Are you ready for an inflationary storm? Inflation had already entered the system courtesy of the Fed printing over $3 trillion last year while the U.S. federal government paid out over $2 trillion in stimulus checks. Then Joe Biden won the presidency. Last week President Biden suggested a stimulus program that will be in the “trillions” with a price tag that will be “twice as high.” Democrats are also proposing massive infrastructure spending, healthcare programs, as well as the Green New Deal and other climate change policies. I’m not saying I’m for or against any of this. I’m simply pointing out that all of it involves printing TRILLIONS of dollars. And that is going to unleash inflation. The Fed’s own research shows that food inflation is the best predictor of future inflation. Take a look at what agricultural food prices are doing and you’ll see a decade-long bear market that is ending. Then of course there’s Gold which has already hit new all-time highs: Not to mention emerging markets. The writing is on the wall. All three of those asset classes are inflationary in nature. All three of them are exploding higher. Simply put, inflation is already in the financial system. And as history has shown us, the longer it’s there, the worse it gets. Those investors who are well positioned to profit from it could see literal fortunes. Regards, Graham Summers Editor, Money & Crisis For more postings by Hard Asset Alliance, click HERE Website:  https://www.hardassetsalliance.com/?aff=TWC WealthCare Connect may receive a referral fee from Hard Asset Alliance for purchases make through these links.

By Dorothy Neufeld   The Periodic Table of Commodity Returns (2011-2020) Being a commodity investor can feel like riding a roller coaster. Take silver. Typically known for sharp, idiosyncratic price movements, it faced double-digit declines in the first half of the decade, falling over 35% in just 2013 alone. By contrast, it jumped over 47% in 2020. Similarly, oil, corn, and others witnessed either steep declines or rapid gains. The above graphic from U.S. Global Investors traces 10 years of commodity price performance, highlighting 14 different commodities and their annual ranking over the years. Commodity Price Performance, From Best to Worst Which commodities were the top performers in 2020? The aforementioned silver tripled its returns year-over-year, climbing 47.9% in 2020. In July, the metal actually experienced its strongest month since 1979. Rank Commodity Return (2020) Return (2019) Return (2018) 1 Silver 47.9% 15.2% -8.5% 2 Copper 26.0% 3.4% -17.5% 3 Palladium 25.9% 54.2% 18.6% 4 Gold 25.1% 18.3% -1.6% 5 Corn 24.8% 3.4% 6.9% 6 Zinc 19.7% -9.5% -24.5% 7 Nickel 18.7% 31.6% -16.5% 8 Gas 16.0% -25.5% -0.4% 9 Wheat 14.6% 11.0% 17.9% 10 Platinum 10.9% 21.5% -14.5% 11 Aluminum 10.8% -4.4% -17.4% 12 Lead 3.3% -4.7% -19.2% 13 Coal -1.3% -18.0% -22.2% 14 Oil -20.5% 34.5% -24.8% Along with silver, at least seven other commodities had stronger returns than the S&P 500 in 2020, which closed off the year with 16.3% gains. This included copper (26.0%), palladium (25.9%), gold (25.1%) and corn (24.8%). Interestingly, copper prices moved in an unconventional pattern compared to gold in 2020. Often, investors rush to gold in uncertain economic climates, while sectors such as construction and manufacturing—which both rely heavily on copper—tend to decline. Instead, both copper and gold saw their prices rise in conjunction. Nowadays, copper is also a vital material in electric vehicles (EVs), with recent demand for EVs also influencing the price of copper. Silver Linings As investors flocked to safety, silver’s price reached heights not seen since 2010. The massive scale of monetary and fiscal stimulus led to inflationary fears, also boosting the price of silver. How does this compare to its returns over the last decade? In 2013, silver crashed over 35% as confidence grew in global markets. By contrast, in 2016, the Brexit referendum stirred uncertainty in global markets. Investors allocated money in silver, and prices shifted upwards. As Gold as the Hills Like silver, market uncertainty has historically boosted the price of gold. What else contributed to gold’s rise? U.S. debt continues to climb, pushing down confidence in the U.S. dollar A weaker U.S. dollar makes gold cheaper for other countries to buy Low interest rates kept the returns of other safe haven assets low, making gold more attractive by comparison Here’s how the price of gold has changed in recent years. Gold faced its steepest recent declines in 2013, when the Federal Reserve bank discussed tapering down its quantitative