July 2023

July 2023

With So Much Left to do, Congress takes a Vacation for the Next Six Weeks

The members of Congress left town late last week for their annual August recess.  However, they left a huge pile of work with little time left to finish it.

The House of Representatives isn’t scheduled to return to work until Sept. 12, leaving only 12 days to finish work on the 12 bills needed to fund the government by the start of the new fiscal year on Oct. 1.

While the Senate is much farther ahead in its work on the 12 bills, most Congressional observers believe there is so much to do that a government shutdown is likely unless they can manage to, once again, pass stopgap funding legislation.

However, passing stopgap legislation is also in question because a number of ultra-conservative Republicans in the House aren’t bothered by a shutdown.

According to Bloomberg News, “President Joe Biden and congressional leaders had hoped a hard-fought compromise on spending caps as part of a deal to avoid a US debt default would pave the way for a relatively smooth budget process. But a push by conservatives to make deeper cuts and attach language on abortion, transgender, and other social issues has upended those plans.”

Those ultra-conservative members want to slash the House spending bills — which are already lower than the deal negotiated by President Biden and Congress in the debt ceiling deal — by an additional $115 billion.

Meanwhile, the House spent part of its time last week investigating UFOs.

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Health Records of 612,000 Medicare Enrollees are Stolen

It was announced this past weekend that more than 600,000 people in the US Medicare program may have had personal data, including medical records, exposed through a data breach.

The data was on systems belonging to Maximus Federal Services, a unit of Maximus Inc.

Medicare patients may have had some of their most intimate health information exposed, including medical histories and visit notes, diagnoses, images, and treatments, along with names, dates of birth, contact information, and insurance data, the agency said.

The agency and the company are contacting the 612,000 people affected and intend to offer free credit monitoring services and instructions on how they can replace compromised Medicare cards.

This follows a recent report in KFF Health News by Michelle Andrews that “The American Hospital Association is ‘very concerned’ about foreign-based hacking groups from countries like Russia, China, North Korea, and Iran," said John Riggi, the national adviser for cybersecurity and risk for the American Hospital Association.

Riggi said "The personal information in people’s medical records may be sold in bulk to criminals who create phony providers to submit fraudulent claims on a mass scale that can result in hundreds of millions of dollars in Medicaid, Medicare, or other insurance fraud. Or they may use the information to create fake identities to apply for loans, mortgages, or credit cards.”

“They flee with the money, and the individual is left to deal with it,’” Riggi said.

What can you do to protect yourself?  “Consumers should generally monitor the notices and bills they receive from insurers and providers and contact them immediately about anything suspicious.”

Other steps to take:

  • Go to the FTC’s identity theft site to learn about the next steps and file an identity theft report, if appropriate.
  • If someone has used your name, contact every provider who may have been involved and ask for a copy of your medical records, then report any errors to your medical providers.
  • Notify your health plan’s fraud department and send a copy of the FTC identity theft report.
  • File free fraud alerts with the three major credit reporting agencies and get free credit reports from them. Consider filing a police report. If your health plan offers free credit or identity theft monitoring following a breach, take advantage of it.

According to Eva Velasquez, president and CEO of the Identity Theft Resource Center, a nonprofit that provides free assistance to victims of identity theft, “It’s best to proceed as if your data has been compromised and will be for sale.” “Don’t be afraid to ask for help.”

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Medicare to Select Drugs for Lower Price Negotiations

According to The Hill, a news outlet in Washington, D.C., “The first ten drugs selected for Medicare price negotiation will be announced by Sep. 1 and will set the stage for unprecedented government action regulating drug costs, with billions of dollars at stake and scores of patients standing to benefit.

“Once the initial batch of drugs chosen for negotiations are announced, the years-long negotiation process — currently being challenged in courts — will kick off. The manufacturers of the Medicare Part D-covered drugs picked by the Centers for Medicare and Medicaid Services (CMS) will have one month to send in their agreements saying they will engage in the negotiation process.”

At the same time, however, the business publication Barron’s reports, "The pharmaceutical industry is launching a major legal assault against a new law that will allow Medicare to pay less for some high-price drugs, in an all-out effort to kill the program.”

