Government Aims at Mentally-Disabled Elderly to Reduce Medicare Drug Costs

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Well, I don't think we can say we didn't see this coming.

The Centers for Medicare & Medicaid Services (CMS) is searching for more ways to tighten its belt. Its newest cutting proposal may be shortsighted for the large numbers of elderly patients. Among other things, CMS is proposing the elimination of antidepressants and immunosuppressants next year for Medicare beneficiaries who have private Medicare Advantage and Part D prescription drug plans. The federal government expects to save $1.3 billion between 2015 and 2019, if the proposed rule passes.

Of course, Medicare recipients are the focus for cost reductions, as they are always focused on when budget cuts come around. It is true that in later life, many complications often come up, health wise, and up go the costs of care. But, should we forget that these are the people from the generation before our own, who worked and contributed to everything we now enjoy?

For those who are financially secure at the beginning of retirement, it only takes one major illness to wipe out that security. That doesn't just happen to those who are elderly, it happens every day to people in all walks of life, even when they are insured. That is because many insurances don't cover the services and medications for many costly treatments, or they have such high deductibles and copayments that the costs quickly accumulate.

But is it morally correct to outline a whole segment of society for exclusion from specific medical treatments. Doesn't that sound a bit close to the term "Death Panels"? Well, let us look at the medications that are slated for exclusion:

Originally, CMS required all Part D plans to cover "all or substantially all" drugs within six classes: antineoplastics, anticonvulsants, antidepressants, antiretrovirals, antipsychotics and immunosuppressants. Under the new proposal, CMS will keep drugs classified as antineoplastics, anticonvulsants, antiretrovirals, although there are even proposed exceptions to that. However, CMS will no longer require Part D formularies to include drugs from the antidepressant and immunosuppressive classes. Antipsychotic drugs will remain on Part D formularies, at least through 2015.

Antidepressants: en.wikipedia.org...

Antidepressants are drugs used for the treatment of major depressive disorder and other conditions, including dysthymia, anxiety disorders, obsessive compulsive disorder, eating disorders, chronic pain, neuropathic pain and, in some cases, dysmenorrhoea, snoring, migraines, attention-deficit hyperactivity disorder (ADHD), substance abuse and sleep disorders.

Antidepressants have been, in my opinion, over prescribed for years to every segment of the population. However, they do have appropriate application in some cases. Severe depression can be completely debilitating. In the elderly, the progression of illness and inability to care for day to day needs, the insomnia that frequently afflicts them, the pain from progressive diseases such as arthritis and carcinoma, these things can all lead to severe depression. An appropriate low dose antidepressant can do wonders to improve mood, appetite and sense of well being, enabling a patient to cope with the detriments of old age. At an appropriate dose, of course, because the elderly do not need the high doses of youth. Their systems eliminate drugs more slowly, and therefore they need much lower doses to be effective.



Immunosuppressants: en.wikipedia.org...

Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to: Prevent the rejection of transplanted organs and tissues (e.g., bone marrow, heart, kidney, liver) Treat autoimmune diseases or diseases that are most likely of autoimmune origin (e.g., rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, focal segmental glomerulosclerosis, Crohn's disease, Behcet's Disease, pemphigus, and ulcerative colitis). Treat some other non-autoimmune inflammatory diseases (e.g., long term allergic asthma control).

Well this should clarify the intentions of these reductions. Immunosuppressive drugs are necessary for organ transplant. There has always been a list of criteria required for the receipt of a transplant organ, if a patient doesn't meet the criteria, no transplant. Age is one of the criteria, as noted in this quote from Cedars-Sinai pertaining to lung/heart transplant. www.cedars-sinai.edu... spx

Lung Transplantaton Inclusion Criteria Patients may be considered for lung or heart/lung transplantation if they present with end-stage lung disease including the following conditions: No response to conventional treatment Limited life expectancy (less than two years) Severely impaired lifestyle and exercise tolerance, NYHA Class III - IV symptoms Oxygen dependence Less than 75 years of age for single lung transplants Less than 70 years of age for double lung transplants Less than 60 years of age for heart/lung transplants

By excluding immunosuppressive drugs from the Medicare part D program, you are effectively eliminating all over 65 patients who depend on Medicare as their coverage, when they may have met all other criteria.

Other disorders/diseases that require immunosuppressive therapy are also very common in the elderly, rheumatoid arthritis, myasthenia gravis, lupus and more often present later in life, and that is when treatment with these medications is needed. Removing them from availability leaves misery for those who would benefit.

Antipsychotics: en.wikipedia.org...

