Does new law affect Medicare solvency?

Investment Analysis Clubs Macro Economic Trends and Risks
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https://www.cnn.com/2022/07/15/politics/biden-build-back-bet…
https://www.fda.gov/about-fda/fda-basics/fact-sheet-fda-glan….

The bill would empower Medicare to negotiate prices of certain costly medications administered in doctors’ offices or purchased at the pharmacy. The Health and Human Services secretary would negotiate the prices of 10 drugs in 2026, and another 15 drugs in 2027 and again in 2028. The number would rise to 20 drugs a year for 2029 and beyond.

There are over 20,000 prescription drug products approved for marketing. Nearly all of them cost far more in the US than in any other country. And it’s being touted as a “big deal” that during the next 7 years, the Medicare system will be able to negotiate the prices of .1% of them.

The bill would redesign Medicare’s Part D drug plans so that seniors and people with disabilities wouldn’t pay more than $2,000 a year for medications bought at the pharmacy. Insurers and drugmakers would have to pick up more of the tab. Presumably, this additional funding will come out of the Medicare fund.

Medicare’s hospital insurance trust fund will only be able to pay scheduled benefits until 2028, according to the most recent analysis by the program’s trustees. And yet no one is panicking.

It’s easy to poke fun at politicians, but even easier to poke fun at the voters who serially vote the same guys/gals into office despite the copious evidence that they have been bought by special interest groups.

Jeff

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The bill would redesign Medicare’s Part D drug plans so that seniors and people with disabilities wouldn’t pay more than $2,000 a year for medications bought at the pharmacy. Insurers and drugmakers would have to pick up more of the tab. Presumably, this additional funding will come out of the Medicare fund.

iirc, Part D is funded from General Revenue, the infinite credit card that also covers JC tax cuts.

Steve

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OrmontUS writes,

There are over 20,000 prescription drug products approved for marketing. Nearly all of them cost far more in the US than in any other country. And it’s being touted as a “big deal” that during the next 7 years, the Medicare system will be able to negotiate the prices of .1% of them.

Exactly!

About 90% of the prescriptions seniors fill are for generic drugs. And unlimited price gouging on generics remains intact under the legislation passed with great fanfare in the Senate today.

intercst

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From the CNN article: The latest version of the package would reduce the deficit by more than $300 billion over a decade, according to the Congressional Budget Office.

Reduce it as compared to… what?

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Steve203 writes,

iirc, Part D is funded from General Revenue, the infinite credit card that also covers JC tax cuts.

The 2022 subsidy to the Medicare Part D drug program is $111 Billion (more than $1 Trillion over ten years) and a lot of the subsidy is lost to generic drug price gouging by Part D for-profit health insurers.

I’d love to have the Congressional Budget Office do a study on what that $111 Billion annual subsidy would be if everyone was paying Mark Cuban’s cost plus 15% markup for their generic drugs. I bet it would cut the cost by 2/3rds.

intercst

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“About 90% of the prescriptions seniors fill are for generic drugs. And unlimited price gouging on generics remains intact under the legislation passed with great fanfare in the Senate today.”

The average senior takes 5 different meds.

I take 2 and at my Humana/Walmart plan, I pay $3 each for a 90 day supply of each. $6/3 months or $24 a year.

Am I being ‘price gouged’?

t.

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It wasn't easy to find the list of drugs whose prices are to be negotiated.  Along with the others, 
there is a present for the wives of many in Congress (Botox:-).  That's what I thought - until I read
the small print and it seems that, despite the bill already moving across desks, there still isn't an
official list!

