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Juliette Cubanski, Tricia Neuman, and Anthony Damico – Kaiser Family Foundation
Feb 08, 2024

Good News – in 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Medicare Part D, Medicare’s outpatient drug benefit. This is due to a provision in the Inflation Reduction Act of 2022, which included several changes to the Medicare Part D program designed to lower patient out-of-pocket costs and reduce what Medicare spends on prescription drugs. This new $2,000 cap (indexed annually to the rate of change in Part D costs) comes on top of the elimination of 5% coinsurance in the catastrophic coverage phase of the Part D benefit, in effect for 2024, which translates to a cap of about $3,300 out of pocket for brand-name drugs. These benefit design changes will save thousands of dollars for people who take high-cost drugs for cancer, rheumatoid arthritis, and other serious conditions.

If a $2,000 cap on out-of-pocket drug spending had been in place in 2021, 1.5 million Medicare beneficiaries enrolled in Part D plans would have saved money because they spent $2,000 or more out of pocket on prescription drugs that year. This estimate is based on the Kaiser Family Foundation’s analysis of Medicare Part D prescription drug claims data for enrollees without Part D low-income subsidies in 2021 (the most recent year available for this analysis). Among these 1.5 million enrollees, most (1.0 million or 68%) spent between $2,000 and $3,000 out of pocket, while 0.3 million (20%) had spending of $3,000 up to $5,000, and 0.2 million (12%) spent $5,000 or more out of pocket.

Over the course of several years however, far more Part D enrollees will stand to see savings from this new out-of-pocket spending cap than in any single year. A total of 5 million Part D enrollees had out-of-pocket drug costs of $2,000 or more in at least one year during the 10-year period between 2012 and 2021, while 6.8 million Part D enrollees have paid $2,000 or more out of pocket in at least one year since 2007, the first full year of the Part D program.

In most states, tens of thousands, if not hundreds of thousands, of Medicare beneficiaries will feel relief from the new Part D out-of-pocket spending cap. In California, Florida, and Texas, more than 100,000 Part D enrollees faced out-of-pocket costs of $2,000 or more in 2021, and in another 6 states (New York, Pennsylvania, Ohio, Illinois, North Carolina, and New Jersey), between 50,000 and 82,000 did so. As at the national level, more Part D enrollees in each state will benefit over time. For example, in Iowa, Louisiana, and Maryland, 73,000 Part D enrollees faced out-of-pocket costs of $2,000 or more in at least one year between 2012 and 2021. In Michigan, New Jersey, and Georgia, 148,000, 158,000, and 159,000 Part D enrollees, respectively spent $2,000 or more in at least one year over this same 10-year period. In Texas, 364,000 Part D enrollees did so; in Florida and California, around 400,000 enrollees or more.

Capping out-of-pocket spending will help Part D enrollees with relatively high drug costs, which may include only a relatively small number of Part D enrollees in any given year but, as this analysis shows, a larger number over time. People who will be helped include those who have persistently high drug costs over multiple years and others who have high costs in one year but not over time. While a cap on out-of-pocket costs will help millions of Part D enrollees over time, higher plan costs to provide the Part D benefit could also mean higher plan premiums, a dynamic that the Inflation Reduction Act’s premium stabilization provision was designed to mitigate. Although KFF polling shows that a relatively small share of older adults is aware of the Inflation Reduction Act’s $2,000 cap on out-of-pocket drug costs for Part D enrollees that takes effect in 2025, millions of them will benefit from this cap in the years to come.

National Eye Institute – November 2023

Did you know that about half of the 3 million people in the USA with glaucoma don’t even know they have it? If you get a glaucoma test and start treatment early, you may protect your eyes from serious vision loss. At first, glaucoma doesn’t usually have any symptoms. That’s why half of people with glaucoma don’t even know they have it. Medicare covers a glaucoma screening once every 12 months if you’re at high risk for developing glaucoma. There’s no cure for glaucoma, but early treatment can often stop the damage and protect your vision.

Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve.  The symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam.  

There are many different types of glaucoma, but the most common type in the United States is called open-angle glaucoma – that’s what most people mean when they talk about glaucoma. Other types are less common, like angle-closure glaucoma and congenital glaucoma. Over time, you may slowly lose vision, usually starting with your side (peripheral) vision – especially the part of your vision that’s closest to your nose. Because it happens so slowly, many people can’t tell that their vision is changing at first. But as the disease gets worse, you may start to notice that you can’t see things off to the side anymore. Without treatment, glaucoma can eventually cause blindness. 

Anyone can get glaucoma, but some people are at higher risk. You’re at higher risk if you: 

• Are over age 60, especially if you’re Hispanic/Latino 
• Are African American and over age 40 
• Have a family history of glaucoma

There’s no way to prevent glaucoma. That’s why eye exams are so important – so you and your doctor can find it before it affects your vision. Talk with your doctor about your risk for glaucoma and ask how often you need to get checked. If you’re at higher risk, you need to get a comprehensive dilated eye exam every 1 to 2 years.

Eye doctors can check for glaucoma as part of a comprehensive dilated eye exam. The exam is simple and painless – your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for glaucoma and other eye problems. The exam includes a visual field test to check your side vision.

Scientists aren’t sure what causes the most common types of glaucoma, but many people with glaucoma have high eye pressure. Some people with high eye pressure don’t get glaucoma – and there’s a type of glaucoma that happens in people with normal eye pressure. Normal eye pressure varies by person – what’s normal for 1 person could be high for another. Glaucoma can happen in 1 eye or both eyes. If you have glaucoma, it’s important to start treatment right away.

Treatment won’t undo any damage to your vision, but it can stop it from getting worse. There are three types of treatment:

Medicines. Prescription eye drops are the most common treatment. They lower the pressure in your eye and prevent damage to your optic nerve.

Laser treatment. To lower your eye pressure, doctors can use lasers to help the fluid drain out of your eye. It’s a simple procedure that your doctor can do in the office.

Surgery. If medicines and laser treatment don’t work, your doctor might suggest surgery. There are several types of surgery that can help the fluid drain out of your eye.

Talk over your options with your doctor. While glaucoma is a serious disease, treatment works well. Remember these tips: 

• If your doctor prescribes medicine, be sure to take it every day.
• Tell your doctor if your treatment causes side effects.
• See your doctor for regular check-ups.
• If you’re having trouble with everyday activities because of your vision loss, ask your doctor about vision rehabilitation services or devices that could help.
• Encourage family members to get checked for glaucoma, since it can run in families.

November 11, 2023

By Annabel Bourne – Features Correspondent, BBC

During the 19th Century, the activity of “retro-walking” was little more than an eccentric hobby, but today research is revealing it can have real benefits for your health and brain.

On an apparent wager to win $20,000, a 50-year-old cigar-shop owner called Patrick Harmon embarked on a curious challenge in the summer of 1915 – he planned to walk backwards from San Francisco to New York City.  With the aid of a friend and a small car mirror attached to his chest to help him see where he was going, Harmon made the 3,900-mile journey in 290 days, apparently walking every step backwards. Harmon claimed the journey made his ankles so strong that “it would take a sledgehammer blow to sprain them”.   Perhaps he was onto something.

According to research, walking backwards can have surprising benefits for both your physical health and your brain, as Michael Mosley recently explored in a recent episode of the BBC podcast Just One Thing. Retro-walking, as walking backwards is known in academic circles, has a rich history. There are reports dating back to the early 19th Century of people walking hundreds, and sometimes thousands of miles, in reverse. Many were the result of impulsive bets and others were simply attempts to claim the bragging rights to a bizarre new record.

