All posts by Jason White

Intermountain Healthcare Community Pharmacies Help Address Utah’s Opioid Epidemic

Individuals can now visit any Intermountain community pharmacy in Utah and purchase Naloxone without a prescription from their doctor

SALT LAKE CITY, UTAH, USA, May 26, 2016 /EINPresswire.com/ — Opioid overdoses have reached epidemic levels in the nation as well as in Utah, according to a recent report by the Centers for Disease Control and Prevention. In Utah, deaths from prescription medications increased nearly 400 percent from 2000 to 2014. Opioids include prescription pain medications and the drug heroin. In 2016, Governor Gary Herbert and the Utah Legislature declared drug overdose deaths a public health emergency.

Naloxone is a medication that can reverse the effects of opioids and prevent death from overdose. As part of a multi-action approach, Intermountain Healthcare is expanding efforts to decrease death from opioid overdose by training and empowering pharmacists to prescribe this potentially lifesaving medication. Individuals can now visit any Intermountain community pharmacy in Utah and purchase Naloxone without a prescription from their doctor.

“Our hope, along with other public health partners, is that we can empower individuals to save lives,” said Buck Stanford, Community Operations director for Intermountain Healthcare Pharmacy Services. “Naloxone has been proven to save overdose victims, allowing them to get into treatment and recovery programs.”

Stanford says that opioid addiction is complex and far reaching. “Addiction can affect anyone, of any age, or any lifestyle. When used properly, opioids are effective at controlling pain and helping individuals to recover from injury. However, these are powerful narcotic pain medications that can be abused and lead to addiction or overdose.” A person can overdose, including children, even if they are not abusing or addicted to the medication, Stanford stresses.

Naloxone is covered by most prescription insurance plans. Intermountain Community Pharmacies accept over 200 difference insurance plans.

Intermountain is leading efforts throughout Utah to combat this epidemic at its roots, through public awareness, provider education, and access to substance use disorder treatment. Through the efforts of Intermountain, prescribers receive new training and guidelines around opioids, including appropriate prescribing and recognizing potential abuse or signs of dependency. Additionally, patients receive additional education, including instructions for proper use as well as safe storage to prevent theft and misuse, and disposal of unused medications. Free drop off sites are also available at all Intermountain community pharmacies. For more information on storing and/or disposing medication, see http://UseOnlyAsDirected.org.

Intermountain has also partnered with other agencies in Utah to start the Opioid Community Collaborative to decrease the burden of prescription drug abuse, misuse and overdose deaths in Utah.

“Helping people live the healthiest lives possible sometimes means empowering a system for rescue care,” said Stanford. “Naloxone is one more tool we can use to address this concern. We would encourage anyone concerned about possible misuse to seek more information and professional help.”

Intermountain Healthcare is a Utah-based, not-for-profit system of 22 hospitals, 185 clinics, a Medical Group with some 1,200 employed physicians, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and in efficient healthcare delivery. For more information about Intermountain, visit intermountainhealthcare.org.

Daron Cowley
Intermountain Healthcare
801-442-2834
email us here

TONI KING: TONI KING: Does Medicare pay for diabetic supplies?

Dear Toni:

I am diabetic and I order my diabetic test strips from a mail-order program through my company benefits which are delivered to my front door. Recently, I have been laid off and am enrolling in Medicare.

How do I receive my diabetic supplies since I am new to Medicare?

Toni, I received a letter stating my supplier will no longer be covered by Medicare because it is not a “competitive bidding” supplier. Does this mean that if I continue with my current supplier, Medicare will stop paying for my diabetic test strips? Please explain. Silvia, a Memorial reader.

Hello Silvia:

Beginning July 1, 2013, Medicare began new rules about mail-order diabetic supplies, such as test strips, monitors, lancets etc. And this has confused a lot of folks!

If Medicare is your primary insurance, you use only “Original” Medicare Parts A and B with a Medicare Supplement (Medicare Advantage Part C plans have different rules) and you order your supplies from a mail-order supplier, you must use suppliers who have been awarded a contract under a new “competitive bidding” rules or you will have to pay 100 percent out of your pocket. This process is only for mail order diabetic or medical supplies.

Medicare has a listing of approved mail order and local suppliers; the list is available either online at www.medicare.gov or by calling 1-800-Medicare (633-4227).

