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Replies to post #514152 on Tornado Alley (PROG)
02/18/25 8:44 PM
Now, we know that there’s huge waste in Medicare, in the form of overpayments to Medicare Advantage plans .. https://paulkrugman.substack.com/p/medicare-versus-the-insurance-industry . Through Medicare Advantage insurance companies have been gaming the system; the Medicare Payments Advisory Commission estimates the annual loss to taxpayers at more than $80 billion, that is, roughly twice USAID’s budget. Oddly, however, this clear example of gigantic fraud isn’t on Musk’s radar.
Urogynecologists treat a variety of conditions that range from pelvic organ prolapse to pelvic floor and voiding dysfunction to treatment of recurrent urinary tract infections. Many of these conditions are chronic in nature and require treatment with medication. An often overlooked part of urogynecologic care is an attention to cost, both to the payer and to the health care system. Our study sought to investigate the potential savings by purchasing prescription drugs using pricing from Cost Plus Drugs instead of Medicare. Our study found that use of this program specifically conferred instrumental savings for drugs used to treat urogynecologic conditions, and specifically for vaginal estrogen, which is widely used (although some may argue is not used enough) and has an inherently high cost.
Prescription drug costs contribute significantly to health care expenditure in the United States. Cost Plus Drugs is a novel program that has tremendous implications on costs savings for prescription drugs. Our study demonstrated purchasing drugs used to treat urogynecologic conditions through this program conferred significant savings over purchasing through Medicare. This is especially important as many of these drugs are used to treat chronic urogynecologic conditions.
The U.S. health care costs rank among the highest in the world with a reported $4.5 trillion spent in 2022, accounting for 17.3% of the Gross Domestic Product. For context, this amounts to $13,493 per person annually. Medicare spending was reported to be $944.3 billion, representing 21% of total national health expenditures. A significant portion of Medicare spending is due to the cost of prescription drugs, which represented $405.9 billion in 2022. Additionally, this rate is increasing every year, with an 8.4% increase from the previous year (2021), up from a 6.8% increase the year prior (2020).1
Prescription drugs often have a “mark-up” in their cost that results from several factors, including monopolistic pricing for patent-protected drugs from large pharmaceutical companies and lack of Medicare negotiating power.
We reviewed all generic drugs provided by MCCPDC that were commonly used for the treatment of urogynecologic conditions as determined by author assessment (N = 16). For each of the 16 drugs we identified the MCCPDC prices as listed on the MCCPDC website, for the minimum 30- and maximum 90-count quantities. We then also calculated the 2021 Medicare spending for the 16 drugs as listed on the Medicare Part D database.3 The potential savings were calculated as the difference between MCCPDC and Medicare 30- and 90-count prices, multiplied by the volume-adjusted number of units dispensed to Medicare beneficiaries in 2021.
RESULTS
The total 2021 Medicare cost incurred for these 16 drugs was $860,758,140.00. The total cost of those drugs through MCCPDC calculated using the total 2021 Medicare volume was $398,382,648.47 and $241,924,289.66 for 30- and 90-count pricing, respectively. The total estimated savings was therefore $462,375,491.53 and $618,833,850.34 for 30- and 90-count pricing, respectively (Fig. 1). For each of the 16 drugs investigated, there were reduced costs when using the 90-count pricing of MCCPDC (Table 1).
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