easing program in light of economic recovery. Hitting the Brakes On Oil Oil suffered the worst commodity price performance in 2020, with -20.5% returns. For the first time in history, oil prices went negative as demand plummeted. To limit its oversupply, oil producers shrunk investment, closed wells, and turned off valves. Unfortunately, many companies still faced bankruptcies. By November, 45 oil producers had proceeded with bankruptcy filings year-to-date. This stood in stark contrast to 2019, when prices soared 34.5%. As is custom for oil, prices see-sawed over the decade. In 2016 and 2019, it witnessed gains of over 30%. However, like 2020, in 2014 it saw huge losses due to an oversupply of global petroleum. In 2020, total production cuts hit 7.2 million barrels a day in December, equal to 7% of global demand, in response to COVID-19. Source:  https://www.visualcapitalist.com/the-periodic-table-commodity-price-returns-2021/ For more postings by Virtual Capitalist, click HERE Website:  https://www.visualcapitalist.com/

                                    <h1>Hospital Prices Just Got a Lot More Transparent. What Does This Mean for You?</h1> <div>    <span class="byline">Julie Appleby, Kaiser Health News</span>     <time class="posted-on" datetime="2021-01-05T05:00:00-05:00">         January 5, 2021    </time>     </div> <p>Hospitals face the new year with new requirements to post price information they have long sought to obscure: the actual prices negotiated with insurers and the discounts they offer their cash-paying customers.</p><p>The move is part of a larger push by the Trump administration to use price transparency to curtail prices and create better-informed consumers. Yet there is disagreement on whether it will do so.</p><p>As of Jan. 1, facilities must publicly post on their websites prices for every service, drug and supply they provide. Next year, <a href="https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and">under a separate rule</a>, health insurers must take similar steps. A related effort to <a href="https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CMS-Transparency-in-Coverage-9915F.pdf">force drugmakers to list their prices</a> in advertisements was struck down by the courts.</p><p>With the new hospital rule, consumers should be able to see the tremendous variation in prices for the exact same care among hospitals and get an estimate of what they will be charged for care — before they seek it.</p><p>The new data requirements go well beyond the previous rule of requiring hospitals to post their “<a href="https://healthcaremba.gwu.edu/blog/chargemaster-hospital-administrators-need-know/">chargemasters</a>,&rdquo; hospital-generated list prices that bear little relation to what it costs a hospital to provide care and that few consumers or insurers actually pay.</p><p>Instead, under the new rule put forward by the Trump administration, “these are the real prices in health care,” said Cynthia Fisher, founder and chairman of Patient Rights Advocate, a group that promotes price transparency.</p><p>Here’s what consumers should know:</p><p><strong>What’s the Scope of the Intel?</strong></p><p>Each hospital must post publicly online — and in a machine-readable format easy to process by computers — several prices for every item and service they provide: gross charges; the actual, and most likely far lower, prices they’ve negotiated with insurers, including de-identified minimum and maximum negotiated charges; and the cash price they offer patients who are uninsured or not using their insurance.</p><p>In addition, each hospital must make available, in a “consumer-friendly format,” the specific costs for 300 common and “shoppable” services, such as having a baby, getting a joint replacement, having a hernia repair or undergoing a diagnostic brain scan.</p><p>Those 300 bundles of procedures and services must total all costs involved — from the hardware used to the operating room time, to drugs given and the fees of hospital-employed physicians — so patients won’t have to attempt the nearly impossible job of figuring it out themselves.</p><p>Hospitals can mostly select which services fall into this category, although the <a href="https://www.beckershospitalreview.com/finance/the-70-cms-mandated-services-hospitals-must-post-online-next-year.html#:~:text=Hospitals%20are%20required%20to%20publicize,230%20services%20they%20post%20online">federal government has dictated 70</a> that must be listed — including certain surgeries, diagnostic tests, imaging scans, new patient visits and psychotherapy sessions.</p><p><strong>Will Prices Be Exact?