adequacy-coverage&utm_medium=email&_hsenc=p2ANqtz–xQ5m7mTzVOQDJ-gEuLbZl7pkPEfb_Iw0ezewQc1ln7AN8seXIMO73B28qbm9dojkj8aBYyKmMoIvL46iTkyv7FWksVw&_hsmi=31195410&utm_content=31195410&utm_source=hs_email&hsCtaTracking=ed044791-0cff-437c-b853-bcb03570f762%7C6f34b697-a7d1-4d2a-b580-e9d37afa69ac

Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA.

Unexpected medical bills can cost American consumers thousands

http://www.pbs.org/newshour/bb/unexpected-medical-bills-can-cost-american-consumers-thousands/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31025728&_hsenc=p2ANqtz-_w0iZON_VFW9xi2r9d3HOiykTJ_YND30E5HOAHhuWAio-qbr61Jfk6MqgtuWR8-lR0pZzgxirKKmV2hqg_CbtEf7rXTg&_hsmi=31025728

Who is In Network

http://www.pbs.org/newshour/updates/americans-who-confronted-surprise-medical-bills-share-their-stories/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31025728&_hsenc=p2ANqtz-_6OV-5Ij1pT2YTVAVrdazaB9p8aPoIXD_9L5_HrzAhpJcuAUqEb9lpLG6ehkNgCQSxaAYVzW5LuUjvOVEB7NCIEPp3XA&_hsmi=31025728

 

Filling A Prescription? You Might Be Better Off Paying Cash

http://khn.org/news/filling-a-prescription-you-might-be-better-off-paying-cash/?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=30971433&_hsenc=p2ANqtz–rAQj-sGWH-JKBDVyBtJzuODQFe-bAF_J8z_ZoKZ4dV_VPRMdYkly_MVrJhTdTD6w_9hQLCFr7zZ59qZbt0C5LRhBjsw&_hsmi=30971433

Pharmacist scanning product

Some consumers who use health insurance copays to buy prescription drugs are paying far more than they should be and would be better off paying with cash, especially for generics. The added cost runs as high as $30 or more per prescription, say pharmacists, and the money is largely being pocketed by middlemen who collect the added profit from local pharmacies.

Cash prices started to dip below copays a decade ago when several big box stores started offering dozens of generics for as little as $4 per prescription. But as copays have risen and high-deductible insurance plans become more common, more consumers are now affected.

The phenomenon illustrates the complexity of how drugs are priced in the U.S. and has led to finger-pointing about who is benefitting or who’s to blame.