Here ya go:

[https://www.americanprogress.org/article/congress-can-act-no...](https://www.americanprogress.org/article/congress-can-act-now-to-lower-drug-costs-by-allowing-medicare-to-negotiate-prices/)

Some drugs could be subject to price negotiation under proposed reforms to lower prescription drug costs

Examples of Medicare Part B and Part D drugs that could be subject to negotiation, and spending and
utilization among Medicare beneficiaries, 2019

Medicare Part B
Drug name			Therapeutic class	Average spending per beneficiary	Total 		
											number of beneficiaries
Orencia (Bristol-Myers Squibb)		Musculoskeletal			$31,700		29,031
Cimzia (UCB)				Gastrointestinal		$24,097		18,231
Xolair (Genentech)			Respiratory			$22,345		17,911
Botox (Allergan)			Neurologic			$2,510		146,030
Aranesp (Amgen)				Oncologic			$4,821		47,938
Tysabri (Biogen)			Neurologic			$43,123		5,142

Medicare Part D
Drug name	Therapeutic class	Average spending per beneficiary	Total number of beneficiaries
Revlimid (Celgene)			Oncologic			$110,711	42,215
Xarelto (Janssen)			Blood Agent			$3,595		1,134,222
Januvia (Merck)				Endocrine/diabetes		$3,769		938,165
Lantus Solostar (Sanofi-Aventis)	Endocrine/diabetes (insulin)	$2,585		965,522
Symbicort (AstraZeneca)			Respiratory			$1,827		1,103,477
NovoLog FlexPen (Novo Nordisk)		Endocrine/diabetes (insulin)	$3,063		602,128
Levemir FlexTouch (Novo Nordisk)	Endocrine/diabetes (insulin)	$3,266		496,640
Victoza 3-Pak (Novo Nordisk)		Endocrine/diabetes		$6,141		248,675
Myrbetriq (Astellas)			Genitourinary			$2,558		564,887
Restasis (Allergan)			Ophthalmologic			$2,405		563,545
Spiriva (Boehringer Ingelheim)		Respiratory			$2,799		455,668
Humalog KwikPen U-100 (Eli Lilly)	Endocrine/diabetes (insulin)	$2,775		438,914
Tradjenta (Boehringer Ingelheim)	Endocrine/diabetes		$3,530		336,435
Lantus (Sanofi-Aventis)			Endocrine/diabetes (insulin)	$2,746		422,031
Linzess (Allergan)			Gastrointestinal		$2,384		412,698
Xifaxan (Gilead)			Infectious disease		$8,594		88,695

Table: Center for American Progress  Source: Centers for Medicare and Medicaid Services, "Medicare Part 
B Spending by Drug," available at [https://data.cms.gov/summary-statistics-on-use-and-payments/...](https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-)
medicaid-spending-by-drug/medicare-part-b-spending-by-drug (last accessed January 2022); Centers for 
Medicare and Medicaid Services, "Medicare Part D Spending by Drug," available at 
[https://data.cms.gov/summary-statistics-on-use-and-payments/...](https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-medicaid-spending-by-drug/medicare-)
part-d-spending-by-drug (last accessed January 2022). Therapeutic class information from SSR Health 
(2021) was provided by third-party researchers and is on file with authors

Jeff
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I pay $3 each for a 90 day supply of each. $6/3 months or $24 a year.

Just out of curiosity, how much is Medicare billed for these?

Jeff

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The average senior takes 5 different meds.

I take 2 and at my Humana/Walmart plan, I pay $3 each for a 90 day supply of each. $6/3 months or $24 a year.

Am I being ‘price gouged’?

Maybe. Depends on the cost of the pills.

But your situation is not typical. I take 5-7 generic Rx pills, plus some that are OTC. One thing the insurance companies do is hide costs in order to be able to pass them on to customers (“free delivery”, etc). TANSTAAFL.

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<Mark Cuban’s cost plus 15% markup for their generic drugs. I bet it would cut the cost by 2/3rds.>

I think that Mark Cuban walks on water and deserves our deepest admiration. That being said, everyone should check GoodRX.com and Blinkhealth.com as well as Mark Cuban’s company, costplusdrugs.com, before placing a prescription. I saved more than 2/3 of the list price of letrozole (cancer drug) with Blinkhealth.com.

The sad thing is that so many elderly people, the ones most likely to need prescription drugs, are less tech-savvy than many young people.

Wendy

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WendyBG writes,

<<<Mark Cuban’s cost plus 15% markup for their generic drugs. I bet it would cut the cost by 2/3rds.>>>

I think that Mark Cuban walks on water and deserves our deepest admiration. That being said, everyone should check GoodRX.com and Blinkhealth.com as well as Mark Cuban’s company, costplusdrugs.com, before placing a prescription. I saved more than 2/3 of the list price of letrozole (cancer drug) with Blinkhealth.com.