But due to the difference in biomechanics, backwards walking can bring some physical benefits. It’s often used in physiotherapy to relieve back pain, knee problems and arthritis. Some studies even suggest that backwards walking can positively affect cognitive abilities such as memory, reaction time and problem-solving skills. The practice of walking backwards for health purposes is thought to have originated in ancient China, but it has received attention from researchers more recently in the US and Europe as a way of improving sports performance and to build muscle strength.  

Janet Dufek, an expert in biomechanics at the University of Nevada in the US, has been researching backwards locomotion for more than 20 years. She and her colleagues have found walking backwards for just 10-15 minutes per day over a four-week period increased the hamstring flexibility of 10 heathy female students. Backwards walking can also strengthen the muscles in the back responsible for spine stability and flexibility. And in another study led by Dufek, a cohort of five athletes self-reported a reduction in lower back pain after periods of backwards walking.

“Our research has shown that, indirectly, backward walking has some benefits relative to lower back pain simply because you’re stretching the hamstrings,” says Dufek. “Often one of the pieces that’s tied to lower back pain is tight hamstrings.”

Backwards walking and backwards running drills are already used in some sports training, particularly team and racquet sports which require the agility to quickly move forwards, backwards and laterally. As it reduces the stress placed on the knee joints while building strength, retro-running is also useful for helping to protect athletes from injury.

As well as athletes, retro-walking has been found to benefit the elderly, young, obese individuals, sufferers of osteoarthritis, and post-stroke patients with walking impairments. Backwards walking has also been found to burn more calories than walking forwards. But why is it so beneficial?  “The biomechanics of walking backwards is very different than forward walking,” Dufek told Mosley. “In backward walking, there is a reduced range of motion at the knee that can have some benefits for individuals who may be rehabilitating from knee surgery, for example.”

One recent study found that the range of motion at both the hip and knee joints is greatly reduced during backwards walking. Whilst the forwards gait begins with heel contact, the backwards gait begins with toe contact and the heel sometimes never lowers to the ground. As a result, less impact is felt at the knee joint, and it uses different muscles compared to normal walking. It’s the ankle joint which absorbs the most shock during backwards walking. Muscles activated in plantar flexion movement (used when pointing or standing on your toes) play a greater role in backwards walking to decelerate the ankle and absorb shock.

But the benefits don’t end with stronger ankles.  Researchers have also found differences in the location of neural activity when stepping backwards compared to stepping forwards. The prefrontal cortex, responsible for cognitive skills such as decision making and problem solving, is especially active when stepping backwards.

One Dutch study tested 38 participants’ ability to solve a Stroop test – which uses conflicting stimuli such as the word “blue” in red letters to interfere with how quickly people respond to a prompt – while stepping backwards, forwards or sideways. It found that participants stepping backwards had the fastest reaction times, perhaps because their brains were already used to performing an incongruous task.

Another study strongly concluded that different forms of backwards locomotion, including backwards walking, watching a video of a backwards train journey, and even just imagining moving backwards, improved participants’ ability to recall information. With larger studies of healthy populations as well as those who are unwell starting to add to the mix of research on retro-walking, the evidence for its benefits and limitations is becoming clearer.

But there’s also an element of risk when it comes to retro-walking. Care needs to be taken to avoid unseen obstacles and there are cases where walking backwards during physiotherapy has resulted in falls and serious injuries. There are also other ways of achieving the same results. Scientists in China, for example, found that tai chi and swimming are more effective rehabilitation activities for athletes with lower back pain than backwards walking, jogging, or no exercise at all.

By Marissa Plescia – MedCityNews

Dec 28, 2023

A new KFF report analyzed recent trends in Medicaid outpatient prescription drug utilization and spending. It discovered that although there’s been lower utilization of prescription drugs in recent years, Medicaid spending on prescription drugs has increased.

Although there’s been lower utilization of prescription medications, Medicaid spending on prescription drugs has increased, a recent report shows.