The mail-order program does not require you to change the particular testing monitor, test strips and lancets you currently are using. Remember, Medicare only wants you to use the mail-order supplier that Medicare approves. If you are happy with the monitor, test strips and lancets you are currently using, you will want to use a competitive bidding supplier that stocks your testing items. You will need to provide your new supplier with either a new prescription for your diabetic supplies or have your current prescription transferred.

You need a new prescription from your doctor for your lancets and test strips every 12 months. Very important because if you do not receive a new prescription, you will pay 100 percent our of your own pocket.

If you would rather, you could change from home delivery of your diabetic supplies and purchase your diabetic supplies at a local pharmacy (that is a Medicare provider).

“Original Medicare” Part B will provide the diabetic supplies and you have to pay the 20 percent co pay or your Medicare Supplement can pick up the 20 percent. If you have more questions about the changes in Medicare’s policy, contact Medicare at 1-800-Medicare or talk to your pharmacy.

Many on Medicare are concerned about durable medical equipment (DME) that is sent to your house or that you use on a day by day basis, such as wheel chairs, walkers, oxygen, CPAC devices, at home wound equipment or any medical device you use at home.

Medicare will only cover a durable medical equipment or at-home supplier in your area that has a competitive bidding status.

You should also make sure that the pharmacy or medical supplier accepts assignment for Medicare-covered supplies. Assignment is an agreement between you (the person with Medicare), Medicare, and doctors, other health care suppliers, or providers. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. You only pay your coinsurance amount when you get your supply from a pharmacy or supplier for assigned claims.

Always ask:

Are you enrolled in Medicare?

Do you accept Medicare assignment?

Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com Many of Toni’s readers are making scrapbooks from the articles. If that is you, please send Toni your story about how the column has helped you to www.tonisays.com/ask-toni or call 832/519-TONI (8664).

Greens announce $4.3 billion Medicare expansion plan

THE Greens have announced a $4.3 billion Medicare expansion plan to provide better treatment for patients with chronic illness.

Under the policy, GPs would receive an annual payment of $1000 to provide a package of care for their patient and a plan to manage their condition.

Greens leader Richard Di Natale said the plan would cost about $4.3 billion over four years and mean patients with chronic conditions such as diabetes got the whole range of services they needed.

“Stretched GPs need a system which is set up to really support them in working with a team to better plan and organise care, and to improve health outcomes for chronic disease patients over time,” he said.

Senator Di Natale said the current system needed reform to help those struggling with chronic conditions and improve their outcomes.

“This new system will focus on consistent and effective patient care over time, and on better co-ordinated care,” he said.

OPKO Health Receives Proposed/Draft Medicare Local Coverage Determination for 4Kscore® Test

MIAMI, May 27, 2016 (BUSINESS WIRE) —
OPKO Health, Inc.

OPK, -0.34%

(“OPKO” or the “Company”) announces
that Novitas Solutions has issued a draft local coverage determination
for the 4Kscore
[®]
Test, the only blood test that accurately
identifies an individual patient’s risk for high-grade, aggressive
prostate cancer. Novitas Solutions is a Medicare Administrative
Contractor (MAC) for Medicare jurisdictions L and H, with responsibility
for nearly 10 million Medicare beneficiaries in New Jersey,
Pennsylvania, Maryland, the District of Columbia and Texas, among other
geographies.

The draft local coverage determination is posted to the Medicare
Coverage Database on the Centers for Medicare Medicaid Services (CMS)
website, and proposes to establish reimbursement coverage for patients
with PSA levels 3 ng/mL who have not yet had a biopsy, or patients with
a PSA level of 3 ng/mL who have had at least one prior negative biopsy
and are considered to be at higher risk.

“This first MAC determination is a major milestone for the 4Kscore Test
as it expands access to a potentially life-saving tool,” said Phillip
Frost, M.D., OPKO’s Chairman and Chief Executive Officer. “We believe
this decision by Novitas will help accelerate further coverage decisions
by other payers, and will encourage adoption of the 4Kscore Test by
physicians and patients. More importantly, it will allow broader access
to this important test, which can assist patients and physicians in
further defining a patient’s risk of having a high-grade prostate cancer
that requires immediate or aggressive treatment.”

The draft local coverage determination follows the 4Kscore’s inclusion
as a standard-of-care in the 2015 National Comprehensive Cancer Network
Guidelines and in the 2016 European Association of Urology Prostate
Cancer Guidelines for Prostate Cancer.

