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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at .

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

  • 18Nov

    Did you know it’s illegal for Medicare beneficiaries to use coupons for their Part D drugs? Most people don’t….but it is. Coupons are a way that drug companies can entice beneficiaries to use drugs whose copayment, let alone the full cost of the drugs, would otherwise be too expensive. This means Medicare is then footing the bill for these more expensive brand name drugs that without coupons beneficiaries wouldn’t use. They would instead use lower cost generics. Drug companies are supposed to use safeguards to ensure beneficiaries don’t use coupons to get these high cost drugs, but such efforts are lacking, according to a recent Office of Inspector General report (PDF). The OIG found that up to 7% of beneficiaries use coupons to purchase their drugs, which amounts to about 2 million people buying more expensive drugs than they would otherwise and hence racking up Medicare’s Part D drug tab.

    While beneficiaries are just doing what seems like a smart and legit way to get the drugs they require at a price they can afford, this coupon use is illegal and drug companies are most likely letting it go unchecked to protect and sustain their own profit margins.

    For more information, see:

    The OIG report, Manufacturer Safeguards May Not Prevent Copayment Coupon Use for Part D Drugs (PDF)

    The Wall Street Journal article, Did Someone say Kickbacks? HHS Warns About Medicare Part D Coupons

  • 05Nov

    Low Performing Plans (LPP) get one more year. LPPs, which are Medicare Advantage plans or prescription drug plans with overall ratings of fewer than 3 stars for 3 consecutive years, were supposed to be terminated as of Dec 31, 2014, but the Centers for Medicare and Medicaid Services (CMS) has decided to give them one more year.

    About 165,000 beneficiaries throughout the U.S. and Puerto Rico are in consistently low-performing plans and will receive a notice from CMS reminding them that they can switch to a higher performing plan during the Annual Election Period (AEP) between Oct 15 – Dec 7. If they miss the AEP opportunity, they still have a Special Election Period (SEP) to change to a plan with 3 or more starts in 2015. To use this SEP, beneficiaries must call 1-800-MEDICARE.

    Note that:

    • This is a one-time SEP for individuals enrolled in a plan indicated with the Low Performance Icon in the Medicare Plan Finder.
    • The SEP can only be effectuated by CMS.
    • All enrollments under this SEP are prospective (no retro-active enrollments).
    • Individuals may use the SEP to disenroll from Medicare Advantage (MA) into Original Medicare.
    • A Part D coordinated SEP exists for individuals to enroll in Part D if they select an MA Private-Fee-for-Service plan as long as they make that enrollment at the same time.

    Beneficiaries with questions about their plan choices can call their local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP provides free, individual and unbiased counseling on Medicare questions and ways to supplement Medicare.

  • 14Oct

    Clinics scheduled in Stockton, Tracy, Lodi, Berkeley, San Jose, San Francisco, and Oakland

    One of our California Health Advocates board members, Rajul Patel and his pharmacy students at University of the Pacific’s Thomas J. Long School of Pharmacy & Health Sciences will be offering health clinics in 7 cities throughout Northern California this fall to help Medicare beneficiaries save on their prescription drug costs and better understand their medications. The clinics will also offer a variety of health care screenings and services.

    Now in its 8th year, Rajul and his students participating in Pacific’s Mobile Medicare Clinics have served a total of 2,911 Medicare enrollees and saved seniors and other beneficiaries more than $2.2 million on their out-of-pocket Medicare Part D prescription drug costs, for an average savings of $769 per person per year.

    This year’s clinics will be offered during the annual Medicare Open Enrollment period, Oct. 15th through Dec. 7, in 4 Bay Area cities – Berkeley, San Jose, San Francisco and Oakland – as well as 3 Central Californian cities – Lodi, Stockton and Tracy. (Dates and locations are listed below.)

    Trained pharmacy students will assist beneficiaries with Part D plan review and enrollment, determine if they qualify for additional government assistance to help lower their out-of-pocket medication costs, and explore other cost-savings opportunities.

    Attendees will also receive a comprehensive review of all of their medications and have all of their medication-related questions answered. Since the program’s inception, Pacific student pharmacists have identified 137 potentially severe medication-related issues among clinic attendees, including severe drug-drug interactions and sub-optimal drug therapy that warranted physician follow-up.

    Under the supervision of licensed pharmacists, the student pharmacists will also offer vaccinations, including the flu and pneumococcal vaccines; diabetes screening; and blood pressure, cholesterol and bone-density testing.

    All told, pharmacy students have held 73 clinics in 16 California cities since the program first began, volunteering a combined 9,072 hours of time.