The KFF report relied on 2016 to 2022 State Drug Utilization Data, as well as CMS-64 Financial Management Reports from fiscal year 2017 to fiscal year 2022. It comes as states unwind the continuous enrollment provision, which prevented states from disenrolling Medicaid enrollees during the Covid-19 public health emergency. Because of the continuous enrollment provision, Medicaid and CHIP enrollment reached historic highs, peaking at 94.5 million people in April. This represents an increase of 23.1 million people from 2020.

But despite the growth in Medicaid enrollment, Medicaid prescription drug utilization was below fiscal year 2017 levels through fiscal year 2022, the researchers found. In 2017, there were 765.6 million prescriptions. In 2020, the number of prescriptions declined to 716.9 million. Then in 2022, the number of prescriptions increased to 761.1 million (but still less than in 2017). In 2017, there were 11.4 prescriptions per enrollee, versus 10.8 prescriptions per enrollee in 2020 and 9.4 prescriptions per enrollee in 2022. This proves that there was “lower drug utilization among those individuals enrolled during the continuous enrollment provision.”

Despite the decline in utilization of prescription drugs, net spending (spending after rebates) on Medicaid prescription drugs is estimated to have increased to $43.8 billion in 2022 from $29.8 billion in 2017. This represents a 47% increase. Net spending per prescription increased to $58 in 2022 from $39 in 2017. Gross Medicaid spending (spending before rebates) on outpatient prescription drugs also increased to $92.3 billion in 2022 from $64.7 billion in 2017.

The increase in Medicaid drug spending is likely due to the increased spending on high-cost brand drugs, KFF noted. “Studies have found substantial drug price increases beyond the rate of inflation in recent years as well as increasing launch prices for new drugs,” the report stated.

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At Greg Says we see this report as another example of how the pharma industry needs to be held accountable for the ever-increasing cost of essential medications.

By HealthDay – Jan. 4, 2024

A hearing aid’s first purpose is fairly obvious, but a new study argues that the devices also provide an important second benefit — a longer life.

“We found that adults with hearing loss who regularly used hearing aids had a 24% lower risk of mortality than those who never wore them,” said lead researcher Dr. Janet Choi, an otolaryngologist with the University of Southern California’s Keck School of Medicine.

The new study was published Jan. 3 in the journal The Lancet Healthy Longevity. In the study, Choi and her colleagues tracked more than a decade’s worth of federal health survey data on nearly 10,000 adults aged 20 and older, of whom more than 1,800 had suffered hearing loss.

Previous studies had linked untreated hearing loss to reduced life span, as well as other health problems like social isolation, depression and dementia. But there’s been little research regarding whether using a hearing aid can help ward off those health risks associated with hearing loss, the researchers noted.

In the new study, they found a nearly 25% lower risk of early death among the hard-of-hearing who regularly use a hearing aid versus those who never use them. That difference remained steady even after taking into account other factors like age, ethnicity, income, education and medical history. “These results are exciting because they suggest that hearing aids may play a protective role in people’s health and prevent early death,” Choi said in a university news release.

Interestingly, there was no difference in death risk between people who never used a hearing aid and those who had one but only used it occasionally, researchers found. Choi speculated that this lowered risk of death could be tied to the benefits that improved hearing brings to a person’s mental health and brain function.

Other studies have found that using a hearing aid can ease a person’s depression and dementia, Choi said. By treating those problems, the devices could be contributing to overall better health.

Hearing loss affects about 40 million U.S. adults, but only one in 10 who need a hearing aid actually uses one, the researchers noted. Choi said she hopes the new study will encourage more people to wear hearing aids, even if they must overcome barriers like affordability, identifying and fitting the right device, or the perceived stigma that comes with donning the gizmo. Choi personally relates to those challenges. Born with hearing loss in her left ear, Choi didn’t wear a hearing aid until her 30s because it took her years to find ones that worked for her.

Larger studies are needed to further understand the link between regular hearing aid use and the risk of death, Choi said. She’s also working on an AI-driven database that tailors hearing aid options to the needs of individual patients.

More information

The National Council on Aging has more about shopping for hearing aids.