New Rules to Deprive Seniors of Drugs, Doctors

Real Clear Markets – by Diana Furchtgott-Roth

Two provisions in lengthy proposed regulations published by the Centers for Medicare and Medicaid Services in the Federal Register on January 10 would deprive seniors of vital drugs and make it more difficult for them to see their doctors.

These provisions should be changed before the regulations become final. Comments are due by March 7.  

The proposed regulations limit the drugs covered under Medicare’s Part D, the prescription drug component of the program, beginning in 2015.

Now Part D plans have to include drugs within six drug classes, namely antineoplastics, anticonvulsants, antiretrovirals, antipsychotics, antidepressants, and immunosuppressants. CMS is proposing no longer to require all drugs from the antidepressant and immunosuppressant drug classes to be covered by Part D.

Seniors would no longer necessarily have access to insurance for these drugs, with serious consequences. Depression is the most frequent mental health problem in the elderly, and lack of treatment can lead suicide. Depressed patients can cause difficulties for family members and caregivers.

Immunosuppressant drugs are used in the case of a transplant, to prevent the body from rejecting a transplanted organ. Cutting back on these drugs mean that transplants would be more risky and less successful. This would decrease life expectancy of seniors.

CMS calculates that the savings from disallowing these drugs would be $720 million over the five-year period 2015 to 2019. That is $144 million a year, two tenths of one percent of the $677 billion in net Medicare outlays in 2019. In comparison, spending on HIV/AIDS remains untouched, at almost $30 billion in 2014.

Reducing access to major classes of drugs that were required from the beginning of the Part D program would cut Medicare costs by shortening seniors’ lives, but it is not the direction in which our society wants to go. Congress should demand a true cost-benefit analysis of trimming antidepressant and immunosuppressant drugs, including a calculation of the value of lives that could have been saved with the drugs.
As well as depriving seniors of drugs, CMS wants to deprive them of their doctors.

Doctors are dropping out of Medicare due to low reimbursements and massive paperwork. But under the proposed regulations, if seniors receive prescriptions from doctors who do not participate in Medicare, these prescriptions cannot be covered under Part D. This holds even if the senior is paying for Part D.

Since pharmaceuticals are often costly, this regulation, if made final, would have the practical effect of requiring seniors to see doctors who are enrolled in Medicare.

In 2012 another 9,500 doctors left Medicare, according to CMS. (Data are not yet available for 2013.) This is happening as baby boomers are turning 65 and signing up for Medicare and Social Security in record numbers.

Doctors can be “nonparticipating,” where they file claims to Medicare but charge more and bill patients for the difference. Doctors can also opt out of Medicare entirely. They file no claims and patients pay out of pocket.

Under the Affordable Care Act, physicians who order medical devices and home health care must be enrolled in Medicare. The newly-proposed rules would extend this to drugs and all other Medicare services.

Regulations say that this is to prevent fraud and abuse, but the clear intention is to prevent seniors from visiting physicians outside the Medicare system. The government program is becoming increasingly unattractive to both patients and providers, so CMS wants to make sure that no one leaves.

Of course, if seniors visited doctors privately, that would save Medicare the cost of the visit. But CMS says that the proposal does not have any costs or savings, because “we presume that if a beneficiary’s prescriber is not enrolled or does not enroll in Medicare, the beneficiary will find a new prescriber who is enrolled, rather than go without needed medications. Therefore, we do not estimate any savings from this proposal.”

This reasoning neglects the cost of a patient’s time, a patient who might not be able to find a convenient Medicare provider within a reasonable period. It also neglects the peace of mind for those who have seen a doctor for years and who will be forced to see a different one.

The language in the CMS fact sheet announcing the proposed rule is positively Orwellian and reflects the CMS mindset. On page 2 it reads, “In order to ensure that beneficiaries have better access to health plan services….CMS proposes that Prescription Drug Plan Sponsors offer no more than two Part D plans in the same service area.” It makes no sense that to offer better access the number of Part D plans is being limited.

The newly-passed fiscal year 2014 budget cuts $10 million from the Independent Payment Advisory Board, which was given the power under the Affordable Care Act to disallow medical drugs, devices, and procedures that the Board deemed too costly and therefore inefficient. But the new regulations show that CMS has taken over the rationing role.

As our economy grows and society gets wealthier, it is natural that people want to spend more on health care, making their lives longer and more comfortable. By reducing seniors’ freedom to contract with private doctors, and taking vital drugs out of the Medicare program, CMS is being penny-wise and pound-foolish.

