Response to my 3/29 Email (previous blog post) to Congressman Tim Murphy re: Dear Colleague Letters

Thank you for reaching out to me with your thoughts on healthcare reforms and insurance costs. I’ve long been advocating for reforms to the healthcare system and I appreciate the opportunity to share my efforts to reduce your healthcare costs and improve medical care delivery.

As you know, Americans across the county have seen their healthcare premiums, taxes and medical fees skyrocket. That includes deductibles which are so costly it nearly invalidates your insurance coverage. Far too many families have told me their insurance coverage doesn’t actually cover doctor’s care because they never reach the exorbitant out-of-pocket deductible threshold. A main reason for this is because Washington has not been focusing on meeting medical needs, but only on insurance mandates. These mandates are driving up the price of each and every insurance plan and have made insurance coverage and medical care far more expensive than need be. The bottom line is this: the laws need to be fixed because the system is completely unsustainable. Insurance rates keep climbing and now medical care is even further out of reach for the middle class. We can do better.

Make no mistake, the American healthcare system was broken and expensive before the Affordable Care Act was ever signed into law. That’s why our new healthcare framework must put Americans back in charge of their health care under a system that delivers affordable care when needed, by a doctor of your choosing at a price you can afford. No one will be left out and no one will be forced to have an expensive plan that doesn’t meet their needs. 

Our goal must be to make sure everyone has access to affordable coverage and not force a one-size-fits-all expensive plan designed from Washington mandates. Instead, we’ll promote quality measures, stop the Washington dictates and eliminate the $600 to $800 billion wasted annually that make healthcare more expensive, but leaves patients no better off. I support reforms that emphasize universal access to coverage, opens up an insurance market that serves the people (not the insurance companies), rewards individuals for staying healthy, moves those who are sick into care as quickly as possible and treats the chronically ill in plans that make sense for their medical needs.  

I am confident we can fix the system in a way that brings down costs and will never go back to the days that insurance companies prevent an individual from getting coverage for a pre-existing condition. 

Thank you for sharing your ideas, thoughts and concerns. Based on feedback from constituents like you, and from healthcare professionals from across Southwestern Pennsylvania, I wrote on opinion piece recently published in the Washington Examiner titled “A Better Model for Healthcare in America” that you can read by clicking here. 

As always, I invite you to share your comments and please stay in touch moving forward. It is an honor to represent you and Pennsylvania’s Eighteenth District in Congress. To stay in touch with what I’m working on and latest news from Congress, you can follow me on Twitter @RepTimMurphy or you can find me on Facebook at www.facebook.com/RepTimMurphy. I also encourage you to sign up for my e-newsletter by visiting www.murphy.house.gov.

Sincerely,

Tim Murphy
Member of Congress

FY 2018 U.S. Budget, MS Research Needs

Email to Congressman Tim Murphy, PA-18;

Funding MS research through the Congressionally Directed Medical Research Program (CDMRP), National Institutes of Health (NIH), and the Centers for Disease Control and Prevention(CDC) is important to me, as your constituent and an MS activist. I urge you to join your fellow Members of Congress in supporting increased federal funding for MS research by adding your signature to the following letters by Friday, March 31st. 

The peer-reviewed MS Research Program funds innovative, high-risk, high-reward research within the Department of Defense that is complimentary to that funded at the National Institutes of Health. Increased funding is necessary, as less than 15% of research applications to the program are able to be funded annually. To sign the Dear Colleague letter supporting $10 million for the MSRP in FY 2018, email Dante.Cutrona@mail.house.gov (Rep. Costello) or Jacqueline.Usyk@mail.house.gov (Rep. Cárdenas).

The NIH has provided the basic science research that has led to many of the advancements in MS detection and treatments. The President's FY2018 Budget Blueprint has proposed cuts to the NIH by $5.8 billion, nearly 20% below current funding levels. Research needs continued and sustained investment, not budget cuts, in order for researchers to pursue the next generation of treatments and cures for diseases like MS. Representatives David McKinley, Andre Carson, Peter King, and Susan Davis are circulating a Dear Colleague letter requesting a $2 billion increase for NIH above FY 2017's funding level. To sign this Dear Colleague, please email Zach Bunshaft at Zach.Bunshaft@mail.house.gov. 

