medicare drugs Archives

Medicare Spent $1.4B on Discarded Medicare Drugs

According to a recent study, Medicare spent $1.4 billion on drugs in 2017 and 2018 that ended up being discarded. More specifically, Medicare spent $695 million on discarded Part B drugs in 2017, and $725 million in 2018. Most of these wasted tax dollars went towards chemotherapy and cancer-treating drugs that were not used. Medicare now has plans for utilizing that $1.4 billion rather than wasting it.

Wasted Resources

hundred dollar bills and other bills crumbled in a trash can — *$1.4 billion of wasted money was on drugs that were discarded, that could’ve been used for other things.*

Most of the drugs that were discarded in this two-year period were unused units of chemotherapy drugs. They ended up being disposed of because many units were single-dose vials that contained a higher dose than was needed to treat the average patient. This $1.4 billion of essentially wasted money accounts for 16% of Medicare spending, and 2% of Part B drug spending.

According to a report put forward by MedicareAdvantage.com, this amount of spending could:

Cover a year’s worth of insulin for more than 3.3 million Part D beneficiaries
Buy 87,000 hospital ventilators, which the country is in desperate need of due to the coronavirus pandemic
Buy more than 1 billion N95 masks
Cover the cost of 31.6 million flu shots
Go towards necessary women’s health treatments

Why Is So Much Money Wasted?

The report also suggests that Medicare’s “buy and bill” drug supply model is likely to blame for the waste. In the “buy and bill” model, healthcare providers and hospitals purchase, store and administer drugs to patients, and then bill insurers or patients for the drug. All drugs purchased by providers must either be administered or thrown away after opening, which often happens because many vials contain higher doses than is appropriate for patients.

“Because of this model, drug manufacturers are incentivized to produce medication amounts that are more likely to end up discarded when single-dose vials or containers include higher doses than are necessary,” says the report on MedicareAdvantage.com. “Profits are increased by billing for the whole vial even if only a portion of it is needed and used. Doctors and hospitals also enjoy bloated profit margins under this system.”

The Government’s Considerations

The information in this study has prompted CMS to consider enacting two possible solutions:

Require drugmakers, hospitals, and doctors to refund CMS for discarded drugs
Require pharmaceutical companies to right-size drug containers so that no medication gets wasted/discarded
Do both of the above

Medicare AEP Is Over, What If You Missed It?

Every year from October 15 to December 7 is Medicare’s Annual Enrollment. This is the time you can switch from Medicare to Medicare Advantage, and vice versa. You can also change your Medicare Advantage or Part D plans.

*Just because Medicare OEP is over, does not mean you do not have other options to help you save money.*

Time flies and things happen, and before you know it, open enrollment has ended. You may have not gotten the chance to look over plans, change plans to meet your needs, or did not have enough time to research your options. But luckily if you missed open enrollment, there are still some options for you to choose from.

Medicare Advantage OEP

Beginning 2019, the Medicare Advantage Open Enrollment Period runs from January 1 to March 31 every year. During this period, you can switch Medicare Advantage plans, or disenroll from their Medicare Advantage Plan to Original Medicare. If you choose to switch back to Original Medicare, then you can enroll in a Part D prescription drug plan. Do some research to make sure whichever way to choose to go that the network covers your doctors.

Medicare Special Enrollment Period, SEP

If you missed the open enrollment period, you can qualify for Medicare Special Enrollment Period. Here are the circumstances to qualify for SEP:

- Moved out of plan’s service area

- Lost employer-based health insurance

- Used to be eligible for Medicaid and now you are not

- Your plan is ending its contract with Medicare

Moving back to US after living outside of the US

5 Star Plans

In 2010, the Health care Reform Law created a star rating system for Medicare Plans. One star being poor, and 5 stars being the best. Every fall the ratings are updated for these plans. Beneficiaries can enroll in a Medicare Advantage 5-star plan once a year from December 8 to November 30th.

Medicare Supplement Plans

Medicare Supplement Plans can help you pay for Medicare Part B bills that may be hard for you to pay. These plans are sold by private insurance companies, and you can always consider buying one as long as you are 65 years old. There are 10 different supplement plans to choose from, some covering more than others. If you consider buying one outside of the Medicare Supplement Open Enrollment Period (the 6 month period beginning the month you turn 65), then you may be subject to paying more for pre-existing conditions.

Another option you can take is to ask your doctor for the generic, cheaper brand of the precritions you take.

Change Your Drugs

If you missed the chance to find a better plan to cover your prescriptions, then you can always talk to your doctor about cheaper drug options. The Medicare Modernization Act requires that Medicare offer at least two drugs in each category class. What this means is that you can talk with your doctor and ask to take the alternative drug that costs lower.

Missing the Medicare open enrollment period can cause a lot of stress. EZ.Insure offers agents within your region to help you and answer any questions you may have. Our agents are highly trained to provide you the best option for your needs. The agents will provide you with Medicare Supplement quotes from top carriers in your area, and even help you sign up at no cost. To get quotes, enter your zip code in the bar above, or to speak to an agent directly, email replies@ez.insure, or call 888-753-7207. Do not worry if you missed the OEP, we can help you get on the right track.

