Medicare changes?

[Charlie B53]

Dialysis Clinic yesterday, my Nurse spent a lot of time explaining how effective Jan 1, 2016 all my Dialysis and Renal medication MUST be supplied by the Dialysis Clinic.  No longer will the Government/Medicare allow any other agency to supply those meds.

In my case that simply means those renal meds that I currently get through the Veterans Hospital (with a co-pay) and/or through Medicare Part D Humana Pharmacy-by-Mail (with NO co-pay)  ALL must be supplied by the Renal/Dialysis Clinic, ( with NO co-pay). 2 types Water pills, Renal Vitamins, Potassium supplements, Phosphorus Blockers, Iron Supplements

As long as I get what I need in a timely manner it shouldn't make much difference, it simply changes who I notify when a med supply starts getting low.

This will actually SAVE ME MONEY, not a lot, but dropping one or two co-pays IS saving some.

All on Medicare will have to check with their local Clinic to be sure how this will, or if it will, change how your meds are supplied.

Take Care,

Charlie B

[Michael Murphy]

A A while ago I heard rumors that the Medicare was going to require bundling of all Dialysis related Meds is it a possibly that's what this is

[nursey66]

Wow !  That would have saved us a ton of $$$.  My husbands binders were almost 600 dollars a month until his Neph found one that worked for only 200 dollars a month !   He got a transplant 2 months ago, so won't need any of those meds, thankfully .  His anti rejection meds are covered by Medicare, we were told they would be about 3-4 hundred a month for our 20% copay, but so far it's been around 95 dollars and he is taking higher doses yet, for the 1st 3 months. .

[Charlie B53]

I don't know if there will be any co-pays for those meds that will be supplied through the Dialysis Clinic.  You will have to check to find out how this will apply to you.

As a Disabled Vet I am very fortunate that the Veterans Administration also contributes to my care, and costs, for Dialysis.  The only co-pays I have are for those meds I receive through the VA.  And that is far less than what they would be if I were only on Medicare.

As explained to me by PD Nurse Lou, Medicare is paying for Dialysis, all Dialysis related meds should be included.  Government Agencies want total control, or maybe it is no OTHER agency wants to share the burden of the med expense, and are not allowing even private insurance to bear the costs of medications.

Don't know yet if this is a good thing or not.  If there IS a co-pay through the Dialysis clinic who knows how much or how that will compare to what these co-pays are using other private insurance.

Medicare is not even allowing Part D to cover these Dialysis related meds.  I don't understand their logic here.  'I' pay the Part D premium, not Medicare.  Medicare is simplly lumping meds into Dialysis, that since they are a necessary part of our treatment they MUST be provided by the same provider.

At least that's how I understood what Nurse Lou told me.  I am sure we will learn more within the next month.

Hopefully this will be of some savings for all.

[Cowdog]

Info below backs up what I was told at the clinic, binders (a oral only med) moved out of the bundle until 2025. 

Exert from CMS press release on Oct 30,2015 concerning 2016 bundle.
The bundled payment under the ESRD PPS includes all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biologicals (with the exception of oral-only ESRD drugs until 2025) and other renal dialysis items and services that were formerly separately payable under the previous payment methodologies.

Link to press release: http://www.nephrologynews.com/cms-releases-final-rule-2016-esrd-payment-bundle/

[kickingandscreaming]

Too bad. That's what I was afraid of and my Medicare plan charges quite high copays for phosp. binders.

[Charlie B53]

  Qwap!  Now you got me stirred up.

....................(with the exception of oral-only ESRD drugs until 2025...................) and other renal dialysis items and services that were formerly separately payable under the previous payment methodologies.

Link to press release: http://www.nephrologynews.com/cms-releases-final-rule-2016-esrd-payment-bundle/

I don't think DCI understood this.  This may not change a thing in where meds come from or who pays for them.

I'm also slightly irritated that this was open for comment   " published in the Federal Register on July 1, with a comment period that ended on Aug. 25"

As if everyone reads the Federal Register or is notified in any way that anything related to Dialysis funding is subject to review and amendment.

We NEED TO KNOW, and to make our voices heard.   Mere phone calls are next to worthless.  Taking the time to write a short simple letter to or Senator and Congressperson to make them aware of the increasing costs of dialysis and the required expensive medications, costs so high that many jeopardize their lives by not taking those medications in order to keep a roof over their head and the lights on.

Not addressing these costs until 2025 is only continuing to line the pockets of the drug company, AND cost lives of dialysis patients unable to continue taking their meds.

[Simon Dog]

Not addressing these costs until 2025 is only continuing to line the pockets of the drug company, AND cost lives of dialysis patients unable to continue taking their meds.

The drug companies are going to get paid either way - buy patients or medicare.  And remember, unlike dialysis treatments, Medicare is not allowed to negotiate drug prices.

It's a question of taxation and transfer payments.  To what extent will armed force (which in the end, is what tax collection is) be used against the urinators on behalf of ESRD patients to transfer money from those without ESRD to those with.    We should all be grateful the overwhelming force of the state is used on our behalf to take money from those of without ESRD to help those of us with.   Try to temper your desire for more freebies with gratitude for what is taken from your neighbor by force.

[Charlie B53]

I simply love the way you can distinguish 'us' from those 'urinators'.  Isn't the English used the term 'Pissers'?  But I think that was even in use before Dialysis.


I never thought of it as taking any money from the tax pool.  More along the lines of Corporate Greed.  They control the cost of medications, not just renal meds, ALL meds.  And gasoline, etc..

Granted they deserve a 'reasonable' profit.  But when it gets to the point of absolutely ridiculous prices for an item that really doesn't cost much to product.  It's obscene and that is when Government needs to step in and set some sort of 'reasonable' profit margin.

No doubt, well paid bean counters can, and will, shift the numbers around to make look like is tremendously expensive to manufacture.  But when you start to pick apart their numbers and peel off the fat padding, and get down to the actual expense, it does not justify many of these high cost meds.

[Simon Dog]

Granted they deserve a 'reasonable' profit.  But when it gets to the point of absolutely ridiculous prices for an item that really doesn't cost much to product.  It's obscene and that is when Government needs to step in and set some sort of 'reasonable' profit margin.

The rules are always different when it's your money.  If your house appreciates tremendously, do you sell it at what the market will bear, or at a "reasonable profit" when it's time to move?

When you invest in your retirement plan, do you want the companies in which you own stock to maximize shareholder value or make sure buyers can afford their products? 

Is a company's job to serve the public or maximize shareholder value?

The solutions can be market driven.

1. Remove ALL obstacles to re-importation of US made drugs, and make it illegal to ration sales to foreign countries or put up barriers to reimportation.  The net result is US prices will go down and Canadian and other foreign prices will go up.  I spoke to one pharma employee and his attitude (which seems common in the industry) is that people buying from Canada were "thieves" because the company had decided "US patients should pay more.  Much more".

2. Shorten the patent protection period.

3. Disallow patent extension games.  For example, the Oxycontin makers reformulated it into a crush proof pill (it just makes a gooey mess); patented the new formula; and successfully lobbied the FDA to ban the old form that was going off patent protection.

The reason the price gouging can occur once again comes down to governmental force - using the limitless power of the state to protect those supplying at excessive margins from competition.

I never thought of it as taking any money from the tax pool.

That is exactly what it is - every time you get a Medicare funded treatment.

[Simon Dog]

Isn't the English used the term 'Pissers'?

Yes, but "pisser" can also be used as an adjective, whereas "urinator" is unambiguously a noun.