The passage of the 21st Century Cures legislation in 2016 authorized the creation of the National Neurological Conditions Surveillance System at the CDC to track and collect data on the epidemiology of neurological conditions, including MS. There has not been an MS incidence or prevalence study since 1975 and this information will serve as a foundation for researchers to better understand geographic clusters of MS, potential environmental triggers, ethnic or racial differences, outcome measures of current treatments and healthcare practices. Congress must fund to ensure implementation. To sign the Dear Colleague letter supporting $5 million for this System in FY 2018, email Dante.Cutrona@mail.house.gov (Rep. Costello) or Sylvia.Lee@mail.house.gov (Rep. Larson). 

Increased federal investment in MS research is critical to reaching our vision of a world free of MS. Please sign-on to the above Dear Colleague letters by Friday, March 31st.

Sincerely,

Frank Austin

Stop Shouting!

A friend from my California days passed this quote along via facebook.

“In these difficult years,  America has suffered from a fever of words…

We can not learn from one another until we stop shouting at one another!”

                                                                                Richard Nixon

Thank you

 #Diana Paffrath Hardy

FY18 Appropriations Member Request

I am a constituent of Pennsylvania’s 18th Congressional District. I am an 8 ½ year U.S.Navy Veteran with deployments in the North Atlantic, the Mediterranean and the Western Pacific during the Vietnam conflict. Nineteen years ago I was diagnosed with secondary-progressive multiple sclerosis (MS) after15 years of unrecognized and untreated symptoms. I am an active member of the National Multiple Sclerosis Society, a member of the MS Society’s Pennsylvania Chapters’ Government Relations Advisory Committee and a District Activist Leader for the 18th Congressional District. In 2014 I represented the National Multiple Sclerosis Society at a Congressional Roundtable event hosted in Mt. Lebanon, PA. In 2016 I had the honor of serving as a, “Consumer Reviewer” for D.O.D.’s Congressionally Directed Medical Research Program (CDMRP) Multiple Sclerosis Research Program (MSRP).

To capitalize on the momentum the 21st Century Cures Act produced, on behalf of the National Multiple Sclerosis Society, I am asking that Congressman Murphy sponsor a $10 million Programmatic Appropriation in the FY 18 Federal Budget for the Multiple Sclerosis Research Program (MSRP). In previous years the level of funding allowed approximately 14% of the research projects submitted for consideration to be funded. A $10 million appropriation will move multiple sclerosis research forward and offset some of the research funding declines that MS research has endured in recent budget cycles.

I do look forward to the opportunity to discuss this request with Congressman Murphy in greater depth during a visit with the Congressman on March 22.

Sincerely

Frank Austin

Sunlight is THE Best Disinfectant

https://dougcollins.house.gov/press-releases/collins-introduces-legislation-to-increase-drug-pricing-transparency/

COLLINS INTRODUCES LEGISLATION TO INCREASE DRUG PRICING TRANSPARENCY

03/02/17

WASHINGTON—Today Congressman Doug Collins (R-Ga.) introduced H.R. 1316, the Prescription Drug Price Transparency Act, to protect taxpayers and the community pharmacists who serve them by requiring greater transparency from pharmacy benefit managers (PBMs).
PBMs are the middlemen that employers and federal programs use to set formularies, or lists of drugs covered by insurers, for consumers on their health plans. PBMs also use Maximum Allowable Cost (MAC) lists to set reimbursement rates for prescription drugs sold in pharmacies. PBMs have historically refused to explain, either to pharmacies or to the federal programs they represent, their process for setting pharmacy reimbursement prices.
PBMs also claim to deliver cost savings by passing along rebates to federal programs like Medicare Part D, TRICARE, and the Federal Employees Health Benefits Program (FEHBP). However, PBMs’ lack of transparency makes it impossible to determine whether these savings are being passed to federal programs or are increasing the PBMs' bottom line.

