With Medicare policy changes, it’s easy to be distracted by the jargon. For example, the U.S. Department of Health and Human Services has proposed using an “International Pricing Index” to set Medicare Part B prescription drug reimbursement rates. What could be wrong with that?
Unfortunately, there’s a lot hiding in those words. First of all, Medicare Part B pays for physician-administered medications, things like chemotherapy drugs and intravenous drips used commonly to not only treat cancer, but also arthritis, colitis, Crohn’s, multiple sclerosis, and many autoimmune dysfunctions — medicines necessary in everyday cases. This proposal would set the rates for these vital therapies based on government-mandated pricing from other countries.
Let that sink in — our policymakers want to cede key decisions affecting our medical care to foreign bureaucrats. How does this make sense?
The problem is, it doesn’t. And the consequences could be severe for seniors and people with autoimmune dysfunctions who rely on Medicare Part B. I’m one of them.
My story began when I noticed painful joint swelling. During the initial phase, I was unable to walk. Finally, I saw a doctor who told me I wasn’t suffering from the usual aches and pains; I have arthritis.
Arthritis is an autoimmune disorder, which causes my body to attack itself. My physician underscored the importance of treatment, because without it, I would be in a wheelchair today. The joint damage can make it difficult to close a shirt button and eventually deprive sufferers of the ability to walk. In about 40 percent of cases, other organs, such as the lungs and heart, become swollen and cause death.
But it’s a wonder what today’s pharmaceuticals can do. I’ve been on a physician-administered biologic infusion to calm my immune system and slow down this disease. The medication has reduced my pain and fatigue and made life so much better.
Access can be a problem, however. Already, I’ve struggled with scheduling under Medicare Part B and missed one treatment. Changing the reimbursement rates, as proposed, would only make things worse. And if the international index sets the price too low, my medication may not be available to me at all.
Lives at stake
This is a real possibility. For example, in Canada, only about half of the newer cancer therapies utilized in the U.S. are accessible to patients there — and it’s Canadian pricing, among others, that HHS regulators want to import. Just imagine being told by the government that you can’t have the breakthrough chemotherapy drug that could save your life. It happens frequently abroad, and if the pricing index plan goes into effect, it will start happening here.
There’s a reason the U.S. has always avoided pharmaceutical price controls — they lead to medicine shortages, stifle innovation in new treatments and cures, and steal hope from patients and their families. Targeting physician-administered therapies aimed at the most serious conditions is the very worst place to experiment with this outmoded idea. It could cost lives.
Importing other nations’ prescription drug policies is the wrong choice for seniors and a terrible precedent for the country. There are better ways to improve affordability and access, including proven, value-based models. With so many viable alternatives, it would be unconscionable for HHS to cut off seniors and disabled Americans from treatments they desperately need.
