Bill Would Eliminate Medicare Advocacy Services

The Senate Appropriations Committee recently approved the FY17 Labor, HHS, Education Appropriations bill, which would eliminate funding for the State Health Insurance Assistance Program (SHIP). It’s called the Health Insurance Counseling and Advocacy Program (HICAP) in California. It is the only program that provides free, unbiased, one-on-one Medicare coverage and benefit counseling for beneficiaries, family members, and caregivers. According to California Health Advocates, “This dangerous bill aims to eliminate this important, effective program that helps millions of beneficiaries nationwide better understand and navigate the increasingly complex Medicare program.”

Bill Aims to Protect Consumers Amid Health Care Mergers

This week, the Senate Health Committee will hear S.B. 932 (Hernandez). The bill would require state regulators to scrutinize proposed health industry consolidations to ensure that they are in the interest of consumers. The public would have opportunities to offer comment and feedback on the deals. The bill would prevent hospitals from making anti-competitive demands when negotiating with health plans and insurers. Hospitals, especially those with a large market share, would not be allowed to insist on contract provisions that result in them being the only option for care.

This bill has been introduced in the midst of a wave of pending health care mergers in California. Two of four major health insurance mergers have been finalized: Blue Shield of California acquired Care1st last year, and Centene’s proposal to acquire Health Net was approved with conditions by state regulators last month. Two other health insurance mergers are still pending, Aetna-Humana and Anthem-Cigna. Other hospital and health mergers have also taken place, including the Daughters of Charity Health System purchase by an investment firm in 2015.

Anthony Wright, executive director of Health Access California said, “Health industry mergers have led to price increases, less choice, and greater consolidation. Companies…almost always say that the merger will lead to efficiencies and savings, but they rarely…pass those [savings] to consumers, if [the savings] ever actually materialize. Companies that want to merge need to show that the merger causes no harm to consumers, and that consumers will actually benefit. Some of these health mergers are required to face public hearings and scrutiny while others fly under the radar. It’s time to set a clear standard of…oversight for all these deals that have such a profound impact on the health system.”

Group Calls on Senate to Prevent Secret Pharma Money

Section 3041 of the 21st Century Cures Act would remove reporting requirements over pharmaceutical industry payments to doctors and associations that take place in the context of Continuing Medical Education (CME). The UNITE HERE union sent letters to the Senate Committee on Health opposing the legislation. They say it would allow millions of dollars’ worth of pharmacy industry gifts to doctors’ conferences to happen behind closed doors. The bill just passed the House and is expected to be introduced in the Senate soon.

Aside from healthcare providers and pharmaceutical reps, hospitality workers are among the only people who witness the pharmaceutical industry’s presence at CME events. If Section 3041 becomes law, the rest of the public will never see what UNITE HERE members see. In the past two months, UNITE HERE has collected over 9,000 signatures on a petition to the Accreditation Council for Continuing Medical Education (ACCME) to eliminate pharmaceutical money from CME.

UNITE HERE says it is concerned about ballooning costs for its members’ healthcare plans. Prescription drugs, devices, and biologicals are a major factor in rising healthcare costs and the union is concerned doctors may be unduly influenced by contributions from the pharmaceutical industry to prescribe more expensive drugs when more affordable, generic alternatives are available. The letter was also signed by the director and the program manager of PharmedOut, a Georgetown University Medical Center Project that promotes rational prescribing. UNITE HERE represents 270,000 workers in North America who work in the hotel, gaming, food service, manufacturing, textile, distribution, laundry, transportation, and airport industries. For more information, visit NoMoreDrugMoney.org/Senate.

Senate Bill Would Expand Access to Pharmacies

The National Community Pharmacists Association (NCPA) strongly endorses The Ensuring Seniors Access to Local Pharmacies Act, S. 1190. The legislation would expand the number of pharmacies that can offer discounted copays for Medicare Part D prescription drugs. It was introduced by Senators Shelly Moore Capito (R-W.Va.), Joe Manchin (D-W.Va.), Tom Cotton (R-Ark.) and Sherrod Brown (D-Ohio).

Medicare beneficiaries in medically under-served areas would be able to access lower copays at any pharmacy that agrees to accept a drug plan’s preferred pharmacy terms and conditions. S. 1190 is a companion bill to H.R. 793, The Ensuring Seniors Access to Local Pharmacies Act, which has been introduced by Reps. Morgan Griffin (R-Va.) and Peter Welch (D-Vt.). NCPA CEO Douglas Hoey, RPh, MBA said, “Medicare beneficiaries should not be confronted with the Hobson’s choice of continuing to patronize their pharmacy at a higher cost or making a long trip to another pharmacy.”

The bill has been endorsed by the Alliance for Retired Americans, the Center for Medicare Advocacy, Families USA, Justice in Aging, the Medicare Rights Center, the National Consumers League, the National Rural Health Association, and the U.S. Pain Foundation. “Today many Medicare beneficiaries are effectively told by drug plan middlemen which pharmacy to use based on exclusionary arrangements among the pharmacy benefit manager (PBM) middlemen and, in most instances, large publicly traded chain pharmacies,” Hoey added. According to a recent Medicare study, in urban areas 54% of preferred pharmacy drug plans failed to meet the government’s threshold for reasonable access to pharmacies. In rural America the closest preferred pharmacy can be 20 miles away or more.

Last Updated 10/09/2019

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