Antipsychotics (also known as neuroleptics or major tranquilizers)[1] are a class of psychiatric medication primarily used to manage psychosis (including delusions, hallucinations, or disordered thought), particularly in schizophrenia and bipolar disorder, and is increasingly being used in the management of non-psychotic disorders (ATC code N05A).

Although antipsychotics are not slated for removal thru 2015, it is worth looking at what the effect of their removal would mean. Antipsychotics are used to alleviate delusions and hallucinations in patients with parkinson's disease, schizophrenia and more. These mental disorders which are caused by disease and chemical imbalance, can be horrific for the patient, because the world they live in becomes a terrifying place. These medications reduce those effects and allow the patient to be a participating member in society in many cases. It also often allows them to stay in their homes for care, instead of being institutionalized. With close monitoring, it allows them more in life.

continued

Ok, now let us look at the proposed savings from this reduction.

The federal government expects to save $1.3 billion between 2015 and 2019, if the proposed rule passes.

The 1.3 billion dollars for the five year period of 2015-2019 is an annual savings of $260 million per year. There are over 49 million Medicare recipients. That is a savings of approximately $5.30 per recipient over the five year period. Now remember, most of these Medicare recipients are paying for their Part B outpatient coverage and their Part D Prescription coverage. Only those at the very bottom of the economic ladder have no out of pocket costs. In addition they have copayments for their medications that are as high as 70% of cost. However, if it is allowed that these medications do not have to be covered, all of the Medicare recipients are potentially going to lose coverage for those specific medications.

And when have you ever heard of a profit based business NOT cutting costs where ever they can?

Is it truly worth it to our society to begin what will surely be an avalanche of changes in the benefits to the elderly, for $5.30 per recipient per year?

They just keep going after the least of these. It just never quits.

And here we have our new 'Death Panel', aka congress and senate!
If they would forgo their much-needed wage increases there would be no need to effectively eliminate a large percentage of the populous.

Us old duffers have been reduced to the level of progressive and economic fodder.

Seems the higher up the ladder one climbs, the smaller their heart becomes. To be a politician, you need a heart the size of a gnat's ass.

reply to post by misschareesee2


Unfortunately, that is correct. I think many people in our society feel that the elderly are a waste of funds. They forget that if everything goes their way in life, and they live to a ripe old age, they are setting the criteria by which they will be judged and treated.

What goes around, comes around.

BT

reply to post by nugget1


Nugget, me thinks you besmirch the gnat.

I can't say I disagree with you though. The ability to totally disassociate from the reality that the people you are undermining are your parents and grandparents is mind boggling.

BT

reply to post by BearTruth


You know the 'Pro-gun' lobby is going to be all over this!

For some time now they have time and again, stated the problem with gun violence is not due to a lack fair laws or to many illegal weapons on the streets.
the real issue is lack of decent mental health care---


Their not wrong ya know--- the guy who shot up the movie theater here in CO. was a real nut job with a history of mental illness but lack of funding meant he was denied access to the help he needed--- and people died because of this oversight.
he isn't the only one. The Sandy shooter sure could have used a managed care program too---

reply to post by HardCorps


And there is a whole other can of worms.

It isn't often that a geriatric patient goes out and wreaks havoc. They usually are more homebound. However, where Medicare goes, so goes the whole insurance world. Soon the coverage for Medicaid and private insurance will follow suit.

Then we truly will have a segment of society with untreated or under treated psychotic illnesses.

I shudder to think how they will be dealt with in those circumstances.

BT

reply to post by misschareesee2


Terrifyingly appropriate pics. The extremes to which a society will go, to rid itself of undesirables.

Let us hope that our society does not continue down that path.

BT

reply to post by BearTruth

In the Third Reich, that path was incremental. The proverbial boiling frog in a pot. I see it happening. I can see it. Hold on tight to your love and sanity.

reply to post by BearTruth


“I don’t think that we can make judgments based on people’s ‘spirit.’ Uh, that would be, uh, a pretty subjective decision to be making. I think we have to have rules that, uh, say that, uh, we are going to provide good quality care for all people. End-of-life care is one of the most difficult sets of decisions that we’re going to have to make. But understand that those decisions are already being made in one way or another. If they’re not being made under Medicare and Medicaid, they’re being made by private insurers. At least we can let doctors know — and your mom know — that you know what, maybe this isn’t going to help. Maybe you’re better off, uhh, not having the surgery, but, uhh, taking the painkiller.”

-Barack Obama

Take a pill grandpa. You fought in WWII, worked, raised a family, saved all your life.

Hell, take two pills!

reply to post by beezzer

(Chilling!)

"But understand that those decisions are already being made in one way or another."

reply to post by beezzer


Beezer, that quote speaks volumns.

There are times in life, where the end of life decision has to be made. But that is end of life.