</strong></p><p>No. At best, these are ballpark figures.</p><p>Other factors influence consumers’ costs, like the type of insurance plan a patient has, the size and remaining amount of the annual deductible, and the complexity of the medical problem.</p><p>An estimate on a surgery, for example, might prove inexact. If all goes as expected, the price quoted likely will be close. But unexpected complications could arise, adding to the cost.</p><p>“You’ll get the average price, but you are not average,” said <a href="https://www.jhsph.edu/faculty/directory/profile/11/gerard-anderson">Gerard Anderson</a>, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health who studies hospital pricing.</p><p>Tools to help consumers determine in advance the amount of deductible they’ll owe are already available from many insurers. And experts expect the additional information being made available this month will prompt entrepreneurs to create their own apps or services to help consumers analyze the price data.</p><p>For now, though, the hospital requirements are a worthy start, say experts.</p><p>“It’s very good news for consumers,” said <a href="https://business.lehigh.edu/directory/george-nation-iii">George Nation</a>, a professor of law and business at Lehigh University who studies hospital pricing. “Individuals will be able to get price information, although how much they are going to use it will remain to be seen.”</p><p><strong>Will Consumers Use This Info? Who Else Might?</strong></p><p><a href="https://zackcooper.com/">Zack Cooper</a>, an associate professor of public health and economics at Yale, doubts that the data alone will make much of a difference for most consumers.</p><p>“It’s not likely that my neighbor — or me, for that matter — will go on and look at prices and, therefore, dramatically change decisions about where to get care,” he said.</p><p>Some cost information is already made available by insurers to their enrollees, particularly out-of-pocket costs for elective services, “but most people don’t consult it,” he added.</p><p>That could be because many consumers carry types of insurance in which they pay flat-dollar copayments for such things as doctor visits, drugs or hospital stays that have no correlation to the underlying charges.</p><p>Still, the information may be of great interest to the uninsured and to the increasing number of Americans with high-deductible plans, in which they are responsible for hundreds or even thousands of dollars in costs annually before the insurer begins picking up the bulk of the cost.</p><p>For them, the negotiated rate and cash discount information may prove more useful, said Nation at Lehigh.</p><p>“If I have a $10,000 deductible plan and it’s December and I’m not close to meeting that, I may go to a hospital and try to get the cash price,” said Nation.</p><p>Employers, however, may have a keen interest in the new data, said James Gelfand, senior vice president at the ERISA Industry Committee, which lobbies on behalf of large employers that offer health insurance to their workers. They’ll want to know how much they are paying each hospital compared with others in the area and how well their insurers stack up in negotiating rates, he said.</p><p>For some employers, he said, it could be eye-opening to see how hospitals cross-subsidize by charging exorbitant amounts for some things and minimal amounts for others.</p><p>“The rule puts that all into the light,” said Gelfand. “When an employer sees these ridiculous prices, for the first time they will have the ability to say no.” That could mean rejecting specific prices or the hospital entirely, cutting it out of the employer plan’s insurance network. But, typically, employers can’t or won’t limit workers’ choices by outright cutting a hospital from an insurance network.</p><p>More likely, they may use the information to create financial incentives to use the lowest-cost facilities, said Anderson at Johns Hopkins.</p><p>“If I’m an employer, I’ll look at three hospitals in my area and say, ‘I’ll pay the price for the lowest one. If you want to go to one of the other two, you can pay the difference,’” said Anderson.</p><p><strong>Will Price Transparency Reduce Overall Health Spending?</strong></p><p>Revealing actual negotiated prices, as this rule requires, may push the more expensive hospitals in an area to reduce prices in future bargaining talks with insurers or employers, potentially lowering health spending in those regions.</p><p>It could <a href="https://www.nytimes.com/2019/06/24/upshot/transparency-medical-prices-could-backfire.html">also go the other way</a>, with lower-cost hospitals demanding a raise, driving up spending.