Bureaucrats in Washington Putting Profits Over Patients

Over 20 years ago, my mom was diagnosed with Stage 4 Non-Hodgkin's Lymphoma. Her doctor's quick action, prescribing just the right treatment for her type of cancer is the reason she is alive today. I'm concerned that if she were diagnosed now as a Medicare beneficiary, her access to care would not be as swift, ending with a much different result.

My concern stems from recent changes bureaucrats (not doctors) at the Centers for Medicare and Medicaid Services (CMS) in Washington are making to Medicare Part B that covers treatments for the most serious conditions like my mom's cancer.

CMS is now permitting Medicare Advantage plans, for example, to use step therapy that essentially forces doctors to prescribe treatments hand-picked by the insurer (usually the cheapest option), as the first course of action, even if the treatment is not the most effective option. Step therapy is commonly referred to as "fail first" because physicians can only move on to their preferred treatment when the first option has proven to fail. Vulnerable patients should not be forced to undergo ineffective therapies as a cost saving measure. If my mom were forced to endure this practice, it likely it would have cost her life.

Equally concerning, CMS is proposing to use the International Pricing Index (IPI) model to set the price Medicare will pay for Part B drugs to what 14 other countries pay. While these countries may have lower drug costs, the move will squelch US medical innovation and hinder access to patient care. Just consider this, between the years 2011-2018, US patients had access to 95% of the cancer drugs launched, while patients in Great Britian and Greece (countries that use the IPI model) had access to just 74% and 8%, respectively.

I am grateful everyday that my mom had access the very best care and medical innovations that have enabled her to be part of my and my three daughters lives today. All Medicare beneficiaries deserve this level of care and gift of time.

CMS should reconsider these recent changes to Medicare and instead focus on patient-centric reforms that lower drug costs without putting patients' lives at risk.