"Study: ‘Profit-Maximizing’ Part D Plans Cause Increases in Overall Medicare Spending"

May 09, 2017

Study: ‘Profit-Maximizing’ Part D Plans Cause Increases in Overall Medicare Spending

A new study by economists Amanda Starc of Northwestern’s Kellogg School of Management and Robert Town of the University of Texas highlights how “profit-maximizing” Part D plans are incentivized to limit benefits or increase costs for Medicare beneficiaries because they are not responsible for costs incurred by other parts of the Medicare (ex. hospitalizations). As detailed in the study, Part D plans are motivated by incentives that are sometimes counter to the best interests of patients; they are explicitly incentivized to reduce drug spending, while they have no financial responsibility for the holistic health of the patient. In the study, the authors conclude that in covering drugs less generously, Part D plans end up costing traditional Medicare $475 million per year – a stat that does not account for other social costs, such as the inconvenience and suffering of beneficiaries who end up in the hospital.  This study highlights the importance of Medicare’s six protected classes, which ensure that patients with the most complex conditions are guaranteed access to the full range of drugs under Medicare Part D – limiting future medical complications, hospitalizations, and additional costs to the Medicare program. 

"Vox: Treating Depression is Guesswork"

April 25, 2017

Vox: Treating Depression is Guesswork

A recent article in Vox examines the challenges in diagnosing proper treatments for people with depression, namely the fact that not all treatments work for every patient. The author hones in on the frustrations depression patients face when they are prescribed medicine or therapy that is designed to help treat depression, but are ineffective to their specific needs, and show varying results from patient to patient due to the complexity of the disease itself. “No one thinks those two people have the same biological problem,” said Conor Liston, a research psychiatrist at Weill Cornell Medical College. “And yet those two people get the same label.” This article underscores the importance of the six protected classes, as proposals to limit access to certain medications under the Part D program which are not interchangable - such as antidepressants - would have a profound impact on the patients who benefit from having access to the full spectrum of treatment options.

"NIH Warns Against Use of 'One-Size-Fits-All' Treatments for Depression"

November 01, 2016

NIH Warns Against Use of 'One-Size-Fits-All' Treatments for Depression

The National Institutes of Health (NIH) recently published an article that highlights the necessity of unique treatment approaches for individuals battling depression. Depression, one of the most common mental disorders in the U.S., is not easily treated with  “one-size-fits-all” therapy, the article explains, and is usually treated using antidepressant medications, therapy, or a combination. "It’s often a trial-and-error process to figure out which approaches will work best for each individual," the author notes.  Researchers used information about early-life stressors and amygdala activity to predict the ability of certain antidepressants to treat symptoms of depression. Some correlation between physical differences in the amygdala and responsiveness to specific antidepressants emphasize the necessity of access to a range of antidepressants as part of individualized treatments. 

"Bloomberg BNA: Protecting Medicare’s Protected Classes: Chapter Two"

July 14, 2016

Bloomberg BNA: Protecting Medicare’s Protected Classes: Chapter Two

Remember the fireworks that exploded in 2014 when Medicare proposed to remove three of six categories from the Part D drug benefit’s protected classes?  

"Bloomberg BNA: Senators Urge CMS to Keep Six Protected Classes in Drug Benefit"

July 07, 2016

Bloomberg BNA: Senators Urge CMS to Keep Six Protected Classes in Drug Benefit

An article in Bloomberg BNA highlights a recent letter from Senators Chuck Grassley (R-IA) and Sherrod Brown (D-OH) urging the Centers for Medicare and Medicaid Servcies to maintain the current "six protected classes" policy requring Part D plans to provide the full range of treatment options to especially vulnerable patients with certain medical conditions. “Despite Part D’s success and the effectiveness of the six protected classes policy, the Medicare Payment Advisory Commission (MedPAC) report released earlier this month included a recommendation to make changes to this popular policy,” Grassley and Brown wrote to acting CMS Administrator Andy Slavitt in a June 30 letter. The bipartisan letter was in response to Part D recommendations in MedPAC's June report to Congress that would permit drug plans to remove antidepressants and immunosuppressants for transplant rejection from protected classes requirements.

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