</p><p>Bottom line: Price transparency can help, but the market power of the various players might matter more.</p><p>In some places, where there may be one dominant hospital, even employers “who know they are getting ripped off” may not feel they can cut out a big, brand-name facility from their networks, no matter the price, said Anderson.</p><p><strong>Is the Rule Change a Done Deal?</strong></p><p>The hospital industry went to court, arguing that parts of the rule go too far, violating their First Amendment rights and also unfairly forcing hospitals to disclose trade secrets. That information, the industry said, can then be used against them in negotiations with insurers and employers.</p><p>But the U.S. District Court for the District of Columbia disagreed with the hospitals and upheld the rule, prompting an appeal by the industry. On Dec. 29, the U.S. Court of Appeals for the District of Columbia <a href="http://www.steamboatinstitute.org/app/uploads/2020/12/AzarvsAHA_AppealsOpinion.pdf">affirmed</a>; that lower-court decision and did not block the rule.</p><p>In a written statement last week, the American Hospital Association’s general counsel cited “disappointment” with the ruling and said the organization is “reviewing the decision carefully to determine next steps.”</p><p>Apart from the litigation, the American Hospital Association plans to talk with the incoming Biden administration “to try to persuade them there are some elements to this rule and the insurer rule that are tricky,” said Tom Nickels, an executive vice president of the trade group. “We want to be of help to consumers, but is it really in people’s best interest to provide privately negotiated rates?”</p><p>Fisher thinks so: “Hospitals are fighting this because they want to keep their negotiated deals with insurers secret,” she said. “What these rules do is give the American consumer the power of being informed.”</p><p><a href="https://khn.org/morning-briefing/">Subscribe</a>; to KHN's free Morning Briefing.</p><img src="https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1609865513213&cid=d00b2cf1-c1ee-4755-84a1-fdb1dfde4eed&ea=https%3A%2F%2Fkhn.org%2Fnews%2Farticle%2Fhospital-prices-just-got-a-lot-more-transparent-what-does-this-mean-for-you%2F&el=Hospital%20Prices%20Just%20Got%20a%20Lot%20More%20Transparent.%20What%20Does%20This%20Mean%20for%20You%3F"/>  ;                             

Do you know how to win before trial? Lawyers drag out cases so they can bill for more time. You don't have to wait for trial to win! You aren't billing for your time! Many pro se litigants fail to do things "the right way" as JurisDictionary® explains. Then they get trapped into going through a full-blown trial where time constraints and nervous pressure makes winning difficult. If you have a winnable case, my course shows you how to win before trial. Do you have the winning facts and law on your side? Then learn how to win before trial! 1.    There is no evidence you cannot get in before trial. 2.    There are no witnesses you cannot question under oath before trial. 3.    There are no documents or things you cannot get in before trial. 4.    There are no legal arguments you cannot make before trial. 5.    There is nothing going to happen at trial that cannot be made to happen before trial. The "trying" of your case with the first pleading and continues with discovery and motions before trial. Common reasons cases go to trial are: 1.    Lazy lawyer didn't do the pre-trial work he could have done. 2.    Stupid lawyer didn't know how to do the pre-trial work he could have done. 3.    Greedy lawyer didn't want to do the pre-trial work he could have done. 4.    No lawyer had no idea how to do the pre-trial work that could have been done ... pri-trial work you will learn in this case-winning tactics course.. Don't wait for trial! 1.    Trial is uncertain, especially with unpredictable juries and crooked lawyers. 2.    Trial is "think on your feet" with opponent trying to throw you off with objections. 3.    Trial is a nasty battle against lawyers' willing to cheat if they can. 4.    Trial is a last bite at the apple, with no take backs and no retreats. Win before trial ... and do it without a lawyer! It's easier than you may imagine! Learn How to Win in Court – For information on the “How to Win in Court” online course, click HERE   For more JurisDictionary content, click HERE Website:  https://www.howtowinincourt.com?refercode=SR0094 WealthCare Connect may receive a referral fee from Juris Dictionary for purchases make through these links.

