Tag Archives: Medicare

Why Do Drugs Cost So Much?

by Chris Adams A response to A Tale of Two Drugs, an article by Barry Werth published in the MIT Technology Review Oct. 2013 Drug prices. Why are they so high? In a recent article for the MIT Technology Review, Barry Werth considers the pricing of two recently developed and very expensive drugs. The first drug is used for cystic fibrosis and costs almost $25,000 per month. The second drug is used for metastatic colon cancer and is priced at $11,000 per month. So why are these drugs so expensive? Why do companies charge so much for their drugs? The simple answer is that they can and so they do.

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Seniors and the Screening Loophole

“But doctor, I thought screening for colorectal cancer was covered by Medicare!?” Our seniors are facing policy loophole that lands them with an unexpected bill. In a recent report, Colonoscopy Screening After the Affordable Care Act: Cost Barriers Persist for Medicare Beneficiaries on the colonoscopy copay issue by AARP, there continues to be a debate about what portion of a preventative service a patient should be responsible for. For our seniors, prior to the implementation of the Affordable Care Act (ACA), Medicare beneficiaries typically incurred some level of cost sharing for health care services they received. For example, they were responsible for Part B premiums, Part B Deductibles, and a 20 percent coinsurance

ACA Mandates Insurance Coverage for Clinical Trials

By January 1, all insurers will be required to cover routine care for patients enrolled in clinical trials. (Typically any experimental care is provided at no cost to the patient.) “This should be seen as a step forward for the U.S. oncology community,” wrote Dr. Y-Ning Wong in the ASCO Daily News from the American Society of Clinical Oncology’s meeting in Chicago. “However, patients and providers must remain vigilant about the law’s implementation.” Currently there is a patchwork of state laws; as of January  2014, the Affordable Care Act (ACA) creates a federally required minimum that all private insurers must cover at least the usual care when patients enroll in a

Too Many Colonoscopies in Over-75s?

A study published in the March 11 JAMA-Internal Medicine suggests that 23 percent of over-75-year-olds have colonoscopies that may be “potentially inappropriate” according to national guidelines which include an upper age limit, as well as how often negative colonoscopies should be repeated. In a retrospective population study, University of Texas researchers looked at billings for 100 percent of colonoscopies performed in Medicare beneficiaries in Texas who were aged 70 years and older who had a colonoscopy in 2008 or 2009. They also examined a nationwide sample of 5% of Medicare claims. Colonscopies were classified as “screening” if records (including claims from 2000 to 2009) did not indicate a diagnosis, or

Oldest of Old Americans Will Drastically Impact U.S. Cancer Care

The numbers are stark and will touch every single American. A picture of cancer in the greying American population was drawn in a recent study in the Journal of Geriatric Oncology examining trends in the National Cancer Institute’s population-based SEER data: The number of “oldest of the old” Americans (age 85 or older) will double between 2000 and 2030; and will have tripled by 2040 (from 4.3 million to 15.4 million). Cancer in the oldest old is the 2nd leading cause of death: More than 1 in 5 over age 85 will develop cancer. The total cost of cancer care will rise 39% in just 10 years, between 2010 and 2020—much of that

Wanted: 100 U.S. Representatives

H.R. 4120 has 37 cosponsors, but your help is needed to push the number to 100 by the end of September. Colorectal cancer screening is covered under Medicare without cost sharing (or co-pay), but if a Medicare patient undergoes a screening colonoscopy during which a polyp or other tissue is removed, that patient is required to pay. This policy is unfair, confusing and deters individuals from receiving a test that could save their lives. Earlier this year, H.R. 4120, the ‘‘Removing Barriers to Colorectal Cancer Screening Act of 2012,” was introduced in the U.S. House of Representatives by Rep. Charlie Dent (R-PA). H.R. 4120 would waive a Medicare beneficiary’s coinsurance

Supreme Court Ruling in Plain English

The Supreme Court has ruled that the Affordable Care Act, including its individual health insurance mandate, is constitutional. The Court did not uphold the individual mandate on the grounds that Congress can use its power to regulate commerce between the states to require everyone to buy health insurance. Rather, the Court agreed that the penalty that someone must pay if he or she refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that requires states to comply with new

The Calls to Congress are done – for now, but Support of H.R. 4120 still needed

Seniors’ access to a screening colonoscopy is at risk and YOU can help! We need you to continue to add your voice and urge your Representative to support H.R. 4120! Simply submit an Action Alert. H.R. 4120, the Removing Barriers to Colorectal Cancer Screening Act of 2012, will fix a regulation that requires Medicare beneficiaries to pay coinsurance when their screening colonoscopy involves the removal of a polyp. The current policy can cost patients $100 to $300 and serve as a deterrent to screening. We need cosponsors for this legislation if it is to pass into law & YOU can help!

Virtual Colonoscopy Works for Older Folks Too

 Time to catch up on some colorectal cancer news that we might have missed. In Nutshell News: Virtual colonoscopy works just as well for over 65′s, over-the-counter and prescription stomach acid is connected to c. difficile diarrhea, and the recession cut into colorectal cancer screening among people with health insurance.

New Bill in Congress Aims to Save Seniors’ Lives

Legislation was introduced in Congress today that will correct an oversight to the Affordable Care Act (ACA) that requires Medicare beneficiaries to pay coinsurance when their screening colonoscopy also involves the removal of a polyp or cancer. When a screening colonoscopy turns therapeutic, the cost to the Medicare patient is significant – $100 to $300 – and it could serve as a deterrent to screening. The legislation, Removing Barriers to Colorectal Cancer Screening Act of 2012 (H.R. 4120), was introduced by Rep. Charlie Dent of Pennsylvania.

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