“PBMs engage in predatory practices designed to boost their own profit margins at the expense of insurers, contracting pharmacies, patients, and—in their relationships with federal programs—taxpayers. The lack of transparency in their operations has allowed them to control the market unjustly, with the result that these companies withhold savings that they have promised to pass on,” explains Collins.

In their relationships with community pharmacies, PBMs often change the prices on their MAC lists, often to rates that reimburse pharmacies significantly below pharmacies’ acquisition costs for prescription drugs, which forces community pharmacies to sell prescriptions at a loss. Because of PBMs’ failure to regularly update MAC pricing lists, the true cost of prescription drugs is hidden from employers, consumers, pharmacists, and the federal government. As these pharmacies lose money and are driven out of business, patients lose access to the medical services offered by their local pharmacists.

“I’m introducing a bipartisan bill to ensure that PBMs update their MAC lists for Medicare Part D, TRICARE, and FEHBP every seven days to protect competitive pricing and to preserve pharmacy access and choice for patients. The Prescription Drug Price Transparency Act provides essential oversight to prevent waste, fraud, and the abuse of taxpayer funds and better protects patient privacy,” Collins said.

Support for this legislation extends across the aisle, and Congressman Dave Loebsack (D-Iowa) is the bill’s lead Democratic co-sponsor. Other original co-sponsors for H.R. 1316 include Reps. Brian Babin (R-Texas), Rod Blum (R-Iowa), Buddy Carter (R-Ga.), John Duncan, Jr. (R-Tenn.), Cathy McMorris Rodgers (R-Wash.), and John Sarbanes (D-Md.).

“Whether it is in large cities, or small towns, pharmacists across the country serve as the first line of health care services for many patients. I appreciate all of their hard work to serve our communities and to provide quality, affordable and personal care,” said Loebsack.

“However, I also recognize how challenging it can be for some small pharmacists to compete with bigger companies. One pressing challenge facing many community pharmacists is the ambiguity and uncertainty surrounding the reimbursement of generic drugs. To help address this problem, I am proud to join my colleague Rep. Collins to reintroduce the Prescription Drug Price Transparency Act, which also helps ensure federal health plan reimbursements to pharmacies to keep pace with generic drug prices.”

“I have always said that sunlight is the best disinfectant, and that is what this critical legislation will do with prescription drug pricing. For too long, Pharmacy Benefit Managers have been able to hide behind a curtain in the drug pricing chain as families across the country watch the prices of their lifesaving medications soar. As a pharmacist for more than 30 years, I saw firsthand the distress of families attempting to balance their health care needs with their bottom line when the cost of their prescription medications was on the rise and unpredictable. That is why the Prescription Drug Price Transparency Act is so important. The legislation will provide some light to how PBMs determine the pricing reimbursement of prescription drugs, which will provide greater transparency on how drug prices are set so patients can finally get the truth about drug pricing increases,” said Carter, a pharmacist himself.
“I am pleased to join Rep. Collins in introducing this legislation that is critical to protecting our seniors and pharmacists from being ripped off by these PBMs, whose practices are unfair and wasteful. It's time for transparency, so we can hold PBMs accountable for their roles in our drug price crisis,“ Duncan said.

The National Community Pharmacists Association, the Community Oncology Alliance, and the National Association of Specialty Pharmacy have endorsed this legislation.

Attitude

My late mentor in this MS journey believed the following. Ron Bird, you are still having an impact!

“The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, the education, the money, than circumstances, than failure, than successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company... a church... a home. The remarkable thing is we have a choice everyday regarding the attitude we will embrace for that day. We cannot change our past... we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% of how I react to it. And so it is with you... we are in charge of our Attitudes.”