    If you would like to have your Part D plan reviewed and/or have a comprehensive evaluation of your medication, please call for an appointment. Phone numbers for each clinic site are listed below.

    IMPORTANT: Beneficiaries attending the clinic should bring the following:
    • Their red, white, and blue Medicare card
    • All of their medications

    Bay Area clinics

    San Jose
    Oct. 26, Sunday, 10 a.m. – 5 p.m.
    Seven Trees Community Center, 3590 Cas Dr., San Jose
    Call for an appointment: (209) 946-7728

    Oakland
    Nov. 1, Saturday, 10 a.m. – 6 p.m.
    Allen Temple, 8501 International Blvd., Oakland
    Call for an appointment: (510) 343-2473

    San Francisco
    Nov. 9, Sunday, 10 a.m. – 6 p.m.
    Jewish Community Center of San Francisco, 3200 California St., San Francisco
    Call for an appointment: (415) 292-1200

    Berkeley
    Nov. 22, Saturday, 10 a.m. – 6 p.m.
    Ed Roberts Campus, 3075 Adeline St., Berkeley
    Call for an appointment: (510) 841-4776 ext. 3112

    Central Valley Area clinics

    Lodi
    Oct. 23, Thursday, 1 p.m. – 6 p.m.
    LOEL Center and Gardens, 105 S. Washington St., Lodi
    Call for an appointment: (209) 369-1591

    Nov. 11, Thursday, 1 p.m. – 7 p.m.
    Hutchins Street Square (Room: Kirst Hall), 125 S. Hutchins St., Lodi
    Call for an appointment: (209) 369-6921

    Stockton
    Oct. 17, Friday, 1 p.m. – 5 p.m.
    Franco Center, 144 Mun Kwok Lane, Stockton
    Call for an appointment: (209) 466-4697

    Oct. 18, Saturday, 10 a.m. – 6 p.m.
    University of the Pacific, 751 Brookside Road, Stockton
    Call for an appointment: (209) 946-7658

    Oct. 25, Saturday, 10 a.m. – 6 p.m.
    Harvest House, 1609 N. Wilson Way, Stockton
    Call for an appointment: (209) 477-0378

    Nov. 2, Sunday, 10 a.m. – 6 p.m.
    O’Connor Woods, 3400 Wagner Heights Rd., Stockton
    Call for an appointment: (209) 956-3400

    Nov. 14, Friday, 1 p.m. – 6 p.m.
    First Congregational Church, 3409 Brookside Rd., Stockton
    Call for an appointment: (209) 951-8545

    Nov. 20, Thursday, 1 p.m. – 6 p.m.
    Northeast Community Center, 2885 E. Harding Way, Stockton
    Call for an appointment: (209) 468-3918

    Tracy
    Oct. 28, Tuesday, 1 p.m. – 6 p.m.
    Tracy Community Center, 950 East Street, Tracy
    Call for an appointment: (209) 831-4230

    For general information about the program, visit go.pacific.edu/medicare or contact them at (209) 932-2958. See the pdf of the 2014 outreach schedule for a printable copy.

    This article is edited from a Sept 29, 2014 University of the Pacific press release.

  • 23Sep

    Did you know that although the U.S. comprises 5% of the world’s population, it holds 50% of pharmaceutical company profits? On a per capita basis, Americans spend about $1,000 per person each year on drugs. That’s approximately 40% more than the next highest spending country, which is Canada.

    There are a number of reasons why this spending imbalance is occurring and some of these are discussed in the PBS articles linked to below. Americans use more drugs and have more access to the newest drugs on the market. They also pay more for them. U.S. prices for brand-name drugs are 50% to 60% higher than in France and twice as high as what citizens of the United Kingdom or Australia pay. That’s because in many countries, government agencies essentially regulate the prices of medicines and limit the amount they will reimburse. There is also a technique called “pay for delay,” in which brand-name manufacturers pay generic manufacturers settlements to keep their competition from producing identical drugs. Another option drug manufacturers use is called “evergreening.” This strategy is to redirect the customer from the drug they are taking to another brand drug the same company is making in an effort to keep them from purchasing the generic alternative

    See the PBS Newshour articles below for more information on why Americans spend so much more on pharmaceuticals than citizens in other democratic countries.

  • 20Aug

    This short infograph demonstrates both visually and statistically some disturbing facts of Americans being overmedicated, so much so that every 19 minutes someone dies of a medication overdoes. While many commonly taken medications are taken as a way to “enhance” people’s lives by allowing people to sleep better, stay awake longer, get more work done, are people’s lives improving? Or in some cases, are these medications masking symptoms and in turn causing more problems? This info graphic shares some revealing data regarding these questions.