About the 4Kscore Test

4Kscore is the only blood test that accurately identifies an individual
patient’s risk for aggressive prostate cancer, the lethal form of
prostate cancer. The 4Kscore Test uses a proprietary algorithm that
incorporates the blood levels of four different prostate-derived
kallikrein proteins: Total PSA, Free PSA, Intact PSA and Human
Kallikrein-2 (hK2), plus the patient’s age and other clinical
information to calculate the percentage risk (probability) of finding a
Gleason Score 7 or higher grade of prostate cancer. The four kallikrein
panel of biomarkers utilized in the 4Kscore Test is based on over a
decade of research conducted by scientists at Memorial Sloan-Kettering
Cancer Center and leading European institutions and is included as a
standard-of-care in the 2015 National Comprehensive Cancer Network’s
Prostate Cancer Early Detection Guidelines. The 4Kscore Test provides
individualized risk for the presence of aggressive prostate cancer and
adds new information to the shared decision-making discussion between
the physician and the patient.

About OPKO Health, Inc.

OPKO Health, Inc. is a diversified healthcare company that seeks to
establish industry-leading positions in large, rapidly growing markets.
Our diagnostics business includes Bio-Reference Laboratories, the
nation’s third-largest clinical laboratory with a core genetic testing
business and a 420-person sales force to drive growth and leverage new
products, including the 4Kscore® prostate cancer test and the Claros®1
in-office immunoassay platform. Our pharmaceutical business features
Rayaldee™, a treatment for secondary hyperparathyroidism (SHPT) in stage
3-4 chronic kidney disease (CKD) patients with vitamin D insufficiency
(pending FDA approval) and VARUBI™ for chemotherapy-induced nausea and
vomiting (oral formulation launched by partner Tesaro, IV formulation in
Phase 3). Our biologics business includes hGH-CTP, a once-weekly human
growth hormone injection (in Phase 3 and partnered with Pfizer), and a
long-acting Factor VIIa drug for hemophilia (entering Phase 2a). We also
have production and distribution assets worldwide, multiple strategic
investments and an active business development strategy. More
information is available at www.opko.com.

SAFE HARBOR STATEMENT

This press release contains “forward-looking statements,” as that term
is defined under the Private Securities Litigation Reform Act of 1995
(PSLRA), which statements may be identified by words such as “expects,”
“plans,” “projects,” “will,” “may,” “anticipates,” “believes,” “should,”
“intends,” “estimates,” and other words of similar meaning, including
statements regarding expected benefits of the 4Kscore, the ability to
obtain broader access to the tests for patients, our ability to
accelerate coverage decisions, the power of the 4Kscore to provide
valuable information to accurately identify aggressive prostate cancer
and guide clinical decision making, whether it will accurately predict
high-grade cancers, improve patient outcomes and reduce biopsies,
whether OPKO will successfully commercialize the 4Kscore, and the market
for and expected sales of 4Kscore, as well as other non-historical
statements about our expectations, beliefs or intentions regarding our
business, technologies and products, financial condition, strategies or
prospects. Many factors could cause our actual activities or results to
differ materially from the activities and results anticipated in
forward-looking statements. These factors include those described in our
filings with the Securities and Exchange Commission, as well as the
risks inherent in funding, developing and obtaining regulatory approvals
of new, commercially-viable and competitive products and treatments. In
addition, forward-looking statements may also be adversely affected by
general market factors, competitive product development, product
availability, federal and state regulations and legislation, the
regulatory process for new products and indications, manufacturing
issues that may arise, patent positions and litigation, among other
factors. The forward-looking statements contained in this press release
speak only as of the date the statements were made, and we do not
undertake any obligation to update forward-looking statements. We intend
that all forward-looking statements be subject to the safe-harbor
provisions of the PSLRA.

View source version on businesswire.com: http://www.businesswire.com/news/home/20160527005108/en/

SOURCE: OPKO Health, Inc.

OPKO Health, Inc.
Tara Mackay, 305-575-4100
Investor Relations
or
Media
Rooney
Associates
Terry Rooney, 212-223-0689
trooney@rooneyco.com
or
Marion
Janic, 212-223-4017
mjanic@rooneyco.com
or
Investors
LHA
Anne
Marie Fields, 212-838-3777
afields@lhai.com
or
Bruce
Voss, 310-691-7100
bvoss@lhai.com

Copyright Business Wire 2016

Missouri Hospitals Seek To Focus Readmission Penalties On Patient Poverty

Christian Hospital says its costly difference of opinion with Medicare hinges on how to count the large number of poor people that the St. Louis hospital treats.

