Medicare No Longer Covers Pricey Brain-Cancer Therapy
NextSource Biotechnology is exiting a federal discount program, leaving its $1,000-a-capsule drug unaffordable for patients who depended on the Medicare Part D drug benefit. In related news: a GAO analysis finds that big prescription drug ad campaigns have driven up use by Medicare beneficiaries.
The Wall Street Journal:
Costly Brain-Cancer Drug No Longer Covered By Medicare
The seller of the brain-cancer drug Gleostine has pulled out of a federal discount program for Medicare patients, leaving some struggling to pay for a therapy that can cost as much as $1,000 per capsule. NextSource Biotechnology LLC’s decision to leave the program, rendering its drug ineligible for the Medicare Part D drug benefit, comes after the Miami company raised the drug’s price exponentially since acquiring rights in 2013. Gleostine, which treats a tumor known as glioblastoma and other brain cancers, is off-patent but has no generic alternative. (Loftus, 6/17)
CBS News:
Expensive Brain-Cancer Drug No Longer An Option Under Medicare
"There are lots of people right now who are not getting the drug," and some will likely die as a result, Henry S. Friedman, a neuro-oncologist and professor of neurosurgery at Duke University School of Medicine, told CBS MoneyWatch. "There are patients who can't afford the drug, and other drugs may not be as effective. "The Centers for Medicare & Medicaid Services, or CMS, confirmed NextSource had withdrawn from the Medicaid drug rebate program, meaning states cannot receive federal funding reimbursement for Gleostine. However, states can still pay for the drug with their own funds, with each state's Medicaid program making those coverage decisions. (Gibson, 6/17)
Stat:
Prescription Drug Ads May Have Increased Medicare Spending
The large sums of money spent on advertising prescription drugs directly to consumers may have contributed to increased use by Medicare beneficiaries and driven up spending by the federal health care program, according to a new report by the Government Accountability Office. The analysis found Medicare Parts B and D, as well as beneficiaries, spent $560 billion on medicines from 2016 through 2018. More than half of that spending — $324 billion — went to purchasing drugs that were advertised directly to consumers. Of the 553 advertised drugs, the GAO found that Medicare Parts B and D purchased 104 and 463 drugs, respectively. (Silverman, 6/17)
In other news about Medicare —
Modern Healthcare:
Medicare Advantage Members Actively Managed Their Care Less In 2020
Fewer Medicare Advantage plan members actively managed their care in 2020, and they had less communication with their health plans, a new report finds. Data analytics firm J.D. Power wrote in its 2021 U.S. Medicare Advantage Study that the country's nine largest plans are still struggling when it comes to member communication and engagement. The seventh annual study found just 55% of MA members actively managed their care in the past year, a decline of nine percentage points from 2019. The two most common ways plan members actively manage their care is by checking whether a treatment or service is covered and asking their doctor or pharmacist for a generic drug instead of a brand-name one, J.D. Power wrote. (Bannow, 6/17)
The New York Times:
Lifelong Exercise Adds Up To Big Health Care Savings
Becoming more physically active today might help us avoid thousands of dollars in health care costs later, according to a new study of exercise and Medicare claims. It finds that people who start to exercise before or during middle age typically save anywhere from $824 to $1,874 annually on health care costs after retirement, and the earlier they start their workouts, the greater those savings can be. The study involved mostly well-educated white men and women and has other limitations, but the findings highlight how significantly exercise might benefit people’s bank accounts, as well as their bodies. (Reynolds, 6/16)
