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In a speech at a University of Southern California-Brookings Institution event, Seema Verma, Administrator of the Centers for Medicare and Medicaid Servicespointed to 2016 figures showing more than $1 billion in missed savings. 

By Alaric Dearment

MedCity News – Oct 21, 2018

Medicare Part D plans must do more to encourage generic drug utilization as statistics show patients spending significant sums on branded drugs when generic alternatives are available, the head of the agency that runs Medicare said Thursday.

Speaking at a University of Southern California-Brookings Schaeffer Initiative for Health Policy event, Centers for Medicare and Medicaid Services Administrator Seema Verma pointed out that while 90 percent of prescriptions dispensed in the US are for generic drugs, in 2016 Medicare Part D beneficiaries spent $1.1 billion in out-of-pocket expenses for branded drugs that have comparable generics. “So savings for patients are being left on the table,” she said. Additional barriers stand in the way of full generic utilization, she added. “So stay tuned for more from us on that issue.”

The remarks relate to a broader effort by the Trump administration to lower the costs of prescription drugs, costs that Verma pointed out are – in the case of Medicare – growing rapidly, from 17 percent of Medicare’s total budget in 2012 to 23 percent in 2016. She emphasized that encouraging market competition would be the means by which costs were reduced rather than what others have suggested, such as allowing Medicare to directly negotiate drug prices with manufacturers.

The Food and Drug Administration has also encouraged generic competition, in part by publishing alistof branded drugmakers that it says use restrictive means – such as Risk Evaluation and Mitigation Strategies – to thwart generic competition. Another possible means is to crack downon manufacturers’ use of citizen petitions to delay generic entry.

Other initiatives, like the proposal to require manufacturers to include list prices in ads for their products, have sparked debate. A legal expert said the First Amendment would not likely protect drugmakers from having to include such information in their ads. However, another disputed whether the administration’s move would actually result in lower drug prices, adding that it would instead probably create confusion among consumers and potentially discourage people from taking medicines.‘Greg Says’believes one of the highest priorities for the CMS needs to be how to control the rising cost of prescription meds. It will take a combined effort of the government, drug manufacturers and insurance companies to reduce the cost of prescription drugs

According to a recent article in BenefitsPro.com,“Bankruptcy is claiming more older Americans.”  This is heartbreaking news, but undoubtedly true.  The subhead reads, “The number of Baby Boomers filing bankruptcy has tripled since 1991,due in large part to higher medical bills, lower pensions and lack of savings.  Older adults represent an increasing percentage of bankruptcy filers, increasing from 2.1 percent in 1991, to 12.2 percent today.”

According to the article, “Older Americans report they are struggling with increased financial risks, namely inadequate income and unmanageable costs of healthcare, as they try to deal with reductions to their social safety net.  Simply because of their age, this group is less able to effectively respond to the shifting risks.”

“Study data indicate that between February of 2013 and November of 2016, there were 3.6 bankruptcy claims filed per 1,000 people aged 65 to 74.  Yet 27 years ago there were only 1.2 claims per 1,000 in the same age bracket.  The Social Science Research Network study asked bankruptcy seekers what drove them to it. Nearly 75 percent cited debt collectors; two thirds said their income had fallen and approximately 60 percent laid the blame on unmanageable medical bills.”

 ‘Greg Says’thinks that independent agents like myself need to do a better job of educating seniors regarding how best to protect their financial assets from the rising costs of healthcare. Yes, understanding all of the protection options is challenging and yes, most seniors aren’t prepared to do that on their own.  That’s why it’s so important for seniors to seek the freeadvice available from certified independent agents in order to be best protected from the financial trauma associated with the high costs of healthcare today.

The Centers for Medicare and Medicaid Services (CMS) on Aug. 1 extended the length of time you can keep a short-term policy from just 90 days to one year. In addition, you’ll be able to renew the same short-term policy annually for up to three years.

Short-term, limited-duration insurance is a type of health insurance coverage that was primarily designed to fill gaps in coverage that may occur when an individual is transitioning from one plan or coverage to another plan or coverage, such as in between jobs. This type of coverage is exempt from the definition of individual health insurance coverage under the Patient Protection and Affordable Care Act (PPACA) and is therefore not subject to the PPACA provisions that apply to the individual market.

