Medicare to stop covering critical medications?

Buried beneath the avalanche of recent news reports about the latest Obamacare-mandated funding cuts to the Medicare Advantage (MA) program is a related but far more disturbing story — the Centers for Medicare and Medicaid Services (CMS) has taken a major step toward rationing medications to the elderly. Since passage of the Medicare Modernization Act of 2003, seniors enrolled in the Medicare prescription drug program have been guaranteed access to “all or substantially all” of the drugs in several classes of pharmaceuticals. President Obama’s health care bureaucrats, however, have proposed removing three of these classes from the “protected” list.

The New York Times reports, “The administration’s proposal would remove the protected status from… immunosuppressant drugs used in transplant patients, antidepressants and antipsychotic medicines.” Yes, you read that correctly. These are drugs used to facilitate organ transplants and treat patients suffering with mental illness. The Times names a few of the medicines in question: “They include many well-known drugs, such as Wellbutrin, Paxil and Prozac to treat depression, and Abilify and Seroquel to treat schizophrenia.” There can be little doubt that the next step CMS plans to take will involve a decision not to cover the most expensive of these medications at all.

This is why CMS represents this as a cost-saving measure. But the amount of money these changes will save is virtually nothing by Medicare standards. Moreover, as Yevgeny Feyman writes in Forbes, “The likely reduction in therapeutic choices could result in higher health care costs in other parts of the program, like Part A (for hospital care) or Part B (for physician services).” Further undermining the CMS cost-saving claim is that, due to the very market features that make it unpopular with Beltway bureaucrats, the Medicare prescription drug program may be the only federal entitlement in history whose costs have come in below its initial CBO projections.

Nonetheless, the Obama administration didn’t lose its affinity for health care rationing when Donald Berwick was forced out of CMS. Rationing is as much about control as it is about money. And this is where the nexus between the CMS drug proposal and Obamacare’s MA cuts can be found. Medicare’s prescription drug benefits are administered only through Medicare Advantage, and the President as well as his bureaucratic accomplices have been gunning for MA since Obama’s brief pit stop in the Senate. MA introduced private competition and patient choice into Medicare. That cannot be tolerated. Medicare must be wholly returned to their fiscally inept control.

Predictably, the CMS proposal has produced bipartisan protests. As the Times further reports, “Republican and Democratic members of the Senate Finance Committee warned that the proposal could ‘diminish access to needed medication’ without saving much money.” On February 19, House Energy and Commerce Committee Chairman Fred Upton, House Ways and Means Committee Chairman Dave Camp and Senate Finance ranking member Orrin Hatch wrote to HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner thus: “As authors of Medicare’s successful prescription drug program.… We are strongly opposed to this proposed regulation.”

The following day, the CMS head received another protest letter from a surprisingly diverse coalition of more than 200 groups, including the AIDS Alliance, the National Kidney Foundation, the U.S. Chamber of Commerce, the Association of Community Cancer Centers, the Lupus Foundation of America, the Pharmaceutical Research & Manufacturers of America, the United Way, various hospitals, physician associations, insurance companies and pharmacy chains. The letter warns Tavenner that the rule makes “unnecessary changes to programs that are already extraordinarily effective” and that it “will impede beneficiaries’ access to affordable health plans and medicines.”

Even some left-leaning media outlets are uncomfortable with the Obama administration’s rationing policy. In the Huffington Post, Professor Kenneth Thorpe of Emory University’s Rollins School of Public Health, recently pointed out that the CMS rule “will not only fail to rein in Medicare’s long-term spending growth, but will inflict severe and unnecessary harm on our nation’s poor and elderly who are suffering from serious physical and behavioral illnesses.” Thorpe makes much the same point as does Feyman: “Restricting access to the medicines patients need to manage depression, avoid organ transplant rejection, and treat psychosis will drive healthcare utilization in far more costly ways.”

It’s a little disorienting to find such an objective view in a publication that normally repeats Obama administration talking points verbatim, but there it is. Presumably, this departure from partisanship is an indication of just how far CMS has over-reached this time. Most Americans regard health care rationing as repugnant and unnecessary, and we look on it with even less favor when it is imposed on the elderly. As Professor Thorpe writes, “That’s a betrayal of Medicare’s promise of access to care for our most vulnerable, older Americans.” Well said.

Written by David Catron for the Spectator, February 24, 2014.

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