Medicare rule changes put patients at risk
The federal government should not be in the position to make life-or-death health care decisions. But that is exactly what the government is trying to do with a series of changes to Medicare that could have unthinkable consequences for patients who rely on prescription drugs to treat acute or life-threatening illnesses.
As the president of the Sherie Hildreth Ovarian Cancer Foundation, I am deeply concerned about how one of the proposed changes would impose "step therapy" on certain patients with life-threatening illness who rely on medicines paid for by Medicare Part B. Step therapy is nothing more than a cost-cutting measure that makes it harder for sick patients to get the prescription drugs they need. Under step therapy, patients are required to first fail on lower-cost medicines before insurance will cover the cost of more effective and more expensive treatments.
This is an alarming course of treatment for anyone who is sick. But for those living with a serious condition, step therapy could mean months of debilitating pain and irreparable damage before patients can get the medicines their doctors say they need. These are unnecessary, burdensome and potentially harmful steps that most patients cannot afford to take.
My voice joins a growing chorus of patient advocates sounding the alarm on this important issue. Forty organizations recently penned a letter to Secretary Alex Azar at the U.S. Department of Health and Human Services, warning that "when these policies interfere with the patient-physician relationship, they can result in delayed treatment, increased disease activity, loss of function and potentially irreversible disease progression."
Bureaucrats in Washington D.C. want to compound the threat to patients by reversing coverage protections that have been in place for almost two decades. In 2003, Medicare recognized six "protected classes" of illness that require highly specialized care. Conditions treated within these six classes include cancer, HIV/AIDS and mental health.
The federal government wants to remove these protections, thereby preventing doctors from being able to map out the best course of treatment for patients with serious and complicated conditions. If these protected classes go away, patients could be denied access to the medications that will best manage their conditions, including chemotherapy.
Making matters even worse, the U.S. Department of Health and Human Services wants to import into Medicare the price controls other countries had adopted. However, those countries only have access to a fraction of the medical treatments available in the United States. Survival rates for many types of cancers in America are significantly higher than for patients in the U.K. That's because the U.K.'s health care system restricts access to many therapies to drive down costs, and we should only expect similar consequences to take here in the U.S. if we insist on adopting a similar approach.
We all want solutions that will help make prescription drugs more affordable. But these new policies are misguided and will place even greater obstacles between patients and their medicines. If policymakers want to protect the health and well-being of patients, they will abandon these regulatory schemes and work to ensure all patients receive the care that they need.
Bruce Hildreth is a Gladstone resident and is president of the Sherie Hildreth Ovarian Cancer Foundation.