This is good news for families and individuals wrestling with soaring health insurance premiums: The federal government just made it easier to buy and maintain lower-priced, short-term health insurance. The changes are the latest tweaks to the Affordable Care Act (ACA or Obamacare) made by the Trump administration aimed at giving middle-class consumers access to more affordable health insurance. The announcement reversed a 2017 Obama-era rule that had reduced the coverage window of short-term insurance from one year to 90 days.

Short-term health insurance is 80 percent cheaper than non-subsidized, Obamacare coverage, according to a study eHealth published in August. The same study found that the average monthly cost of ACA insurance for a family of four that didn’t qualify for an Obamacare subsidy was $1,376 — up 15 percent from 2017 and more than 60 percent higher than the same policy in 2014, when Obamacare was launched.

“We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies,” said CMS Administrator Seema Verma in a statement announcing the rule change. “The final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans.”

Short-term health plans are cheaper, in part, because they aren’t required to include all of the benefits mandated by the ACA and, as the name implies, they’re only guaranteed for a limited amount of time. The plans originally were designed for people facing temporary gaps in medical coverage, and this remains the primary reason people buy short-term policies.  But a growing number of consumers are turning to the policies as a longer-term solution as premiums for non-subsidized ACA plans continue to rise.

‘Greg Says’ considers short-term health insurance plans to be a credible alternative to ACA-compliant plans particularly for those 63 and 64, approaching Medicare.  These plans are under-written so they’re not available to those with serious health issues and they exclude pre-existing conditions.  But for those able to qualify, they have lower premiums and lower deductibles than the ACA-compliant plans.

The rule, finalized Thursday by the Centers for Medicare and Medicaid Services, is part of the Trump administration’s goal toward “value-based care,” which aims to reduce the costs of healthcare while improving outcomes.

Hospitals will be required to post the prices they charge for surgeries and other medical procedures online under a new Trump administration rule.

The rule, finalized Thursday by the Centers for Medicare and Medicaid Services, is part of the Trump administration’s goal toward “value-based care,” which aims to reduce the costs of healthcare while improving outcomes. Officials hope to be able to drive down costs by showing patients more information about what different medical procedures will cost, and at times encourage them to shop around.

Previously, CMS required that hospitals make the information available to anyone who asks for it. Under the new rule, hospitals will need to update the prices every year beginning Jan. 1, 2019.

“The agency is considering future actions based on the public feedback it received on ways hospitals can display price information that would be most useful to stakeholders and how to create patient-friendly interfaces that allow consumers to more easily access relevant healthcare data and compare providers,” CMS said in a statement.

The posted prices are different than what most patients and health insurance companies pay for care, because each insurer or government payer such as Medicare negotiates payments.

 

by Kimberly Leonard, The Washington Examiner

August 03, 2018

 

It takes a number of strategies to stay healthy and vibrant late into life. Get plenty of sleep, exercise regularly and challenge your brain.

Numbers are importantto Jan Sirota, a retired investment banker who lives in Sarasota, Florida. Sirota just celebrated 11 years of marriage, he cycles 40 miles per day, mentors four high school students and races cars 150 miles per hour in High Performance Driver Education events. The number that doesn’t seem to matter?  His age.

“I’m 75, and it’s irrelevant to me,” Sirota says. “There’s no reason to say that I’ll slow down because I’m getting older.”

Many older adults do slow down, however, when faced with chronic disease, disability or isolation. So why is it that some people, like Sirota, can escape that fate and live vibrantly later in life? “Certainly genetics play a big part in this, and then of course luck. However, I don’t want anyone to think we can’t fight destiny a little bit,” says Dr. Patricia Harris, a geriatrician and professor at the David Geffen School of Medicine at UCLA.

Age-Related Changes

Some change is inevitable. We lose muscle and bone mass as we get older, and we experience a decline in sex hormones, kidney function, mental sharpness and reaction time. Cartilage in the joints often wears away and causes pain, digestion slows, balance becomes impaired and vision and hearing may decline. Chronic disease may also develop, such as cardiovascular disease or Type 2 diabetes.

A shift in social connections can also affect us in older age. Our children grow up and move away. We no longer see co-workers when we retire. People close to us – friends, siblings, a spouse – succumb to illness or dementia. This can lead to loneliness, isolation or depression, and a downward spiral.

“Loneliness is one of the biggest problems I see,” Harris says. “It leads to depression and a loss of motivation to manage health. People become sicker and frailer, which keeps them from getting out and socializing. It increases the risk for an early death.”