Medicare penalizes hospitals that readmit too many patients within 30 days of discharge, and Christian expects to lose almost $600,000 in reimbursements this year, hospital officials said. Christian is one of 14 hospitals in the BJC HealthCare System.

Steven Lipstein, chief executive of BJC, which includes Barnes-Jewish hospital in St. Louis, said Medicare doesn’t play fair because its formula for setting penalties does not factor in patients with socioeconomic disadvantages — low-income, poor health habits and chronic illnesses for instance — that contribute to repeated hospitalizations.

If Medicare did that, Christian’s penalty would have been $140,000, Lipstein said.

As every hospital executive knows, half a million dollars pays for “a whole lot of nurses.”

In total, hospitals around the country lost $420 million last year under Medicare’s Hospital Readmissions Reduction Program, an initiative of the federal health law that seeks to push hospitals to deliver better patient care.

Since the program began in 2012, “recent trends in readmissions suggest that (it) is having the desired impact,” Health Affairs reported in January.

Hospitals have lobbied Congress and Medicare to change the rules and gained some ground May 18 when Rep. Patrick Tiberi, R-Ohio, introduced a bill in the House to adjust Medicare’s program to account for socioeconomic status. The bill was co-sponsored by Rep. Jim McDermott,  D.-Wash.

Meanwhile, the Missouri Hospital Association is trying to pull public opinion behind it.

A motion blurred photograph of an empty hospital corridor

This year, the association overhauled its consumer website, Focus On Hospitals, to include not only the federal readmissions data, but also each member’s readmissions statistics, adjusted for patients’ Medicaid status and neighborhood poverty rates.

The federal government already adjusts its readmissions data for age, past medical history and other diseases or conditions, and that’s public on Medicare’s Hospital Compare website.

The association explains its adjustment methodology in an article on the site. “There is emerging national research that suggest poverty and other community factors increase the likelihood a patient will have an unplanned admission to the hospital within 30 days of discharge,” it states.

The hospital group’s alternative data — Lipstein’s source for how Christian could have reduced its 2015 penalty — comes from a study it commissioned. One finding: Missouri hospitals’ readmissions rates improved by 43 to 88 percent when patients’ poverty levels were considered.

“The question is, has [readjustment] been done in a just and fair way,” Lipstein said. The Missouri Hospital Association “has provided methodology that suggests what the feds are doing is unfair.”

The controversy over penalties is likely to grow beyond the readmissions question. Federal health officials have announced that they want to shift from paying doctors and hospitals based on the services they provide and move toward a value-based system that encourages a better quality of care and better outcomes while controlling costs.

Medicare bases penalties on readmissions on the care of Medicare patients who were originally hospitalized for one of these five conditions — heart attacks, heart failure, pneumonia, chronic lung problems and elective hip or knee replacements.

This year, Medicare penalized almost half of all hospitals — 2,592 to be exact — for excessive readmissions. More than 500 were fined 1 percent of their Medicare payments, or more, for the fiscal year that will end Sept. 30.

Still, the system harms so-called safety-net hospitals most, said Herb Kuhn, the Missouri Hospital Association’s president.

“Hospitals in difficult neighborhoods are getting worse scores, and those in affluent [ones] are getting better. It’s time to adjust [rates] for the disease of poverty,” he said.

Kuhn’s experience makes him an influential voice on health policy issues. He was deputy administrator of the Centers for Medicare Medicaid Services from 2006 to 2009 and before that, director of the agency’s Center for Medicare Management. In April, Kuhn completed a three-year term on the Medicare Payment Advisory Commission, which advises Congress.

The commission proposed an alternative to Medicare’s readmission penalties last year. Others are also studying modifications.

The Centers for Medicare Medicaid Services has taken a cautious stance, but last year CMS announced it is working with the National Quality Forum, a nonprofit group whose research influences CMS’s quality metrics, on a trial to test socioeconomic risk adjustment.

But Leah Binder, CEO of the Leapfrog Group, a nonprofit patient safety group, says Medicare’s readmission penalties have pushed hospitals to improve care and adjusting the data for patients’ poverty levels could deter them.

“Hospitals are paid a lot of money. I think they can find a way to handle their readmissions, the way they should have been handling them all along,” Binder said.

