Update for Week Ending July 2, 2022

Update for Week Ending July 2, 2022

TSCL Endorses New Legislation to Protect Seniors from Misleading Drug Ads

A new bill was just introduced into the House of Representatives that would protect seniors, prevent drug manufacturers from obscuring dangerous side effects of their prescription drugs in their advertisements, and help consumers make informed decisions.

The United States and New Zealand are the only countries in the world that permit direct-to-consumer pharmaceutical advertising — and there are serious consumer safety concerns around the proliferation of these ads.

Frequently, the ads supplant the knowledge and judgment of physicians in determining whether a drug is most suitable for a particular medical condition. Studies have shown that an ad’s use of visuals when discussing the side effects of a drug distracts American consumers from the risks.

To address these concerns, U.S. Representatives Susan Wild (D-Pa.), Cindy Axne (D-Iowa), Katie Porter (D-Calif), Angie Craig (D-Minn.), and Abigail Spanberger (D-Va.) (with whom TSCL is working in support of her bill H.R. 82, The Social Security Fairness Act) introduced the Banning Misleading Drug Ads Act.

This new legislation would require the U.S. Food and Drug Administration (FDA) to finalize a 15-year-old proposed rule clarifying that drug ads must include a statement related to side effects, contraindications, and effectiveness — while also prohibiting distractions from neutral information. If enacted, this rule would prevent advertisements from including “distracting representations” — including statements, text, images, or sounds — that detract from the communication of the major statement.

TSCL has endorsed this legislation. TSCL Chairman Richard Delaney released this statement in support of the bill:

“An estimated 65 million Medicare beneficiaries rely on Congress to ensure patient safety and protect consumers from misleading advertising tactics by prescription drug manufacturers. We support legislation that helps keep ads honest by endorsing the Banning Misleading Drug Ads Act of 2022.”

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One More Try for Prescription Drug Legislation in the Senate

Congress is in the middle of its annual July 4th recess but before they left for home last week it was revealed that Senate Democrats are putting together a last-minute plan that would let Medicare negotiate prices directly with manufacturers for some prescription drugs, with the goal of passing it ahead of the midterm elections.

According to STAT News, it is by no means certain that Congress will pass prescription drug pricing reform as part of a broader domestic policy package being negotiated between Senate Majority Leader Chuck Schumer (D- N.Y.) and moderate Sen. Joe Manchin (D-W.V.), but this week, the chances are looking better than ever.

In order to pass a bill Schumer will need the support of all 50 Senate Democrats.  Then it could be passed with only Democratic votes under the chamber’s budget reconciliation process.  No Republicans are expected to support the bill.

However, it is not yet clear if it will have the support of other moderate Democrats like Kyrsten Sinema, D-Ariz., or Bob Menendez, D-N.J. Menendez is an uncertain vote because his state of New Jersey is home to 14 of the top 20 pharmaceutical companies in the world.

The new plan would impose penalties for drug companies that hike prices faster than inflation and implement a $2,000 annual out-of-pocket cap for Part D patients. Insulin would be capped at $35 a month, a provision that Democrats are also working to pass as a standalone measure.

The new agreement would also strengthen language around the Department of Health and Human Services secretary’s obligation to negotiate prices to prevent a different secretary who does not support the bill’s purpose from watering down the provisions. New language would also limit Medicare premium increases — an expected side effect of capping patient copays. The negotiation process would begin in 2023.

In addition, the new agreement would make vaccines free to Medicare patients and extend full subsidies for low-income enrollees from 135 percent of the federal poverty level up to 150 percent. The deal includes language to prevent brand-name drug makers from blocking generic products from coming to market.

TSCL welcomes this new effort, and we will closely review the bill once it is finalized.

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New Health Care Cost Transparency Rule Now in Effect

Last week a new federal rule that is supposed to give a clearer picture of what insurers and employers pay for health care went into effect. However, there are doubts about how successful it will prove to be.

Patients often have no idea what a procedure or service costs, and therefore, have little ability to comparison shop. As a result, they can be stuck with a higher bill than they expected.

Now, because of the new rule, insurers will have to list their negotiated rates with in-network providers, as well as out-of-network allowed amounts and billed charges for certain items and services. However, it is thought that it will take a while for the new rule to impact the average consumer.

As an example, while the idea of shopping for a CT scan online has obvious appeal, the fact is that we may not be able to do that yet because health care is full of unfulfilled, tech-driven promises. Some researchers also assert that consumers just aren't as inclined to shop for health care the way they would for a car or cell phone.

And while there is a lot of price data available, the law did not require payers and providers to work together to define what a total episode of care means.

Take for instance, a hip replacement. Does it include anesthesiology? Does it not? Is there any post-care or follow-up? Or no post-op? Even if [the payer and provider] both display hip replacement, they can display wildly different prices."

There has been no discussion of how this may or may not affect Medicare, but it is not inconceivable that if all the uncertainties can be answered and individuals are able to determine the costs of health care procedures, Medicare will look and see if and how this may affect the services it pays for.

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As we continue moving toward a new normal in dealing with the Covid 19 pandemic, TSCL remains constant in our fight for you to protect your Social Security, Medicare, and Medicaid benefits.

For progress updates or for 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 Facebook or on Twitter.