    Medicated to Death

    Source: TopRNtoBSN.com

  • 17Jun

    Below is a humorous but sadly too true commentary on the outrageous prices of drugs and how the pharmaceutical industry does everything in its power to avoid discussing prices….and to distract our attention by…looking at squirrels!

    Wow, this drug is really expens — Look! A squirrel!!

    For years, the pharmaceutical industry has had a pretty simple strategy for discussing the prices it charges for its drugs: don’t.

    Indeed, whenever the high price of pharmaceuticals is in the news, drugmakers try desperately to change the subject and distract from the issue. Now more than ever, that strategy is on full display as the industry is under increasing fire for the prices of specialty pharmaceuticals – some priced at more than $100,000 for a single course of treatment. Shifting blame may have been effective in the past, but when public health and access to life-saving drugs is being threatened by these increasingly outrageous prices, it just won’t do the trick anymore. As the drugmakers ramp up yet another campaign of distraction, here are some simple facts to consider:

    FACT: Astronomical prices for specialty drugs will blow up Medicare Part D budgets and force higher premiums for seniors

    An analysis in Health Affairs last week found that the price of the important hepatitis C drug Sovaldi could increase the cost of Medicare Part D and premiums for seniors by 8%. From this one drug alone, seniors on Part D could see an 8% premium hike.

    FACT: Astronomical prices for specialty drugs will devastate state Medicaid budgets and displace important priorities like education and infrastructure

    One recent analysis highlighted on Vox illustrated that, because Sovaldi is so expensive, California could potentially spend more administering the drug for people on Medicaid than it does for K-12 and secondary education combined. Yes, you read that correctly.

    FACT: Astronomical prices for specialty drugs put upward pressure on premiums for all consumers

    At its core, the cost of health insurance is a reflection of the cost of health care. The skyrocketing prices that drugmakers are charging has a ripple effect throughout the system, raising premiums and increasing health care costs for individuals, families, and employers.

    FACT: Health plans offer consumers a range of coverage options, including policies with lower cost-sharing

    To distract from their unjustifiable pricing, drugmakers have latched onto distorted coverage comparisons that ignore the range of cost-sharing options consumers can choose from. Hey, anything beats talking about the actual price.

    FACT: Consumers have out-of-pocket limits that mean health plans and state and federal governments rather than patients are paying the vast majority of the cost of these stratospherically priced drugs

    Pharmaceutical companies know that consumers’ out-of-pocket costs are capped under the Affordable Care Act, allowing them to ask for what amounts to a blank check from insurers and government programs. Not surprisingly, drugmakers are making the law work for them.

    BONUS FACT: Drugmakers have no straight-face explanation to justify the increasingly astronomical prices they have been charging for their medications

    That’s why they want to talk about anything – ANYTHING – other than the prices they are charging.

    The most important fact is that we all want patients to have access to the best treatments. That’s why we cannot afford to allow pharmaceutical companies to have us simply look the other way any longer when it comes to pricing. These unsustainable drug prices threaten our health care system – public and private – access for patients, as well as the very innovation that pharmaceutical companies relish. We cannot have sustainable innovation without sustainable prices to support it, and that’s why health plans and a diverse set of stakeholders have called on drugmakers to come to the table to find a private sector solution to this challenge before the government feels like it needs to.

  • 29May

    “Part D already costs about $80 billion a year and is on track to double by 2022 as benefits improve and Baby Boomers retire. For two reasons, a significant chunk of that money is wasted on overpayments to drug companies: When Part D began, millions of patients were shifted over from Medicaid, the state-federal program for low-income people that gets far lower drug prices than Medicare. Suddenly, the cost of providing drugs to the same people shot up. Congress barred Medicare from negotiating the way Medicaid and the Department of Veterans Affairs do with drug makers to get lower prices. Instead, lawmakers insisted the job be done by private insurance companies.”

    This is a quote from a USA Today editorial and it highlights the absurdity of prohibiting Medicare from negotiating prescription prices with drug makers, especially in a time  when government calls for cuts in Medicare and ways to reduce Medicare spending. Both Medicaid and the Department of Veteran Affairs negotiate for lower prices, but Medicare Part D, from it’s inception in 2006, is barred from doing this.