Categories: Health Industry, Medicare, Syndicate

Tags: , ,

Missouri Is First State To Rebuke Proposed Aetna-Humana Merger Over Antitrust Concerns


Reuters:
Aetna-Humana Tie-Up Is Anti-Competitive In Missouri: State Regulator


A tie-up of Aetna Inc and Humana Inc would be anti-competitive in Missouri for several types of insurance, including individual Medicare Advantage plans where the combined company would have more than a 50 percent market share, the Missouri Department of Insurance said. The department said in an order, dated May 24 and posted on its website, that if the proposed acquisition of Humana by Aetna were to go forward, the companies would need to stop selling individual insurance, small group and certain Medicare Advantage plans in its state. (Humer, 5/25)

Justice Department Joins Lawsuit Accusing Calif. Hospital Chain Of Improper Medicare Billing


Kaiser Health News:
Missouri Hospitals Seek To Focus Readmission Penalties On Patient Poverty


Christian Hospital says its costly difference of opinion with Medicare hinges on how to count the large number of poor people that the St. Louis hospital treats. Medicare penalizes hospitals that readmit too many patients within 30 days of discharge, and Christian expects to lose almost $600,000 in reimbursements this year, hospital officials said. Christian is one of 14 hospitals in the BJC HealthCare System. Steven Lipstein, chief executive of BJC, which includes Barnes-Jewish hospital in St. Louis, said Medicare doesn’t play fair because its formula for setting penalties does not factor in patients with socioeconomic disadvantages — low-income, poor health habits and chronic illnesses for instance — that contribute to repeated hospitalizations. (Gillespie, 5/26)

Sickle Cell Disease Therapeutic Pipeline Market Review, H1 2016


Wiseguyreports.com adds “Global Sickle Cell Disease Drugs and Companies Pipeline Review H1 2016”.

PUNE, INDIA, May 25, 2016 /EINPresswire.com/ — Summary

Sickle Cell Disease – Pipeline Review, H1 2016’, provides an overview of the Sickle Cell Disease pipeline landscape.
The report provides comprehensive information on the therapeutics under development for Sickle Cell Disease, complete with analysis by stage of development, drug target, mechanism of action (MoA), route of administration (RoA) and molecule type. The report also covers the descriptive pharmacological action of the therapeutics, its complete research and development history and latest news and press releases. Additionally, the report provides an overview of key players involved in therapeutic development for Sickle Cell Disease and features dormant and discontinued projects.

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Global Markets Direct’s report features investigational drugs from across globe covering over 20 therapy areas and nearly 3,000 indications. The report is built using data and information sourced from Global Markets Direct’s proprietary databases, company/university websites, clinical trial registries, conferences, SEC filings, investor presentations and featured press releases from company/university sites and industry-specific third party sources. Drug profiles featured in the report undergoes periodic review following a stringent set of processes to ensure that all the profiles are updated with the latest set of information. Additionally, various dynamic tracking processes ensure that the most recent developments are captured on a real time basis.
The report helps in identifying and tracking emerging players in the market and their portfolios, enhances decision making capabilities and helps to create effective counter strategies to gain competitive advantage.

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Norah Trent
WiseGuy Research Consultants Pvt. Ltd.
16468459349
email us here

Bill that would equalize hospital, off-campus Medicare payments advances out of committee

The U.S. House Ways and Means Committee has passed the “Helping Hospitals Improve Patient Care Act,” a bill that, among other things, aims to provide financial relief to hospitals that were in the process of building off-campus outpatient centers in 2015 when reimbursement policy changed.

Ways and Means Health Subcommittee Chairman Pat Tiberi, R-Ohio, and Ranking Member Jim McDermott, D-Washington, introduced the bipartisan legislation last week. It has received support from the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges.

One of the bill’s main features is turning back the clock – for some facilities – on a policy of the Bipartisan Budget Act of 2015 that lowered the rate at which Medicare reimbursed off-campus doctors’ offices owned by hospitals. Prior to the budget act, clinics off-campus were reimbursed at the same rate as hospitals.

The reasoning was that hospitals incurred higher expenses. Also, supporters believed the budget act policy would reduce hospitals’ incentive to acquire physician offices.

The ACA and other hospital groups criticized the policy, saying it would block access to healthcare for patients who used off-campus, outpatient clinics.

The Helping Hospitals Improve Patient Care Act, or H.R. 5273, pays off-campus hospital outpatient departments the higher Medicare Hospital Outpatient Department rate for those facilities that were in the process of mid-build from Nov. 2, 2015 to Dec. 31,2016, or 60 days after enactment of the budget act, whichever is later.

