Seniors caught between cancer and the cost of treatment

Seniors caught between cancer and the cost of treatment


Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.

New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.

For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher co-payment for drugs than for some other medical services.

Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.

For more on cancer, see:

Seniors fear cancer and Alzheimer’s

Health update: New 'virtual' colonoscopy

Costly Provenge gets Medicare seal of approval

Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.

New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.

For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher copayment for drugs than for some other medical services.

Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.

For more on cancer, see:

Seniors fear cancer and Alzheimer’s

Health update: New 'virtual' colonoscopy

Costly Provenge gets Medicare seal of approval


WASHINGTON BUREAU -- The U.S. Government Accountability Office (GAO) says Internal Revenue Service (IRS) top managers must do more to ensure smooth implementation of the Patient Protection and Affordable Care Act (PPACA).
IRS officials are not doing enough to ensure on-time and on-target implementation of the 47 PPACA provisions that it will be responsible for complying with through 2018, James White, a GAO director, writes in a report summarizing the GAO's findings.

“While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems,” White says.

To ensure compliance, the IRS “must improve aspects of its planning, particularly at an agencywide or strategic level,” White says.

The RS has defined strategic-level goals and project plans in multiple documents but has not integrated the goals or plans, White says.

White says the GAO has given briefings to members of Congress and their staff on its findings, starting June 8, in response to lawmakers' concerns that the IRS would not be able to properly implement PPACA provisions on their effective dates.

In its briefings, GAO officials have said that the IRS management team has not developed a timeline for developing performance measures and collecting associated data.

The IRS also has not provided a cost estimate for all of PPACA, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed, White says.

The GAO is recommending that the commissioner of Internal Revenue move to define program goals and develop a project plan in one document that effectively integrates all aspects of the program.

The GAO also is recommending that top IRS managers document a schedule for developing performance measures that link to program goals and develop a more complete cost estimate that is consistent with the GAO Cost Estimating Guide.

Top managers also should modify and document the IRS risk management approach, to have more assurance that all risks, including strategic-level risks for the program, “are identified and analyzed, and that mitigation options are assessed,” White says.

The GAO acknowledges that the IRS management team has generally followed leading practices in planning to implement the PPACA provisions, White says.

The GAO also acknowledges that top IRS leadership has been involved; that cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; and that work has started on compliance controls.

White notes that risks are being identified and analyzed at the individual project level.

OTHER COVERAGE THE IRS ROLE IN IMPLEMENTING PPACA FROM NATIONAL UNDERWRITER LIFE & HEALTH:
IRS Gives Nonprofit Plans, Hospitals More Time to Comply with PPACA
PPACA: IRS Starts to Design Health Plan Quality Research Fee
PPACA: IRS Looks at Group Health Definitions
IRS Might Issue ACO Guidance
PPACA Stars at IRS Budget Hearing

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