    This is a very different scenario than in other countries, like Canada and Europe, where all government health plans bargain with the drug companies to protect their citizens. “Per capita drug spending in the U.S. is about 40% higher than in Canada, 75% greater than in Japan and nearly triple the amount spent in Denmark,” according to an article in Health Care for America Now.

    And, it’s no accident that the law prohibits Medicare to negotiate lower drug prices. A recent article by the National Committee to Preserve Social Security & Medicare points out that “the drug lobby worked hard to ensure Medicare wouldn’t be allowed to cut into the profits which would flow to big Pharma thanks to millions of new customers delivered to them by Part D.”

    For years these big Pharma companies have used the argument that negotiating lower drug prices would actually hurt seniors in the long run because it would take away the necessary funds for innovative research and development to “save lives.” Yet, this just isn’t true. “Half of the scientifically innovative drugs approved in the U.S. from 1998 to 2007 resulted from research at universities and biotech firms, not big drug companies, research shows,” according to an article in Health Care for America NOW. The article also notes that “despite their rhetoric, drug companies spend 19 times more on marketing than on research and development.” In fact, 5 pharmaceutical companies have reported million-dollar increases in their spending on lobbying the federal government during the 1st quarter of 2014 alone.

    Join us and many other advocacy groups in helping Americans and our government save money by urging Congress to allow Medicare the same drug negotiate powers as Medicaid and Veterans Affairs.

    For more information see, Negotiating for Lower Drug Costs in Medicare Part D.

  • 13Mar

    Here’s a short video from the Kaiser Family Foundation on the Centers for Medicare and Medicaid Services’ proposed changes to the Part D prescription drug benefit. Currently CMS requires Part D plans to cover the vast majority of drugs in 6 specific classes. One proposed change is to drop 2 of these categories next year (anti-depressants and immunosuppressant drugs) and then drop anti-pyschotics a year later. Several advocacy groups are concerned that this change would reduce people’s access and ability to get the drugs they require. They point out that not all drugs are the same and it’s important to have a wide range of drugs available. Another proposal is to limit the number of plans each plan sponsor can offer. Research shows that more choices aren’t necessarily better for seniors; it can actually be more overwhelming. Many beneficiaries tend to stick with a plan they originally pick.

    Watch the short video below for more information on these changes…

  • 04Mar

    Below is an infographic with some disturbing facts about the cost and numbers of prescriptions Americans are taking. This article, Pill Nation: Are Americans Over Medicated? is provided by The Nursing Bible blog.


    Pill Nation

  • 30Jul

    A day before Medicare’s 48th birthday, the Department of Health and Human Services (HHS) released new information confirming a strong Medicare program. Over 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act (ACA). These savings average $1,061 per beneficiary in drug costs while a beneficiary is in the “donut hole” coverage gap that the law closes over time.

    In addition, 16.5 million people with traditional Medicare took advantage of at least one free preventive service in the first six months of 2013.

    This news also comes at a time of historically low levels of growth in Medicare spending. From 2010 to 2012, Medicare spending per beneficiary grew at 1.7% annually, more slowly than the average rate of growth in the Consumer Price Index, and substantially more slowly than the per capita rate of growth in the economy. All of this good news is a direct result of the the health care reform law.

    Savings on Prescription Drugs

    Because of the Affordable Care Act, beneficiaries’ out-of-pocket savings on medications continue to grow. As mentioned, over 6.6 million beneficiaries have saved over $7 billion on prescription drugs in the Medicare Part D donut hole since the law was enacted, for an average of $1,061.

    People with Medicare in the donut hole now receive discounts and some coverage when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase. The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011. The law will provide additional savings each year until the coverage gap is closed in 2020.

    For more information on how the Affordable Care Act closes the donut hole, see our article: What’s New for Part D in 2013? Lowered Costs, New Covered Drugs, Appeal Changes.

    Preventive Services

    By making certain preventive services available with no cost-sharing obligations, the ACA also helps Americans take charge of their own health.  People can now better afford to work with health care professionals to prevent disease, detect problems early when treatment works best, and monitor health conditions.

    In Medicare, the ACA eliminated coinsurance and the Part B deductible for recommended preventive services, including many cancer screenings and other important benefits. For example, before the law’s passage, a person with Medicare could pay as much as $160 in cost-sharing for some colorectal cancer screenings. Today, that screening is free.

    In the first 6 months of 2013, 16.5 million people with traditional Medicare took advantage of at least 1 free preventive service. For more information on the additional coverage for preventive services, see our article: Heath Care Reform Brings Changes to Medicare.

    For more information on the health care reform law, visit: healthcare.gov.

    This article was edited from a press release from the Department of Health and Human Services.

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