Arthritis Foundation--DC

December 7, 2009 VIA EMAIL Charlene Frizzera, Acting Administrator Centers for Medicare & Medicaid Services Attention CMS-4085-P Mail Stop C4-26-05 7500 Security Blvd. Baltimore, MD 21244-1850 RE: Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs Proposed Rule: Maximum Allowable Costs (CMS-4085-P) Dear Ms. Frizzera: The Arthritis Foundation welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) October 22, 2009 proposed rule entitled “Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs.” The Arthritis Foundation is the only national not-for-profit organization that supports the more than 100 types of arthritis and related conditions. Founded in 1948, the Arthritis Foundation has multiple service points located throughout the country. The Arthritis Foundation is the largest private, not-for-profit contributor to arthritis research in the world, funding more than $400 million in research grants since 1948. The foundation helps people take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis. Currently, 46 million people or 1 in 5 adults has arthritis. By the year 2030, an estimated 67 million or 25% of the projected total adult population will have arthritis. Cost Sharing: The Arthritis Foundation, representing millions of Medicare beneficiaries with arthritis, would like to express our support for CMS’s proposal to establish maximum allowable cost-sharing amounts for Part D prescription drug plans. We applaud CMS proposal to establish a cost sharing threshold per tier and identify plans with cost sharing practices that are discriminatory. We feel that the over use of specialty tiers is a discriminatory practice that targets individuals who have medical conditions, such as rheumatoid arthritis, that necessitate use of expensive medications. The steep co-payments associated with such tier placement presents a significant barrier to patient compliance with needed medication regimens. For people with rheumatoid arthritis, foregoing these medications result in compromised health status, additional medical costs and likely disability. The Foundation urges you to clarify section 423.104 to ensue that ALL tiers, including specialty tiers, may not exceed the levels determined by CMS to be discriminatory. Biologics for rheumatoid arthritis have transformed patient’s lives and have prevented disability for millions of Americans. However, these drugs are placed into Specialty Tiers and are therefore out of reach for many beneficiaries who can not afford the hundreds of dollars needed each month to treat their rheumatoid arthritis. These beneficiaries with rheumatoid arthritis are faced with co-payments for prescriptions that are ten to twenty times as high as the fixed co-payments that Part D plans typically require for other medications. Insurers are increasingly abandoning the traditional co-pay and increasing the number of patients forced to pay a percentage of the ever-increasing cost of prescription medications. It is important to note that there are no generic options for biologics at this time. The Arthritis Foundation requests that CMS study the overall impact, non-adherence and financial burdens place on beneficiaries whose access to vital, life-saving drugs has been limited due to this discriminatory practice. Furthermore, drugs that are classified in a particular tier during open-enrollment and in the plan-finder when beneficiaries are choosing a plan can be suddenly re-classified to another tier, mid-year by health plans. The Arthritis Foundation strongly encourages CMS to require more transparency by plans so that they provide full disclosure in their policies regarding the high co-pays borne by consumers for Tier 4 and higher. Patients are often not told about mid-policy classification changes and are unaware of the increased co-pays required until confronted at the pharmacy. CMS must require greater transparency as well as simplified and accurate comparison tools. In summary the Arthritis Foundation recommends that CMS: • Eliminate or reduce the number of Specialty tiers • Establish maximum allowable Part D cost-sharing amounts in the final rule. • Study the effects of high out of pocket costs on the chronically ill and/or disabled beneficiary as it relates to adherence, discrimination and financial hardships. • Improve and increase disclosure of the drug pricing system. • Prohibit plans from changing the price of drugs and/or formulary mid-year. If plans are not prohibited from this “bait and switch” practice, then at the very least, beneficiaries must be allowed to dis-enroll throughout the year, when this occurs. • Immediate notification to beneficiaries when a medication they are taking is going to substantially increase in price. • Ensure that plans inform beneficiaries of applicable ways to get medications for free or at lower prices (i.e. local, state or pharmaceutical company programs) • End the discriminatory practice of cost sharing and place a reasonable cap on the amount a Medicare drug plan can charge seniors, one that is similar to the federal employees benefit. We appreciate your consideration of our comments. Please feel free to contact me (amelnick@arthritis.org or 202-887-2910) if you have any questions or if you need additional information. Sincerely, Amy Melnick, MPA Chief Public Policy Officer Arthritis Foundation