Do you wish to know where the economy is heading? The bond market holds the answer, say the veterans.   The birds of the moment, the flighty birds, flock to the stock market. But the owls nest in the bond market.   The owls are the wiseacres.   The Federal Reserve's hocus-pocus fails to trick them. They know the card is up the sleeve. And they enjoy exposing the fraud.   New York Times economics reporter Neil Irwin: Savvy economic analysts have always known the bond market is the place to look for a real sense of where the economy is going, or at least where the smart money thinks it is going. For example: Is inflation ahead? The bond market will tell you — Treasury bonds in particular. Bonds and Inflation Longer-dated Treasury notes will telegraph the signal. If they wire an inflationary message, their prices will fall. And their yields will rise.   (Bonds operate as seesaws operate. When prices go up, yields go down. When yields go up, prices go down).   Yields would rise because inflation would eat into the bond’s value... as the termite eats into wood. Under inflation a bond is a sawdust asset.   Bond purchasers would demand a higher yield to compensate them for inflation’s ravages.   That is, they would demand insurance against the termite’s evils. The Message of the Bond Market Does today’s bond market indicate inflation is ahead?   It does not. 10-year Treasury notes presently yield under 1% — 0.923%.   These are historic lows. 10-year yields average 4.40% across time.   In brief… the bond market indicates no inflationary menace. Inflation is as tame as a tabby.   But is today’s bond market the reliable inflation detector it once was? Alas, it is not. That is because the Federal Reserve has distorted, garbled, jammed and censored its messages.   The bond market is transmitting static.   Investors who depend upon its clear telegraphing fumble about, lost.   The owls are down from their perches. The Fed’s Buying Spree And so we ask:   Do 10-year yields hover at historic lows because inflation expectations hover at historic lows?   Or do 10-year yields hover at historic lows because Federal Reserve Treasury purchases hover at record highs — which pummels down yields?   The Federal Reserve has purchased a walloping $2.4 trillion of Treasuries this past year...doubling its Treasury holdings.   It now owns 16.5% of United States government debt — a record amount. It owned 9.3% before the pandemic… in contrast.   Macroeconomic analyst Peter Schiff: The bond market is not working the way it has in the past because the Fed is artificially manipulating interest rates. The biggest buyer (of Treasuries) is the Federal Reserve…   The Fed is... trying to influence the economy, stimulate the economy, prop up the stock market. That is the purpose of the Fed buying Treasury bonds… And so when you have the Fed in the market, the whole thing is distorted… The bond market is broken. You can’t look at the bond market. It would appear not. But the wildly distorted bond market holds aloft the wildly distorted stock market. 1,124 Times Earnings??? The Federal Reserve’s gargantuan bond purchases are the energy behind quantitative easing. Schiff: The Fed is trying to maintain these excess stock market valuations... the key to the overvalued stock market is the overvalued bond market. We must agree — the stock market is overvalued. The S&P’s price-to-earnings ratio presently reads 37.21. Its historic average is 16.   Individual stocks are preposterously, deliriously overvalued. Netflix boasts a P/E ratio of 84. Amazon, 92.   And Tesla? An impossible 1,124 — if you can believe it. The stock trades at 1,124 times company earnings.   That is, at current earnings a fellow purchasing the stock would require 1,124 years of accumulated earnings to justify the purchase!   But let us recover our wits… and refocus our attention on the question of inflation... Food: An Omen of Inflation Bonds report little inflation ahead. Yet we have documented how the Federal Reserve has overpowered bonds’ signals with its own.   Is inflation closer than bonds indicate? Let us seek our answer in the supermarket…   Food prices have jumped 3.9% these past 12 months — most of all consumer items. It is the greatest increase in 11.5 years.   The Federal Reserve’s Personal Consumption Expenditures (PCE) is an atrocious bellwether of inflation. Its crystal-gazing is hopelessly botched.   Yet the Federal Reserve itself admits that food prices give a far truer inflation reading: We see that past inflation in food prices has been a better forecaster of future inflation than has the popular core measure… we find that the food component still ranks the best among them all… We doff our cap to Phoenix Capital Research for supplying the quote.   The 10-year bear market in food prices is ending, concludes Phoenix:   “Higher inflation is coming. And coming soon.” Clues From the Stock Market Is the stock market — ironically — the market presently telegraphing inflation? Consider commodities…   The S&P Metals & Mining ETF has jumped nearly 130% since March. The S&P Oil & Gas Exploration & Production ETF is 94% higher.   In all, inflation-sensitive assets have outraced the broader market since March. The “contrarian” KCI Research: Inflationary equities are appreciating at their most rapid clip since the recovery out of their late 2015 and early 2016 lows… Commodity prices are signaling that we are on the cusp of higher than expected future inflationary pressures. Yet, the bond market argues the signals are false. Deflation — disinflation, at least — is its message.   