When a person has fifteen or twenty years left ahead of them, is not the time to condemn them to suffering, yet that is where this particular path seems to be leading. Although, we would be directed to remember that they can, of course, pay for the expensive therapies out of pocket. Even if that means they do not eat or have heat in their homes.

I hope people pay attention and realize this.

BT

Why don't we just institute eugenics while we're at it? We can save a while bunch of money that way. Eliminate the problem in the womb.

/sarcasm

BearTruth
www.mainstreet.com...

By excluding immunosuppressive drugs from the Medicare part D program, you are effectively eliminating all over 65 patients who depend on Medicare as their coverage, when they may have met all other criteria.

I certainly do not agree with Medicare for talking these drugs off the formulary, but for such a well-researched and well-written series of posts you have a completely erroneous conclusion. You are doing no such thing. Every single one of these patients still get Medicare and still get Part D (prescriptions). They can also still get the drugs no longer in the formulary, though they may have to pay more for them. For drugs classified as generic, they may even be cheaper. That's because Part D Co-pays can actually be more money that buying the same drug on the open market. What this proposal does is place these drugs in the same category as Viagra and Cialis, which were taken off the formularies because of public "outrage" that seniors might still enjoy sex at taxpayer expense.

Part D programs DIFFER WIDELY. They are not all "cheap." We can talk about this somewhere else. Drugs are classified into a number of "tiers" with preferred generic drugs being Tier 1 and more expensive drugs still under patent protection as Tier 4. Every category of drugs has Tier 1 generics available, which can be as cheap as $4.00/30 days. They are still available OUTSIDE the formulary and are still modest in cost. Tier 4 is going to be expensive, no matter whether it is in a Part D formulary or not.

Further, Medicare Advantage* programs tend to be very good and very affordable, especially compared to typical Obamacare premiums. They take on very little risk and approach Cadillac plans in terms of comprehensiveness of coverage. As an example, a high-deductible plan ($5000) prior to Obamacare cost $300 per month with no drug coverage. Because Obamacare requires certain parts, the after-Obamacare equivalent: $548/month. But Medicare Advantage for approximately the same coverage INCLUDING Part D: $78/month + $104 from Medicare Part B = $182/month.

My intent in this post is not to object to your entire essay here, but to the idea that Medicare patients are "effectively eliminated" from Medicare, which is what your quote implies. That's clear hyperbole. It simply is not true at all. Except for these classes of drugs, the entire Medicare program is still active for them, and many of the drugs are still "effectively available" to them because they are relatively cheap Tier 1 generics anyway.

* Medicare Advantage is a strange beast. You can get your Medicare coverage in two ways. The first is "from the government" meaning you take your card and find your health care from anyone who accepts Medicare. You also may buy a "Medicare Gap" insurance policy that covers areas Medicare does not. The second way is to "assign" your Medicare coverage to a private insurer or HMO. In THIS case the insurer "takes" the Medicare premium you pay through social security (normally $104.90/month) and charges you an additional amount, which varies depending on the coverage you choose, and can be from nothing to several hundred dollars per month. very adequate coverage can be had for less than an additional $100/month.

The disadvantage of this is that you must use a certain set of providers. In the case of an HMO you may be limited by geography, i.e.: Your coverage may be less in an area away from your home area and/or overseas. You have to use "their providers." The advantage is, of course, that your costs may be much less. There have been proposals to ELIMINATE Advantage proposals entirely over the years.

reply to post by BearTruth


There's a couple things here that bother me. First is why in the heck are 70 - 75 year old people getting transplants in the first place. That's utterly ridiculous. With transplant waiting list a mile long I don't see the point and before you say that's heartless, I'm old enough to say that even a my age a transplant is a misuse of medical resources.

Second is the over and misuse of the anti-depressant drugs. Good grief, they're serotonin and dopamine re-uptake inhibitors and the do not reduce pain. If the person is in pain give them an applicable pain medication. If they can't sleep give them a sleep medication like ambien or something. The US probably incorrectly prescribes 75% of the medications that are given out anyway.

Don't get me started on the anti-psychotics.

reply to post by BearTruth


They are going to save money but at what cost?

I guess people dont know how to respect their elders anymore these days. Why does cms need to cut costs when more and more baby boomers need more help now a days. This actually makes me sick to my stomach. Why dont we follow Iceland and get all this corruption out of North America! Lets start with Harper and Obama and move down the line!

This would be on Kathleen Sebelius. The republicans were right, the democrats are trying to kill grandma.

reply to post by BearTruth


ass-backwards it is.

Medicare was for these very people, now it's just a fund everyone elected wants a piece of.

Saving money is now more important than saving lives.