Week Ending October 22, 2022

Week Ending October 22, 2022

Important Reminders

  • Medicare Open Enrollment Season

We are now in Medicare open enrollment season. The 2023 season began last Saturday and runs through Dec. 7. During the annual open enrollment period, beneficiaries can review and change their Medicare coverage options, ranging from Medicare Advantage and prescription drug plans to Original Medicare.

The Centers for Medicare & Medicaid Services has projected the average monthly premium for Medicare Advantage plans will fall by $1.52 in 2023 to $18, while the average monthly premium for a basic Medicare Part D prescription drug plan will fall by 58 cents to $31.50. Among other changes this year, the Inflation Reduction Act will limit monthly cost sharing for insulin products to $35 and reduce costs for adult vaccines.

As you no doubt have seen, in addition to political ads all over the airwaves, there are also ads regarding the Medicare open season. Just remember that those ads are sponsored by insurance companies and that if you call one of the phone numbers that they advertise, you will talk to an insurance agent whose job, in addition to giving you basic Medicare Advantage information, is to try and sell you on their policy.

On the other hand, if you want basic information without an insurance agent trying to sell you their policy, you can get free health insurance counseling through your state’s State Health Insurance Assistance Program (SHIP) which helps people with Medicare and their families do the following:

  • Choose a plan
  • Review coverage
  • Understand costs
  • File a complaint or an appeal
  • Make informed Medicare decisions

You can also contact your state to:

  • Find Medicare Savings Programs that can lower your Medicare costs
  • Get information about how to apply for Medicaid
  • Check if you are eligible for other state programs that can help with health-related costs

Click here for more information about these programs:

Explore Your Medicare Coverage Options here to see more information about Medicare and the annual enrollment season in general:

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  • Remember Your Vaccinations

We remind you that it is time to get both your Covid booster shot as well as your seasonal flu vaccination. Medical experts are concerned that this flu season will be harder than usual. They are also concerned there will be another wave of Covid this winter.

Since both of these vaccinations are covered by Medicare, there is no reason not to get them as soon as possible.

While the Centers for Disease Control has said it is ok to get both shots at the same time, you may want to consider getting them a couple of weeks apart to avoid having any side effects at the same time.

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Drug Prices Went Up Again

Although President Biden’s new drug price reduction law was passed this year, the law will not take effect immediately.

The need for the new law, however, was underscored by the release of a study showing that drug price increases for over 1,200 drugs exceeded inflation between July 2021 and July 2022, including many drugs used to treat cancer and other chronic conditions, according to a new report from the Department of Health and Human Services (HHS).

The increases in these drugs averaged 31.6%. Beginning in 2023, the Inflation Reduction Act requires drug manufacturers to pay rebates to Medicare if they enact price increases greater than inflation. The law also requires the federal government to negotiate prices for certain Medicare drugs with high spending.

Between 2016 and 2021, drug spending growth was largely due to an increase in spending per prescription and a 43% increase in the cost of specialty drugs, according to another new HHS report.

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Study finds No link between Drug Costs and Research and Development Costs

Over the last several years drug companies and their trade groups have opposed many of the reforms proposed in Congress and supported by TSCL to lower drug prices by arguing that high drug prices are needed to recover research and development investments.

Most debates around drug price regulations have centered on how to strike the right balance between lower drug prices and greater incentives for innovation, yet no study had investigated whether there is an association between how much drug companies invest in research and development to develop new drugs and how much they charge for these drugs. If high research and development costs justified high drug prices, then an association between these 2 measures would be expected.

However, it was reported last week in the Journal of the American Medical Association Network Open, researchers found no association between a drug’s list price and research and development costs. The study looked at 60 drugs approved by the Food and Drug Administration between 2009 and 2018.

“Drug companies should make further data available to support their claims that high drug prices are needed to recover research and development investments if they are to continue to use this argument to justify high prices,” the authors said.

With some Republican Senators already proposed new legislation to repeal the new drug price reduction law just passed by Congress, TSCL hopes this new study becomes a major factor in the debate about any attempt to repeal the new drug price reduction law.

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Record Spending by Big Drug Companies to Fight Drug Price Reduction

The pharmaceutical industry has spent more than $100 million on lobbying so far in 2022. According to OpenSecrets, the pharmaceutical industry has spent $101 million lobbying on behalf of 483 clients in 2022, fighting Democratic efforts to rein in prescription drug costs. That is double the amount of the next largest industry.

In addition, a new report by the House of Representatives targets 14 pharmaceutical companies for spending more on stock buybacks and dividends than they did on research and development over a five-year period. The 14 companies spent a combined $31 million in the first quarter of 2021 on lobbying.

The House report said numerous drug companies were spending a significant percentage of their research and development to suppress generic and biosimilar competition instead of on innovative research, while still raising the prices of their drugs.

According to an analysis released last week by the Kaiser Family Foundation drug companies raised prices faster than inflation for about half of all drugs covered by Medicare between July 2019 and July 2020. The median price increase was 5.6% for drugs covered by Medicare Part D and 5.4% for drugs covered by Part B, compared with a 1% inflation rate over the period.

According to the Campaign for Sustainable Rx Pricing, leading drug companies also reported massive profits in the fourth quarter of 2021.

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Limited Expansion of Medicare Coverage of Dental Care Could be Coming

TSCL has been pushing Congress to include Medicare coverage of dental care because so many seniors do not have dental insurance and good dental care is crucial for overall good health.

Now, according to Kaiser Health News, “Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services while falling short of the comprehensive benefits that many Democratic lawmakers have advocated.”

Last year Congressional Democrats made a push to include dental coverage under Medicare in the legislation that lowered prescription drug prices. However, in the end, it did not make it into the final bill.

Under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. For instance, wiring teeth to repair a fractured jaw, a dental exam before a kidney transplant, or extraction of infected teeth before radiation treatment for certain neck and head cancers are covered.

Obviously, that’s very limited coverage and it leaves so many seniors out in the cold when it comes to proper dental care.

The Kaiser Health News report says, “CMS is considering extending coverage to dental services that are ‘inextricably linked’ to the success of other covered medical procedures…. If the proposal is finalized, Medicare Advantage plans would be required to expand coverage as well…. And Medicare supplemental or Medigap policies would have to pay for the patient’s share of the cost.”

While this change would be welcome, clearly it will not go nearly far enough toward the kind of dental coverage needed by seniors.

TSCL will continue to monitor this and report on the new changes whenever they are announced.

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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.