This post originally appeared in The Virginia Gazette on February 19, 2019.
At his pre-election campaign rallies, President Trump promised to protect Medicare. But now, his administration quietly embraces drastic changes that could choke off seniors' access to lifesaving treatments. Consider the administration's new guidance for Medicare Advantage, which enables about 20 million Medicare beneficiaries to obtain subsidized health plans from private insurers. The guidance, which took effect in January, allows insurers to force beneficiaries to try older, low-cost medications before they can access more advanced, expensive drugs.
This callous practice, known as "step therapy," was previously prohibited in Medicare Advantage because it prevents doctors from prescribing the medicines they feel will work best for each individual. During the months that patients are forced to try older, less effective treatments, their ailments can worsen, causing immense suffering and even premature death.
Administration officials have also proposed weakening key patient protections in Medicare Part D, the popular prescription drug benefit used by 44 million Americans. Right now, all Part D plans must cover all medications in six "protected classes" of therapies: anticonvulsants (epilepsy), antidepressants (mental health), antineoplastics (cancer), antipsychotics (mental health), antiretrovirals (HIV/AIDS), and immunosuppressants (transplants).
When it created the Part D program more than a decade ago, Congress specifically protected these classes to ensure that seniors who battle cancer, HIV/AIDS, depression, and other serious diseases would have a full range of treatment options. It also leveled the playing field by ensuring that all the insurance companies that participated in Part D included medicines associated with expensive diseases in their formulary.
But the administration wants to allow Part D plans to stop covering some of the most critical medications in these classes. It's no surprise, then, that many of the top medical organizations in the country, including the National Kidney Foundation, the AIDS Institute, and the American Cancer Society Cancer Action Network, have lined up against this proposal.
The administration is also pursuing misguided reforms to Medicare Part B, which covers sophisticated treatments, such as gene therapies and advanced biologics, which must be administered by medical professionals in a healthcare facility. One change could slash reimbursements for some doctors who administer these treatments.
Cutting payments to doctor's offices and clinics could force many of them to stop treating Medicare patients. The last time authorities substantially cut Part B payments, fully half of community oncologists "reported sending their Medicare patients elsewhere for chemotherapy, primarily to more expensive hospital outpatient infusion centers," according to a survey conducted by the American Society of Clinical Oncology.
For more than half a century, Medicare has helped seniors access the care they need and deserve. Our government promised us that the Medicare taxes, which were deducted from our paychecks every payday, would be used to ensure we had acceptable health care when we retired. Up to this point, especially in Medicare Part B and Part D, that promise has been kept. RetireSafe believes the proposed changes described above break that promise our government made to each of us.