Diana Furchtgott-Roth is a contributing editor at RealClearMarkets, a senior fellow and director of Economics21 at the Manhattan Institute, and a columnist for the Examiner.


26 thoughts on “New Rules to Deprive Seniors of Drugs, Doctors

  1. sure would be nice if more people, seniors or not, would wake up to what this current system is really about, and learn that maybe fewer prescription meds would be in their best interest, and instead getting to the underlying cause of their illnesses. This can take a lot of paradigm shifting and I realize not everyone is prepared to do that. But it does make me sad when I hear about all these folks and their “required and necessary” prescription medicines. How can this be?

    1. there is a rare, very rare, occasion where a prescribed med is the correct thing! The rest of this, our US Med System is a mismatch that began at least as long ago as the 1940’s. Profits fueled the charge. Unsuspecting new Med recruits didn’t have a clue.And so they were taught the drug route to health. NoT. Of Course…is the truth. As a general statement. Honest and True. Drugs kill. Not Heal.
      So if you are in need of med assistance, do your own research along with what any health pro might give to you..
      Your intelligence in this matter is just as reliable as some one else’s thoughts….And it’s your life….
      You are likely to live much longer, much more robust, full of energy, by so doing than if you relenquish yourself to anothers care…
      I take no prescrip med’s nor have I I am a click away from 70yr and have a full life even though I have had too many beers on more than one occasion…..
      If in research, you find yourself confused, do more of it not less and specifically concerning your own questions….The answer is there somewhere, to your satisfaction to where you can feel a comfort in your chosen treatment for what ever it is you seek…

  2. EE, I agree. My Dad is on so many pills and shots for his diabetes, he is only masking the issue, never fixing the root of the problem. A lot of these older folks, like my Dad and many others trust their doctors like they know everything. They just don’t realize they have been a pawn in the medical industrial complex, that does nothing to fix anything, just mask it. My Dad will follow the diet he is given by his doctor, which is full of carbs, and when I try to tell him different, he just shuns me. He will not try any natural alternative or go to a 90%vegetable diet. I try again and again, to no avail, so I have quit trying, it falls on deaf ears.

    Now my Dad is saying he cannot get like 1/2 of his medicine. I feel sorry for him, but last time I talked to him about this, I wanted to say, told you so, but I didn’t. I have to respect his decisions even though they were wrong!

    1. Yep Missy, it’s hard. I face the same thing with my own parents. I know I could help them and want to — I’m their daughter — but I have stopped pushing my ideas because it only drives them away from me. I have to respect their choices, even though I am making different ones for myself. I hate seeing them suffer, get sicker and spend all their money on doctors and medicines, though.

      1. it is really hard, and the weirdest thing is, my Mother (parents divorced over 20 years ago) has always went to the gym, she took supplements, ate healthy, etc. Now she does smoke and drinks wine, but the difference in their health is crazy. My Mom is never at the doctor, no prescription meds, etc. My Dad complete opposite. I have tried to bring that up, and again to no avail!! It does hurt the heart, but all we can do is try!!

        1. So is the main difference that your mom exercises and her diet? Or do you attribute her health to the fact that she doesn’t go to the doctor and take prescriptions? That is an honest question! Like, what drove your dad to the doctor in the first place — how different was his diet? Or is it more that your mother avoids doctors and thus escaped the poisons of prescription drugs? Maybe it is both. I grew up eating the processed food my parents fed me, and I did suffer ill health, but I made a decision along the way to clean up my diet and avoid doctors. Doing pretty well now. 🙂

          1. I think it is because my Mom was self employed, raising three kids on her own, that she decided after the divorce to take better care of herself, she could not afford the doctor’s etc. So on her own she had no choice to be more conscious of her health. On the other hand my Dad worked for companies, always had benefits, etc. So I am thinking in his mind, he had to take no self responsibility, if he did not feel right he could just go to the Doc, they would fix it. Now, there is a world of difference, she is 68 Healthy, vibrant, not perfect, there are aches and pains, but she goes the natural way. My Dad, has had a heart attack, triple bypass, a host of other surgeries, diabetes, etc. He cannot feel his feet, he has trouble balancing, almost deaf and blind, he is 70.

