Uncovering Medicare Challenges
Each year, nearly 1.4 million Americans transition into the Medicare system and for those with chronic conditions, this transition is wrought with significant healthcare access barriers, such as high-cost sharing, restrictive insurer practices and a broken prior authorization system.
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At the briefing, Ms. Kathleen Gallant, a patient advocate and ex officio board member of the NPF, and Mr. John Earley, a patient advocate who serves on the NPF National Advocacy Committee, spoke eloquently about their experiences transitioning to Medicare with a chronic autoimmune disease, Dr. Worthing says, noting that they shared their challenges with high out-of-pocket costs, worries about losing access to medication, testing, specialty care, and the hassles of having to research different plans and budget for all the copayments.
“People shouldn’t be forced to switch medicines when they switch to Medicare, and it should be easy to obtain information in a timely manner about plans and out-of-pocket drug costs,” Dr. Worthing notes. “It’s critical for our lawmakers and policymakers to understand challenges patients face when they transition to Medicare so that they can help fix the flaws and barriers in order to smooth the transition.”
The ACR does support some aspects of the administration’s drug pricing proposals. For example, the College supports the proposal requiring pharmacy benefit managers (PBMs) to pass negotiated savings on drug prices along to patients, and that pharmacists be allowed and encouraged to inform patients when it’s less expensive to pay cash than to use their insurance, due to high copayments. The ACR is also encouraged by Health and Human Services’ (HHS) suggestion that PBMs should not receive reimbursement (or kickbacks) from drug makers, because they inflate prices and cause formularies to be dictated by money instead of science.
In the coming weeks, the ACR will continue to meet with lawmakers on Capitol Hill and policymakers on Secretary Azar’s team at the HHS, and provide careful comments on administration proposals as they are released.
For More Information
Watch video footage from the June 25 briefing titled “Medicare Access Challenges in the Chronic Disease Community: The Patient Perspective.”
Read more about the briefing.
Carina Stanton is a freelance science writer in Denver.