Medicare Cracks Down on Opioid Problem

Medicare has announced new guidelines for beneficiaries who receive high-dose opioids. Due to the rising deaths from opioids in America, the government and Medicare officials have decided to take action to fix the problem and reduce deaths. The overdose of opioids has been a rising cause of deaths in the USA, killing over 60, 000 people in 2016. The new guideline was designed to crack down on doctors over prescribing opioids, as well as to make sure beneficiaries are not abusing their medications.

*Because some Medicare beneficiaries overuse their prescription opiods, CMS has created new guidelines,*

The Centers for Disease Control and Prevention, CDC, estimated that almost 100 Americans die every day due to an opioid overdose. President Trump decided that it was time to take action and battle the opioid addiction, starting with how much and often they are being prescribed.

Of the estimated 50 million Medicare beneficiaries in America, one in three are prescribed opioids or painkillers. Medicare wants to take part in the opioid addiction problem by putting restrictions/guidelines on the opiods that are given to their beneficiaries.

The New Guideline

The new plan has been finalized in April that will make it harder for Medicare patients to receive high doses of painkillers. The Centers for Medicare and Medicaid Services, CMS, will require all new opioid prescriptions for short term acute pain limited to no more than a weeks worth of supply.

In 2019, morphine prescriptions will be limited to 90mg at a weeks time. If a doctor or patient tried to receive more

If a Medicare patient is prescribed more than the set amount of the guidelines, the pharmasict must talk to the doctor. If they agree with the answer, they will allow the patient to get the prescription.

than this set limit, then it would trigger a “hard safety edit” in which the pharmacist must talk to the prescribing doctor about the dosage. If the pharmacist is happy with the answer then they can override and fill the prescription, and if not then they do not have to fill it and Medicare will not pay for it. If denied, the doctor will have to appeal the decision and show why it is medically necessary for the patient to have the high doses in order for Medicare to reconsider. These guidelines will not apply to those who are suffering from cancer or in hospice.

The new limit is a hopeful tactic to catch doctors who overprescribe, and keep an eye on patients who take more opiates than necessary from different doctors. This way Medicare and the government can try to reduce overprescription that will lead to overdose or patients selling their prescriptions.

Demetrios Kouzoukas, CMS deputy administrator and director of the Center for Medicare, told MedPage Today that if the prescription exceeds the limit, that would act as a “trigger” for a conversation between the physician, patient and insurer about “appropriate opioid use and prescribing.” To get more than the proposed limit, the limit would have to be overridden by the patient’s insurance plan.

The CMS estimates that about 1.6 million Medicare beneficiaries have prescriptions above the set 90mg level. The real battle will be determining that the correct patients that need the dosage required will receive it, while halting the access of addictive drugs to patients who do not need it.

Trump Takes Action on Lowering Medicare Drug Prices

Medicare drug prices continue to increase making it harder for seniors to afford, President Trump decided to take action. Trump proposed a plan to bring down the prices of Medicare drugs by giving back to customers and focusing on raising foreign drug prices.

The federal government is not allowed to negotiate Medicare drug prices, so Trump said his plan will work without needing Congress’ approval. Insurers get discounts for the expensive name brand drugs, which are negotiated by pharmacy managers. Trump wants these rebates and discount distributed to the customers, which would help lower the prices. President Trump’s plan is to give at least one-third of the rebates to beneficiaries.

Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, stated that the rebates are a “convoluted system,” because they allow manufacturers to raise list prices. This, in turn, increases the amount of money that insurers and pharmacy benefit managers collect in rebates, giving them no incentive to keep prices down.

“When prices go up, patient cost-sharing also goes up,” she said in a speech before the American Hospital Association earlier this week. “We’ve all noticed the increase in the amount we have to pay at the pharmacy counter. For seniors who are sometimes on fixed incomes, the pain is real. This is not acceptable.”

The Trump administration wants to raise the prices of foreign drugs in order to reduce the drug prices at home. The reasoning for this is because foreign places keep their prices low while Americans continue to pay highly for their drugs. The foreign countries benefit from America paying high prices for these drugs and essentially their development. “The United States both conducts and finances much of the biopharmaceutical innovation that the world depends on, allowing foreign governments to enjoy bargain prices for such innovations,” the council’s report said. “Simply put, other nations are free-riding, or taking unfair advantage of the United States’ progress in this area.”

The Food & Drug Administration is focusing on trying to introduce more generic drugs that are identical to name brand drugs. This way customers can opt to buy the generic brand and save some money. The agency is hoping that by producing more generic drugs will increase competition and eventually bring down the pricing of brand-name drugs.

Seniors have been struggling to obtain the medications they need due to how expensive they are. Some have to make drastic changes in order to get these medications because they can die without them. There are still talks amongst the Trump administration about reducing Medicare drug prices and they are hoping to make some positive changes in 2019.