Early Action Steps to Age Well

Research is increasingly demonstrating that the way you take care of yourself today may have a big effect on your health later in life. For example:

Exercise: Studies have linked midlife fitness with reduced odds for developing chronic disease (such as Alzheimer’s disease, stroke and diabetes) later in life. “Exercise has been shown to reduce the risk for cardiovascular disease, muscle loss, obesity, depression, cancer and many other chronic diseases. It has a direct effect at the cellular level. It decreases systemic inflammation, fat in the body and LDL ‘bad’ cholesterol, and it increases HDL ‘good’ cholesterol, bone density and muscle mass,” says Dr. Saket Saxena, a geriatrician at Cleveland Clinic and clinical assistant professor of medicine at Case Western Reserve University School of Medicine.

Healthy Eating:Studies have shown that eating a healthy diet in midlife is associated with better health in our older years. “A Mediterranean-style diet is associated with longevity around the globe,” Saxena says. The diet includes a fair amount of fruits, vegetables, legumes, seeds, nuts, olive oil and whole grains, plus moderate amounts of fish, poultry and wine and low amounts of red meat and meat products.

Avoid Sunlight:Something else you can do now that may help later is avoid sunlight, according to Dr. Manjula Jegasothy, an aesthetic dermatologist and clinical associate professor of dermatology at the University of Miami’s Miller School of Medicine. “Extended UV radiation exposure over a lifetime can cause so much DNA damage that it hastens cell aging throughout the body,” Jegasothy says. “UV exposure also increases the risk of skin cancer. And from an appearance standpoint, UV exposure ages the skin.”

What if You’re Already Older?

If you haven’t taken great care of yourself over the decades, there are still lots of things you can do to make the most of the years ahead.

Follow the basics. “Time and again studies show true benefits of not smoking, keeping weight down and keeping major health conditions like high blood pressure, heart disease or diabetes well controlled,” Harris says. Aim for seven to eight hours of sleep each night to avoid fuzzy thinking and reduce the risk of falls.

Start exercising:“Exercise reduces stress levels in our bodies. It circulates oxygen to all tissues, which is good for the brain. It builds up strength, so you’re at less risk for falling and frailty.  And strong muscles make our bones hurt less,” Harris says. How much exercise do you need? The standard recommendation is 150 minutes per week of moderate intensity exercise, such as a game of tennis or brisk walking. “That’s daunting,” Harris says. “Consider that a goal, not an absolute. If you get out and walk regularly for three minutes when you hadn’t been walking at all, that’s a real accomplishment.”

Be Resilient:Learn to be resilient. Being able to bounce back from adversity, such as the loss of a loved one or a job, can help you cope with life’s ups and downs, stay active and avoid depression.

Socialize More: It helps fight loneliness, depression and isolation. If you’re far from loved ones, make new friends.  Join a club, volunteer or meet your neighbors. “The number of social interactions in a day or week improves life expectancy, even in people with heart disease and colon cancer,” Harris says. “It doesn’t have to be a best friend.  It can be someone in a coffee shop or the person at the cash register in the grocery store.”

Challenge Your Brain:We all can’t race cars like Sirota, but we can try a new a hobby, learn another language or take a class at a local college (many universities, including Harvard and Yale, allow you to take free classes online, although you won’t receive credit. “Staying mentally active in some way staves off dementia,” Harris says. “It has to be something that continues to engage your brain as you get older.”

Get Your Hearing Checked:“Hearing impairment can lead to a decline in socialization and mental stimulation, which can have an impact on activity, which can lead to depression and isolation, which can lead to functional decline and can reduce longevity,” Saxena says.

Reduce Stress:Chronic stress raises inflammation in the body. “People with higher levels of inflammation in the body, like C-reactive protein, have a more limited life expectancy,” Harris says. Try meditating, yoga or tai chi.

Live With Purpose:It’s associated with a reduced risk of cognitive decline and Alzheimer’s disease. Sirota says it just makes him feel good. He’s passing on his business experience to enterprising high schoolers. “It gives me incredible joy to help kids,” he says. You can live with purpose by volunteering, helping a family member or doing anything that gives you meaning.

The Bottom Line

Many aspects of health are related, such as isolation, depression and functional decline. It makes sense, then, that we need a combination of strategies to stay vibrant. “It really takes a lot of things to live longer and healthier,” Harris says.

For Sirota, that means doing as many activities as possible to enrich life. “Never step down your game,” he says. “There’s no reason to not keep doing something until something stops you.”

by Heidi Godman, Contributor – U.S. News & World Report

Feb. 23, 2018