Medicare Advantage plans have potentially deadly side effects. The U.S. Department of Health and Human Services must act.
Dear Secretary Becerra:
I understand folks in your vast Department of Health and Human Services are planning to tighten up the regulations around prescription drug advertisements. It seems they’ve decided some of the ads don’t do a good enough job explaining the potential side effects of the drugs they want us to talk to our doctors about–or at least that the images and music in some ads can be too distracting.
I’m not going to say that’s not a worthy mission. I doubt a lot of us pay close enough attention to the fast-talking narrator who races through all the things that could go wrong if we actually, you know, take the medicine.
But here’s my question: Why doesn’t the government hold private health insurers to the same standard? Why shouldn’t their ads include all the potential side effects people can and often do encounter when they sign up for a Medicare Advantage plan?
In just a few weeks, we’re once again going to be bombarded with ads featuring healthy and happy-looking seniors playing tennis and telling us how wonderful their Medicare Advantage plan is and how much of a no-brainer it is to shun traditional Medicare and opt instead for a plan operated by a big corporation like Humana and Cigna, where I used to work. We’ll hear insurers’ shills tell us about the extra benefits we’ll get, like discounts on gym memberships and some coverage for dental, vision and hearing. They’re short on details of course, and we never hear that coverage for those extra things can be pretty darn meager.
We also never hear about the potentially deadly side effects of Medicare Advantage plans. So here’s what I want you and your colleagues there in Washington to consider: Make sure insurers’ pitchmen–like Broadway Joe–are more forthcoming about what we’ll be getting ourselves into if we do as he suggests. Why should he be allowed to leave out important details we damn well better know about before we sign on the dotted line?
How about something like this:
Medicare Advantage plans are not the same as traditional Medicare. They are owned and operated by private insurance corporations. Unlike traditional Medicare, Medicare Advantage plans often refuse to pay for treatments and medications your doctors say you need. And unlike traditional Medicare, many doctors and hospitals will be off-limits to you because Medicare Advantage companies create their own proprietary and often skimpy “networks” of health care providers. If you go out of network, you could be on the hook for thousands of dollars out of your own pocket. And you’ll likely have to pay extra–often a lot extra–for some of those extra benefits.
I could go on because the list would go on.
And here’s another thought: Maybe the government should require warning labels like the ones it makes tobacco companies put on their cigarette packs. Maybe you should make insurers put something like this on all those mailers that’ll be pouring into seniors’ mailboxes in the next few weeks:
WARNING: THE SURGEON GENERAL HAS DETERMINED THAT MEDICARE ADVANTAGE PLANS CAN BE HAZARDOUS TO YOUR HEALTH AND BANK ACCOUNT.
Make them put it in a black box at the very top.
I’m serious. If you are planning to implement tighter guidelines on pharmaceutical company ads, (which sounds like a good idea) how can you not require private insurers to adhere to similar rules, especially when you consider the billions of taxpayers’ dollars flowing to big insurers that spend part of the money you send them on ads that obscure important details?
I look forward to hearing from you.
Wendell Potter, former Medicare Advantage pitchman
P.S.: Speaking of Medicare Advantage, New York City retirees scored yet another court victory last week in their ongoing efforts to block Mayor Eric Adams from moving all of them out of traditional Medicare and into an Aetna Medicare Advantage plan. They’re fighting the move because they know that an untold number of people enrolled in MA plans don’t get the care their doctors say they need and that MA provider networks are often way too limited. They know that under Medicare Advantage, people often have to pay a king’s ransom to get the care their doctors say they need–and from doctors who might be in-network this week but out-of-network next week.
The fight in New York isn’t over but the retirees keep racking up victories in the courts. I’m proud to stand with them.
Direct to consumer market for medicines in the U.S. is a $10b a year industry. On top of the billions in stock buy backs each year, on top of $20m salaries+ bonuses for pharma CEOs. The whole health care system needs to be burned to the ground and recreated to benefit the public.
I am a pharmacist in a community pharmacy. My boss had me review a remittance of claims from CVS Caremark Medicare advantage plans last week. There were $12,000 in claims paid. CVS Caremark charged $20,000 in pnr fees. What are pnr fees you ask? Proactive Not Reactive fees. CVS Caremark wants to impose adherence policy on patients comsuming blood pressure meds, Statins for cholesterol and diabetes meds.
They have workers working remotely monitoring whether people are getting refills on time.
They used to charge pharmacies fees if we billed too early before 30 days.
Now they charge pnr Prosctive Not Reactive Fees if we don't refill and call the customer by 31 or 32 days; even if the medication is not needed any more.
CVS Caremark also announced they want to charge our pharmacy an additional $71,000 over the next trimesters this year; in other words they plan to keep our money for every prescription.
All to make sure pts adhere to therapy even if adherence is detrimental for them; like if they advance to needing pain meds or psych meds or diabetes meds or chemo as a result of taking statins.