New Rules for Medicare Advantage Plans next year

The government just announced new rules for Medicare Advantage Plans that could affect you (if you're a Medicare beneficiary and enroll in an MA plan). To read about it, go to the Kaiser Daily Health Policy Report for Tuesday 3/31. One change I don't agree with is that:

"CMS will prohibit a practice by Medicare prescription drug plans that charges both a higher copayment for brand-name medication and the difference between the cost of the brand-name drug and a generic version. Higher copays still will be permitted, but the extra cost for the difference between the drugs will no longer be charged to beneficiaries (Alonso-Zaldivar, AP/Boston Globe, 3/30)."

The current practice by some plans may be tantamount to double charging, but I'd rather see CMS require the plan to reimburse the consumer for his or her share of the generic drug (using whatever co-pay pertains to generics), and then make the consumer bear the full extra cost of the branded drug. (An appeals process could handle the few instances where the patient can't tolerate the generic drug.)

If we want a dynamic and innovative drug industry, but one that doesn't put us into the poor house (any faster than we're already going there), we should give new drugs a lot of pricing freedom when they are new and under patent, but cut 'em off at the knees once those rights expire with a policy that agressively promotes generic competition. That's why it's important to limit the games that drug companies play to extend their period of market exclusivity. There's some activity in Congress right now to try to close the latest loophole the drug companies are using -- where they pay a generic company a "Go-away" fee not to compete. (See the report on what's happening this week in the KFF newsletter.) Drug companies protect billions of dollars of revenue by fending off generic copies this way. Fixing the loophole is one of those little things that Congress could do to help keep health care costs under control, but I'm afraid the pharmaceutical lobby will be able to kill it unless we citizens let Congress know it's important.

We should send little email notes to our esteemed congressional legislators saying, "I support legislation to stop drug companies from keeping generics off the market by paying them to "Go-Away. I hope you won't let this issue die, because our health care costs depend on it." -- something like that. Here's how to contact your members of Congress:

• Senators: US Senate, and search in the upper right corner
• Congressman: Write your Congressman