            I just think there is a perfect example of a life with poison from the doc’s and a life of taking self responsibility and finding alternative ways to heal ourselves. My Mom cooked lentil soup every week, it was one of our main staples of food! Now there was the occasional goody, like gumbo! I remember her pantry was always bare, she did not like to buy processed foods, but there was always salad, left over lentil soup or whatever she had cooked. My Dad’s house, nothing but steak rice and gravy every night, breakfast was corn flakes or rice krispies, all veggies from a can, never a salad, and never lentil soup!!

            Looking back it is so weird how their houses were stocked up so different! Mom all healthy, his house all processed!! I remember I was living with Dad and his wife, I was 13 and FAT, I moved in with my Mom, and by the age of 14, I was thin, hair was pretty, complexion cleared, totally different person!!

  3. That’s an amazing contrast, Missy, and it makes perfect sense! Especially interesting, the change in your own health in moving from your Dad’s house to your Mom’s. I bet that made a huge impact on you — lucky you, having a Mom like that AND a Dad like that who could show you those lessons that are otherwise very hard to learn by simply being “told.” 🙂

  4. Back in 2005, my dad was on so many medications, and 9 years of living alone after my mom died, he just threw out all his medications and let nature take it’s course. He finally had a Pontine Stroke and only lived 3 days total after that. His brain literally exploded. So much pressure from the blood his face swelled up to the point he was unrecognizable. I guess that’s the way Marines go out. I thought that took guts.
    . . .

    1. I agree, Cathleen. I have seen this happen, not sure how it unfolded with your dad, but my mother in law was “depressed” (i.e. grief-stricken — normal!) after her husband died, and her blood pressure was “high” from the stress, so I still wonder if she hadn’t gone to the doctor, maybe her grief would have run its course and she would have been fine. Instead, she was put on anti-depressants, sleeping pills, blood pressure meds, then other meds to minimize the side effects (like uncontrollable coughing and gastric upsets) of those other meds, and now she can’t get off any of it — she’s afraid to. Sigh.

  5. I don’t take ANY prescription drugs, haven’t seen a doctor in years, and I’ve never been healthier in my life.

    AND I still smoke cigarettes.

    1. Amen #1, I don’t take any prescription drugs either, I don’t go to the doctor, I am juicing and taking supplements!

      Yes I still smoke, too!!! 🙂

    2. Nature knows best. 🙂

      Damn shame they (doctors) don’t hold to “physician, heal thyself”.

      They’d all be dead or dying from that toxic cr@p they try to foist on us.

  6. Amen, #1, the toxic crap they give people is killing them, but yet the people take it hook, line and sinker. They think that doctors are nutrition experts, they are not, they know how to fix a broken leg, nutrition was never in their books. We have nutrition experts who work for the food industry, they are taught to tote the government pyramid for food consumption, how dumb is that!! Learn your own body and make your own decisions, you are in control of your destiny!! Why? Because we are all FREE, we have FREEDOM, no matter what they want us to believe!!!!!!

      1. Amen, #1!! Satan loves the tele!! They can spew their crap to such a huge audience!! I have a flat screen 50 in. in the living room, I really cannot remember the last time I turned it on. I also know the last time I did turn it on, I watched Netflix on Roku. Television is satan’s spewing tool!!

        We are listening to Joe’s show on liberty tree right now, Henry streams it on cheapstream, Joe is so cool!!

          1. I am learning that the internet and books are much more valuable tools. turn off media, your brain becomes so much clearer, but wait then the chemtrails cloud you again!! LOL! No, it’s not funny, I have to laugh, because it is true! Do you know the other day I typed the word “exercise” and then about 10 minutes later I needed to type it again and could not for the life of me remember how to spell it. I was like this is bull crap. I have always been such a wonderful speller, lately, no it is like my brain is disintegrating. I have been doing a lot of research on the chemicals that they are spraying, they are literally dumbing us down and soft killing us like roaches. It pisses me off so bad. I was listening to a Natural Health Doctor from Central Florida today, he was saying how his vegetables last year in his garden never produced due to the chem trails. He said straight up, we are dying, they are killing us. He is a mainstream natural doc!!!!!

          2. Much of my self-education came from dvds from a site based in Hawaii – Tools for, the rest from books and the internet. I like dvds, because many people who won’t take the time to read a book on certain subjects, are sometimes willing to watch a dvd, or at least a portion of one.

            I have over 100 dvds on different facets of the NWO.

          3. us too!! Bulldog is cool! You guys would get along! I envision one day (a pipe dream) being able to save enough money and pay for all of us, you, me, digger, paul, millard, henry, laura, mark (all of them), etc. to meet in a central location!! That would be so cool! Maybe after the smoke clears!!

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