Two months ago, four giant pharmaceutical companies and two industry groups “filed federal lawsuits accusing the program of being unconstitutional. Ultimately, the companies are signaling that they hope the Supreme Court will overturn the law, which for the first time allows Medicare to negotiate the prices it pays for certain medications.”

The article further points out, "For Medicare, the ability to begin negotiating the prices of some of the most expensive drugs could be a critical lever to bring down costs, which have climbed in recent years. Medicare Part D, its outpatient prescription drug benefit, spent $120 billion on drugs in 2018, up from $74 billion in 2009, as measured in 2018 dollars, according to the Congressional Budget Office. The negotiation program would save the federal government an estimated $98.5 billion by 2031. (For context, Medicare spent a total of $829 billion in 2021.)

“The program could also mean savings for seniors. KFF, an independent health policy group, says the law will ‘put downward pressure on both Part D premiums and out-of-pocket drug costs,’ though the scale of the reductions will depend on the details of the negotiations. …

“… While Medicare pays for thousands of different drugs, a relative handful of high-price, newer medicines account for much of its pharmaceutical spending. In 2021, 10 drugs accounted for 22% of gross spending for its Part D prescription drug benefit, according to a recent KFF analysis. It’s those medicines, like Pfizer and Bristol’s blood thinner Eliquis, and Eli Lilly’s diabetes injection Ozempic, that the law is targeting.

“A pharma victory would certainly be a blow to the savings Medicare and U.S. seniors hope to gain. [Zachary]Baron [a health care law expert and Georgetown Law] is also concerned that it could have larger ramifications. In an article in the policy journal Health Affairs, he argued that the claims brought by Bristol and Merck on violations of the Takings Clause could, if successful, open the door for healthcare providers to challenge the negotiated rates that Medicare pays them. “Such a result would have devastating consequences for Medicare’s ability to contain costs and promote other efficiencies,’ he writes.”

TSCL will be keeping a close watch on these proceedings.  We were pleased when Congress finally passed the legislation allowing Medicare to lower drug prices.  However, it is only the beginning of what needs to be done, and we will continue our efforts to fight for lower drug prices for seniors.

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 Bills to Lower Drug Costs Advance in Congress

The fight to lower drug prices has featured a war between the big drug companies and the businesses known as Pharmaceutical Benefit Managers (PBMs), each blaming the other for the outrageous costs of urgently needed prescription drugs.

(PBMs are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant behind-the-scenes impact in determining total drug costs for insurers, shaping patients’ access to medications, and determining how much pharmacies are paid.)

Last week, according to Bloomberg News, key committees in both houses of Congress voted to advance legislation targeting the actions of PBMs.

The Senate Finance Committee, which has jurisdiction over Medicare and Medicaid, overwhelmingly passed the bi-partisan Medicare PBM Accountability Act. The bill would establish new requirements for PBMs to submit annual reports to Medicare drug plans, disclosing price negotiations and rebate information that affect what seniors pay in premiums and co-pays.

With six PBMs now controlling 95% of the private market, enhanced transparency around how PBMs are delivering and paying for prescription drugs would help Medicare drug plans select PBMs that best serve the needs of beneficiaries, lowering costs for seniors and taxpayers.

The legislation also would ban spread pricing, which occurs when a PBM charges Medicaid more than it pays for prescription drugs.

On the other side of the Capitol, the House Ways and Means Committee voted along party lines, 25-16, to pass the Health Care Price Transparency Act of 2023, which requires PBMs to disclose information about their workers’ drug claims and out-of-pocket expenses to employers.

According to its supporters, the bill will:

  • Provide key patient protections by promoting transparency and use of health insurance pricing information.
  • Codify an existing rule that health insurers already comply with while strengthening transparency.
  • Mandate price transparency requirements via a patient-specific transparency tool.
  • Implement a requirement to make machine-readable files for out-of-network rates, in-network rates, and drug prices public.

The separate bills in the House and Senate now must be sent to the respective floors of each house to be voted on.

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For progress updates or more information about these and other bills that would strengthen Social Security and Medicare programs, visit our website at www.SeniorsLeague.org or follow TSCL on Facebook or Twitter.