Newer facilities are capped at the lower physician fee schedule rate.

“For those select HOPDs that would qualify, this legislation is a significant relief, and we are supportive of the legislation on their behalf,” said American Hospital Association Executive Vice President Tom Nickels. “AHA also supports provisions in the bill that would adjust the Hospital Readmissions Reduction Program to account for socioeconomic status, and extend the Rural Community Hospital Demonstration Program for five years.”

The legislation also gives improved consideration of socioeconomic status in the Hospital Readmissions Reduction Program, that levies fines over excessive readmissions.

It also delays CMS’s authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings as it conducts research and reports on socioeconomic status and quality ratings.

Finally, the bill allows hospitals providing cancer care to continue to be paid at cancer hospital rates at new off-campus locations; extends a program dealing with the reimbursement of small rural hospitals for five more years; and exempts physicians who treat patients in ambulatory service centers from the Electronic Health Records Incentive Program and the Merit-Based Incentive Payment System.

Ways and Means Committee Chairman Kevin Brady, R-Texas, said  the bill, “provides some necessary regulatory relief to providers and makes it easier for beneficiaries to enroll in Medicare.”

Twitter: @SusanJMorse


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Medicare meddling could leave our men sicker

Posted: Thursday, May 26, 2016 12:01 am
|


Updated: 1:01 am, Thu May 26, 2016.

Ana Fadich, guest columnist: Medicare meddling could leave our men sicker

ANA FADICH Guest columnist

Waco Tribune-Herald

If statistics are any guide, the war against chronic disease is going particularly poorly for men.

For nine of the 10 deadliest diseases, American men die at higher rates than women. Half of all men will develop some form of cancer in their lifetimes. More than 300,000 men will drop dead this year from heart disease alone.

Obviously, men are in trouble and need researchers to develop new and better treatments. Of course, patients will only benefit from such treatments if they can access them.

That’s why proposed changes to Medicare’s prescription drug benefit are so worrying. Supporters of these changes claim that they’ll save the federal government billions of dollars. In reality, the measures could undermine research efforts and deprive millions of seniors the medicines they need to stay healthy and may result in fewer medicines being offered to seniors.

Medicare’s “Part D” drug benefit is a successful, popular program. Premiums are affordable, at a national average of about $32 a month, and are expected to remain low. About 9 in 10 beneficiaries are satisfied with their coverage, which is provided through private insurance companies and subsidized by the government.

Despite the fact that Part D has cost 45 percent less than expected, some in Washington think the program needs to be changed. Their concerns center on the price negotiations between private insurers and drug companies. Part D has been so cost-effective in large part because insurers have a financial incentive to bargain hard and squeeze big discounts — up to 30 percent — out of drug companies in exchange for covering a medicine.

Part D critics think government negotiators could drive a harder bargain and secure even lower prices. However, the Congressional Budget Office has studied the issue and concluded that government negotiators wouldn’t save any money — unless they deploy the nuclear option of simply refusing to cover newer, higher-cost medicines.

Such a move would prove disastrous for patients. By imposing artificially low prices on drug companies, the government could stifle research and development. The average new drug costs some $2.6 billion to develop and bring to market, according to a Tufts University study. If Medicare pays artificially low prices, it could render much future drug research financially unviable.

What’s more, if the government pushes prices below what the market can bear, patients could lose access to some existing drugs. The Congressional Budget Office explains that the only way the government could further “achieve any significant savings” would be “to impose access or coverage restrictions on medicines.”

That, of course, means Part D beneficiaries might not get the medicines they need. Breakthrough drugs tend to be the most expensive, so they are the ones most likely to be restricted. Access limitations are a hardship that participants in the Veterans Affairs prescription drug program — which operates under a government-negotiated-price regime — know all too well. The VA drug benefit covers only 163 of the top 200 most-prescribed Part D drugs. Medicare prescription drug plans, on the other hand, cover 191 of those drugs on average.

Using the power of government to drive down drug prices might seem like a worthy initiative. But it won’t work as promised and will in fact hurt those who most need innovative therapies.

Millions of Americans are battling chronic diseases, and men are particularly vulnerable. Victory in this fight requires better treatments. Those will never arrive if lawmakers meddle with Medicare Part D.

Ana Fadich is vice president of Men’s Health Network.

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  • Discuss

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Thursday, May 26, 2016 12:01 am.

Updated: 1:01 am.


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