― Charles R. Swindoll

U.S. Senate Passes MS Awareness Week Resolution

http://www.nationalmssociety.org/About-the-Society/News/U-S-Senate-Passes-MS-Awareness-Week-Resolution

U.S. Senate Passes MS Awareness Week Resolution

March 1, 2017

In advance of MS Awareness Week, which is March 5–11, the U.S. Senate today passed a resolution (S. Res. 77) in support of the week and all people affected by multiple sclerosis). Congressional MS Caucus Chair Senator Bob P. Casey of Pennsylvania introduced the resolution and was joined by his bi-partisan colleagues Senators Collins (ME), Markey (MA), Coons (DE), Menendez (NJ), Brown (OH), Isakson (GA), Feinstein (CA), Van Hollen (MD), Capito (WV), Moran (KS) and Thune (SD). U.S. Rep. Barbara Lee (CA-13) will be introducing a similar resolution in the House of Representatives.

The movement is grateful to these congressional champions for their leadership and support of people affected by MS as we collaboratively work to stop MS in its tracks, restore what has been lost and end MS forever.

The resolution states in part:

Supporting the goals and ideals of Multiple Sclerosis Awareness Week.

Whereas multiple sclerosis (referred to in this preamble as “MS”) can impact individuals of all ages, races, and ethnicities but is at least 2 to 3 times more common in women than in men;

Whereas there are approximately 2,300,000 individuals worldwide who have been diagnosed with MS;

Whereas MS is typically diagnosed in individuals between the ages of 20 and 50, but it is estimated that between 8,000 and 10,000 children and adolescents are living with MS in the United States;

Whereas MS is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body;

Whereas symptoms of MS range from numbness and tingling, to vision problems and paralysis, and the progress, severity, and specific symptoms of MS in any one person cannot yet be predicted;

Whereas, while there is no evidence that MS is directly inherited, studies show that there are genetic and, environmental factors that give certain individuals  a higher risk of developing MS;

Whereas the exact cause of MS is still unknown and there is no cure;

Whereas the Multiple Sclerosis Coalition, a national network of independent MS organizations dedicated to the enhancement of the quality of life for all those affected by MS, recognizes and supports Multiple Sclerosis Awareness Week;

Whereas the mission of the Multiple Sclerosis Coalition is to increase opportunities for cooperation and provide greater opportunity to leverage the effective use of resources for the benefit of the MS community;

Whereas the United States plays a critical role in coordinating MS research globally and amplifies the impact of research in the United States through which results are delivered to MS patients;

Whereas, in 2012, the National Multiple Sclerosis Society was a founding member of the International Progressive MS Alliance, which coordinates research to accelerate the development of treatments for progressive MS by removing international scientific and technological barriers and, as of 2017, includes 16 MS organizations societies from 15 countries, 8 Foundation and Trust members and 5 pharmaceutical partners;

Whereas the Multiple Sclerosis Coalition recognizes and supports Multiple Sclerosis Awareness Week during March of every calendar year;

Whereas the goals of Multiple Sclerosis Awareness Week are to invite people to join the movement to end MS, encourage everyone to do something to demonstrate a commitment to moving toward a world free of MS, and acknowledge those who have dedicated time and talent to help promote MS research and programs; and
Whereas, in 2017, Multiple Sclerosis Awareness Week is recognized during the week of March 5 through March 11.

While building awareness is a year-round effort, MS Awareness Week serves as a platform for everyone affected by MS across the country to share strategies and experiences to live their best lives. Together we are stronger.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

Tags: National MS Society, Senate MS Caucus Chair Senator Bob Casey, Senators Collins (ME), Markey (MA), Coons (DE), Menendez (NJ), Brown (OH), Isakson (GA), Feinstein (CA), Van Hollen (MD), Capito (WV), Moran (KS) and Thune (SD).  

Punishing the Sick

How Obamacare Punishes the Sick

 www.wsj.com // Created: 1d // Updated: 5hr

News - Politics Share 

http://www.todayevery.com/share/B1x8UN2N5x?hint=SB11290374184297783384704582555280727962876?responsive=y/articles

The Cato Institute’s Michael F. Cannon writes that patients with costly conditions like MS are seeing coverage cut.