Which is correct? Time will tell us. Toying With Fire But to toy with inflation is to toy with fire. Strike a match, and you risk an inferno. Explains Jim Rickards: Once inflation expectations develop, they can take on lives of their own. Once they take root, inflation will likely strike with a vengeance. Double-digit inflation could quickly follow.   Double-digit inflation is a non-linear development. What I mean by that is, inflation doesn’t go simply from two percent, three percent, four, five, six.   What happens is it’s really hard to get it from two to three, which is ultimately what the Fed wants. But it can jump rapidly from there.   We could see a struggle to get from two to three percent, but then a quick bounce to six, and then a jump to nine or ten percent.   The bottom line is, inflation can spin out of control very quickly. Minerva’s Owl Is inflation on the way?   We suspect it is on the way, and for the reasons listed. Yet like a dreaded mother-in-law, we do not know when it will turn up.   Nor do we know if it spins beyond control once it does.   The gods have denied us the gift of foresight… and the wisdom that attends it.   Like most, our answer will likely arrive after the fatal hour.   Minerva’s owl — Minerva’s Owl of Wisdom — flies only at dusk...   Regards, Brian Maher   Brian is the Daily Reckoning's Managing Editor. Before signing on to Agora Financial, he was an independent researcher and writer who covered economics, politics and international affairs. His work has appeared in the Asia Times and other news outlets around the world. He holds a Master's degree in Defense & Strategic Studies. Hard Assets Alliance was created as a cooperative of investment professionals who believe there's a better way to invest in precious metals. This is a guest perspective on the markets from one of these partners; we hope you enjoy it. For more postings by Hard Asset Alliance, click HERE Hard Asset Alliance is also listed in the DIY Marketplace Website:  https://www.hardassetsalliance.com/?aff=TWC WealthCare Connect may receive a referral fee from Hard Asset Alliance for purchases make through these links.

                                    Seniors Face Crushing Drug Costs as Congress Stalls on Capping Medicare Out-Of-Pockets     Harris Meyer              January 4, 2021                                                           This story also ran on Fortune. It can be republished for free.     Sharon Clark is able to get her life-sustaining cancer drug, Pomalyst — priced at more than $18,000 for a 28-day supply — only because of the generosity of patient assistance foundations. Clark, 57, a former insurance agent who lives in Bixby, Oklahoma, had to stop working in 2015 and go on Social Security disability and Medicare after being diagnosed with multiple myeloma, a blood cancer. Without the foundation grants, mostly financed by the drugmakers, she couldn’t afford the nearly $1,000 a month it would cost her for the drug, since her Medicare Part D drug plan requires her to pay 5% of the list price. Every year, however, Clark has to find new grants to cover her expensive cancer drug. “It’s shameful that people should have to scramble to find funding for medical care,” she said. “I count my blessings, because other patients have stories that are a lot worse than mine.” Many Americans with cancer or other serious medical conditions face similar prescription drug ordeals. It’s often worse, however, for Medicare patients. Unlike private health insurance, Part D drug plans have no cap on patients’ 5% coinsurance costs once they hit $6,550 in drug spending this year (rising from $6,350 in 2020), except for very low-income beneficiaries. President-elect Joe Biden favors a cap, and Democrats and Republicans in Congress have proposed annual limits ranging from $2,000 to $3,100. But there’s disagreement about how to pay for that cost cap. Drug companies and insurers, which support the concept, want someone else to bear the financial burden. That forces patients to rely on the financial assistance programs. These arrangements, however, do nothing to reduce prices. In fact, they help drive up America’s uniquely high drug spending by encouraging doctors and patients to use the priciest medications when cheaper alternatives may be available. Growing Expense of Specialty, Cancer Medicines Nearly 70% of seniors want Congress to pass an annual limit on out-of-pocket drug spending for Medicare beneficiaries, according to a KFF survey in 2019. (KHN is an editorially independent program of KFF.) The affordability problem is worsened by soaring list prices for many specialty drugs used to treat cancer and other serious diseases. The out-of-pocket cost for Medicare and private insurance patients is often set as a percentage of the list price, as opposed to the lower rate negotiated by insurers. For instance, prices for 54 orally administered cancer drugs shot up 40% from 2010 to 2018, averaging $167,904 for one year of treatment, according to a 2019 JAMA study. Bristol Myers Squibb, the manufacturer of Clark’s drug, Pomalyst, has raised the price 75% since it was approved in 2013, to about $237,000 a year. The company believes “pricing should be put in the context of the value, or benefit, the