Today’s Hot Topics in Medicare News

Patient groups rattled by new Medicare power to negotiate lower drug prices

BY JESSIE HELLMANN: A new federal policy intended to drive down drug prices could have a negative effect on patients, particularly those with chronic conditions, according to health advocates.

The policy announced Tuesday by the Department of Health and Human Services will give some private insurers the option to require patients try cheaper drugs before turning to more expensive ones, regardless of what their doctor prescribes.

The change applies only to Medicare Advantage Part B, which covers drugs administered in doctor’s offices, but could affect more than 20 million Americans enrolled in Medicare Advantage plans. (read more)

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There's never been an easy way for Medicare beneficiaries to save on services and products not covered by Medicare alone, until now.

FACT CHECK: Sanders spins savings in Medicare plan

BY RICARDO ALONSO-ZALDIVAR: Sen. Bernie Sanders is skimming over the facts in claiming that his “Medicare for all” plan will lead to big reductions in what Americans spend for health care.

In a recent tweet, the Vermont independent insists the plan will cut $2 trillion from the nation’s health care bill.

But that’s based on a scenario in which hospitals and doctors accept significantly lower payments for many patients. It’s a big asterisk, and one that Sanders fails to disclose. (read more)

CMS: Medicare Advantage Plans Can Require Step Therapy

BY SHANNON FIRTH: The Centers for Medicare and Medicaid Services (CMS) will allow Medicare Advantage plans in 2019 to apply a “step therapy” approach to Part B drugs.

CMS made the announcement and issued a memo detailing the changes on Tuesday afternoon.

There’s just one problem. Step therapy is a form of prior authorization and physicians really, really hate prior authorization, viewing it as disrupting the patient-physician relationship and creating an unnecessary burden.

In step therapy, patients must attempt another similar but typically less expensive medication before they can be prescribed a pricier one. (read more)

Ocasio-Cortez: ‘Medicare for All’ is ‘not a pipe dream’

BY EMILY BIRNBAUM: New York congressional candidate Alexandria Ocasio-Cortez on Wednesday said her policy proposal of “Medicare for All” is “not a pipe dream.”

“I think at the end of the day, we see that this is not a pipe dream,” Ocasio-Cortez said on CNN’s “Cuomo Prime Time.” 

“Every other developed nation in the world does this,” she continued. “Why can’t America?” 

Democratic socialist Ocasio-Cortez, a rising star of the Democratic party, often touts single-payer health care, or “Medicare for All” – a policy that has become popular among progressives. (read more)

Higher acuity, assisted living behind nursing home Medicare spending growth, experts say

BY MARTY STEMPNIAK: Increased acuity and investment in dual eligibles at the state level have resulted in long-stay nursing home residents driving Medicare spending growth, according to a new analysis published this week in Health Affairs.

Containing costs within the population of those who qualify for both Medicare and Medicaid has long been a major consideration for policymakers. But few studies have taken a deeper look at spending for this population, researchers with the Vanderbilt University School of Medicine note.

Pouring over beneficiary data from 2007 to 2015, investigators found that — regardless of Medicaid participation or age — beneficiaries with long-term (three months or longer) nursing home use had some of the highest spending growth rates. Those averaged between 1.7 and 4.1%, they found. (read more)

The new Medicare Plus Card saves you up to 75% on things not covered by Medicare

Medicare doesn’t cover everything. Luckily, those on Medicare can now start saving on out of pocket expenses like prescription drugs, dental, vision, hearing, and more. Over 1 million people have already received their free Medicare Plus Card.

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