By

Michael F. Cannon

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.

The researchers estimate a patient with multiple sclerosis, for example, might file $61,000 in claims. ObamaCare’s rules let MS patients buy coverage for far less, forcing insurers to take a loss on every MS patient. That creates “an incentive to avoid enrolling people who are in worse health” by making policies “unattractive to people with expensive health conditions,” the Kaiser Family Foundation explains.

To mitigate that perverse incentive, ObamaCare lobs all manner of taxpayer subsidies at insurers. Yet the researchers find insurers still receive just $47,000 in revenue per MS patient—a $14,000 loss per patient.

Predictably, that triggers a race to the bottom. Each year, whichever insurer offers the best MS coverage attracts the most MS patients and racks up the most losses. Insurers that offer high-quality coverage either leave the market, as many have, or slash their coverage. Let’s call those losses what 

they are: penalties for offering high-quality coverage.

The result is lower-quality coverage—for MS, rheumatoid arthritis, infertility and other expensive conditions. The researchers find these patients face higher cost-sharing (even for inexpensive drugs), more prior-authorization requirements, more mandatory substitutions, and often no coverage for the drugs they need, so that consumers “cannot be adequately insured.”

Independent Institute Senior Fellow John Goodman on the Republican Party’s debate over healthcare reform. Photo credit: Reuters.

The study also corroborates reports that these rules are subjecting patients to higher deductibles and cost-sharing across the board, narrow networks that exclude leading cancer centers, inaccurate provider directories, and opaque cost-sharing. A coalition of 150 patient groups complains this government-fostered race to the bottom “completely undermines the goal of the ACA.”

It doesn’t have to be like this. Employer plans offer drug coverage more comprehensive and sustainable than ObamaCare. The pre-2014 individual market made comprehensive coverage even more secure: High-cost patients were less likely to lose coverage than similar enrollees in employer plans. The individual market created innovative products like “pre-existing conditions insurance” that—for one-fifth the cost of health insurance—gave the uninsured the right to enroll in coverage at healthy-person premiums if they developed expensive conditions.

If anything, Republicans should fear not repealing ObamaCare’s pre-existing-conditions rules. The Congressional Budget Office predicts a partial repeal would wipe out the individual market and cause nine million to lose coverage unnecessarily. And contrary to conventional wisdom, the consequences of those rules are wildly unpopular. In a new Cato Institute/YouGov poll, 63% of respondents initially supported ObamaCare’s pre-existing-condition rules. That dropped to 31%—with 60% opposition—when they were told of the impact on quality.

Republicans can’t keep their promise to repeal ObamaCare and improve access for the sick without repealing the ACA’s penalties on high-quality coverage.

Mr. Cannon is director of health policy studies at the Cato Institute.

Tags: The Wall Street Journal, Cato Institute and Michael F. Cannon

Out of Pocket Cost Limits

The following message was sent this day to Senators Bob Casey and Pat Toomey as well as Congressman Tim Murphy:

Protect the Out-of-Pocket Cost Limit

Dear [Decision Maker],

As constituent and multiple sclerosis (MS) activist, I urge you to make sure that Congress continues the cap on out-of-pocket costs included in the Affordable Care Act. This protection helps many people avoid being bankrupted by the cost of their health care. In an online survey on the cost of MS medications conducted by the National MS Society in 2015, more than 16% of people with MS reported using their credit card more often to pay for their medications.

Seventeen years ago the MS Disease Modifying Therapy (DMT) I was injecting had a price of approximately $18,000. Today that same drug's cost is $79,000 (I checked it moments ago). That's a 440% price increase. For the same identical drug!

I've seen the annual deductible rise from $100 to $750/yr.

I've seen the co-pay for the injectable therapy above go from $35/mo. to become a 35%, or $2300/mo. co-insurance.

As Congress decides how to change the ACA, please be sure that the maximum out-of-pocket limit continues. Thank you.

Sincerely,