medicine delivers to patients, health care systems and society overall,” a spokesperson for Bristol Myers Squibb said via email. As a result of rising prices, 1 million of the 46.5 million Part D drug plan enrollees spend above the program’s catastrophic coverage threshold and face $3,200 in average annual out-of-pocket costs, according to KFF. The hit is particularly heavy on cancer patients. In 2019, Part D enrollees’ average out-of-pocket cost for 11 orally administered cancer drugs was $10,470, according to the JAMA study. The median annual income for Medicare beneficiaries is $26,000. Medicare patients face modest out-of-pocket costs if their drugs are administered in the hospital or a doctor’s office and they have a Medigap or Medicare Advantage plan, which caps those expenses. But during the past several years, dozens of effective drugs for cancer and other serious conditions have become available in oral form at the pharmacy. That means Medicare patients increasingly pay the Part D out-of-pocket costs with no set maximum. “With the high cost of drugs today, that 5% can be a third or more of a patient’s Social Security check,” said Brian Connell, federal affairs director for the Leukemia & Lymphoma Society. This has forced some older Americans to keep working, rather than retiring and going on Medicare, because their employer plan covers more of their drug costs. That way, they also can keep receiving financial help directly from drugmakers to pay for the costs not covered by their private plan, which isn’t allowed by Medicare. ‘This Is a Little Nuts’ All this has caused financial and emotional turmoil for people who face a life-threatening disease. Marilyn Rose, who was diagnosed with chronic myeloid leukemia three years ago, until recently was paying nothing out-of-pocket for her cancer drug, Sprycel, which has a list price of $176,500 a year. That’s because Bristol Myers Squibb, the manufacturer, paid her insurance deductible and copays for the drug. But the self-employed artist and designer, who lives in West Caldwell, New Jersey, recently turned 65 and went on Medicare. The Part D plan offering the best deal on Sprycel charges more than $10,000 a year in coinsurance for the drug. Rose asked her oncologist if she could switch to an alternative medication, Gleevec, for which she’d pay just $445 a year. But she ultimately decided to stick with Sprycel, which her doctor said is a longer-lasting treatment. She hopes to qualify for financial aid from a foundation to cover the coinsurance but won’t know until  sometime this month. “It’s just strange you have to make a decision about your treatment based on your finances rather than what’s the right drug for you,” she said. “I always thought that when I get to Medicare age I’ll be able to breathe a sigh of relief. This is a little nuts.”                                                                                  Given the sticker shock, many other patients choose not to fill a needed prescription, or delay filling it. Nearly half of patients who face a price of $2,000 or more for a cancer drug walk away from the pharmacy without it, according to a 2017 study. Fewer than half of Medicare patients with blood cancer received treatment within 90 days of their diagnosis, according to a 2019 study commissioned by the Leukemia & Lymphoma Society. “If I didn’t do really well at scrounging free drugs and getting copay foundations to work with us, my patients wouldn’t get the drug, which is awful,” said Dr. Barbara McAneny, an oncologist in Albuquerque, New Mexico, and past president of the American Medical Association. “Patients would just say, ‘I can’t afford it. I’ll just die.’” The high drug prices and coverage gaps have forced many patients to rely on complicated financial assistance programs offered by drug companies and foundations. Under federal rules, the foundations can help Medicare patients as long as they pay for drugs made by all manufacturers, not just by the company funding the foundation. But Daniel Klein, CEO of the PAN Foundation, which provides drug copay assistance to more than 100,000 people a year, said there are more patients in need than his foundation and others like it can help. “If you are a normal consumer, you don’t know much about any of this until you get sick and all of a sudden you find out you can’t afford your medication,” he said. Patients are lucky, he added, if their doctor knows how to navigate the charitable assistance maze. Yet many don’t. Daniel Sherman, who trains hospital staff members to navigate financial issues for patients, estimates that fewer than 5% of U.S. cancer centers have experts on staff to help patients with problems paying for their care. Sharon Clark, who struggles to cover her cancer drugs, works with the Leukemia & Lymphoma Society counseling other patients on how to access helping resources. “People tell me they haven’t started treatment because they don’t have money to pay,” she said. “No one in this country should have to choose between housing, food or medicine. It should never be that way, never.” This article is part of a series on the impact of high prescription drug costs on consumers made possible through the 2020 West Health and Families USA Media Fellowship. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente. USE OUR CONTENT This story can be republished for free (details). Subscribe to KHN's free Morning Briefing.