The sad thing is that so many elderly people, the ones most likely to need prescription drugs, are less tech-savvy than many young people.

Sure. Check them all.

In addition to the price gouging, Americans are also wasting a lot of time on the phone with these health insurance thieves in an attempt to limit their losses to the price gouging. There’s an economic cost to that, too. And a macroeconomic impact when you multiply it by 63 million Medicare beneficiaries.

intercst

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That being said, everyone should check GoodRX.com and Blinkhealth.com as well as Mark Cuban’s company, costplusdrugs.com, before placing a prescription.

I saw my ENT specialist last week. When I got into the exam room, the PA asked me a number of questions about my health and about my visit. She then asked what pharmacy do you want us to send your scripts to in the event that the Dr. perscribes a medication for you? I told her that I would prefer to get the prescription in writing so that I could “shop it around” for best pricing. This response aggravated her, as she clearly just wanted me to name someplace like the local CVS, Walgreens, Walmart, etc. She immediate got a “bad attitude” with me for the remainder of the interview process.

When the doc came in to examine me, and then asked where he could send a prescription, I asked for it in writing so that I could compare prices and I added “I’m sure you know how that goes”. He did, and told me he would write a prescription for me, and to call the office if I found a great price at a pharmacy that ONLY took electronic prescriptions, and he would send one in for me.

I ended up using a GoodRX coupon at the local CVS and they filled the prescription for $23. If I had not used GoodRx, it would have been anywhere between $36 and $83.

I don’t care if the PA lost her patience with me if it was gonna save me $$.

'38Packard

  • ALWAYS shops prescription med pricing for best available price!
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And, unless you have no choice, don’t let the hospital fill the prescription from their pharmacy (for obvious reasons)

Jeff

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The sad thing is that so many elderly people, the ones most likely to need prescription drugs, are less tech-savvy than many young people.

Or just completely overwhelmed with the constant denial of claim. The one time I am happy for DH’s OCD personality is in dealing with insurance. It’s a full time job, and we are relatively healthy! He has spent hours trying to get charges removed when they ran the wrong test, or when an erroneous charge came up on my mammogram, getting the hospital to understand they took the erroneous IV PUSH off the insurer’s charge, they forgot to remove the portion I was supposed to pay. It’s endless. Nothing is ever done right the first time.

My parents were fortunate they had Sis, a registered nurse, taking care of them. I wonder who will keep our paperwork straight and be our health advocate?

IP

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I told her that I would prefer to get the prescription in writing so that I could “shop it around” for best pricing. This response aggravated her, as she clearly just wanted me to name someplace like the local CVS, Walgreens, Walmart, etc. She immediate got a “bad attitude” with me for the remainder of the interview process.

We get attitude like this regarding blood draws and testing. Our doctors are associated with one of the hospitals in town and seem programmed to push internal testing. I’ve learned to insist on getting written scripts for tests we can take to our local LabCorp, which has better rates with our insurer than the hospital. MUCH better. Only my gynecologist seems to get it. When I asked for a paper scripts she said she was going to recommend it.

IP

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“wellness” “healthy lifestyle”.’

In the end - the reward for living long is going to be euthanasia and pain pills.

Keep watching…

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In the end - the reward for living long is going to be euthanasia and pain pills.

+++
+++

And, Solyent Green!

https://www.imdb.com/title/tt0070723/!

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I saw my ENT specialist last week. When I got into the exam room, the PA asked me a number of questions about my health and about my visit. She then asked what pharmacy do you want us to send your scripts to in the event that the Dr. perscribes a medication for you? I told her that I would prefer to get the prescription in writing so that I could “shop it around” for best pricing. This response aggravated her, as she clearly just wanted me to name someplace like the local CVS, Walgreens, Walmart, etc. She immediate got a “bad attitude” with me for the remainder of the interview process.

I received a prescription from a doctor last week, and they asked which pharmacy. I said “the cheapest one”. And they said, we will send it over to your pharmacy, and if you find a cheaper one, just call us and we will send it there instead.