Asclepios
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Choices
June 15, 2006 • Volume 6, Issue 24This week, at the first hearing on the Part D prescription drug benefit by the House Ways and Means Committee, the cheerleaders for the new program downplayed the problems that people with Medicare have experienced over the last six months.
Representative Clay Shaw, Republican of Florida, compared the frustration and confusion felt by individuals trying to find a drug plan that provided affordable coverage of the medicines they need to choosing a flavor at the ice cream parlor. Representative Bob Beauprez, Republican of Colorado, likened it to the confusion he experiences when he pushes his cart down the breakfast cereal aisle.
Could these gentlemen be further removed from reality?
If the server refuses to put jimmies on your cone, do you face the same health risks as someone who cannot get the needed blood pressure medicine from his or her Part D plan?
If the “all natural” cereal turns out to be loaded with sugar and corn syrup, are you locked into buying it for the rest of the year, even though you are a diabetic?
But the most telling remark came from Representative Mark Foley, Republican of Florida, who, noting the enrollment numbers in Part D, marveled that “the Florida lottery didn’t have that many subscribers in the first year of existence and this is a game of chance.”
The Part D Lotto.
As researchers for the nonpartisan Medicare Payment Advisory Commission (MedPAC) found, many people with Medicare could not get a straight answer from plan representatives when they asked if their drugs were covered. Many more people relied on plan marketing materials for their decision than used Medicare’s web-based plan finder, a flawed tool, but one of the few ways to really compare plans. Even if individuals could figure out which plans covered their drugs and what the restrictions and cost sharing were, nobody can anticipate what their future medical needs might be. That is the real gamble. A new diagnosis can change the medicines one needs, but one cannot change plans until the end of the year.
The Part D boosters in Congress and the administration make a big deal out of consumers’ preference for Part D plans that charge no deductible and flat copayments instead of a percentage of the cost of a drug. Look, they say, the market is working!
What that preference really illustrates is that, out of the confusion that is Part D, people with Medicare want simplicity and predictability in their health coverage. They reject a health care model that is based on shifting costs onto the consumer, making them weigh the cost of care against the medical advice of their doctor. What they really want is the one choice that Congress and the Bush administration will not give them: a drug benefit delivered directly through Medicare with lower prices negotiated directly through Medicare.
Members of Congress should honestly examine whether Part D provides to the American people the drug benefit that they deserve. And they should remember that people with Medicare have another choice coming up—and this one may not be so complicated.
It’s called the election.
Medical Record
“Criticism based in reality is not propaganda. Hiding the truth is. Older Americans and people with disabilities can tell the difference. . . To downplay the very real confusion people with Medicare felt when forced to choose from a dizzying array of plans, each covering different drugs, charging different copayments and subject to change at any time, is about spin, not truth. But these Part D boosters—including some members of this Committee—demand that older Americans be sheltered from news accounts that describe Part D accurately. Disguising the truth is not the path to getting public policy right” (MRC President Robert M. Hayes, Statement for the Record for the House Ways and Means Committee, June 14, 2006).
“I have been denied coverage for Byetta, a medication I have been on for my diabetes for nearly a year. When I was first denied, I was told by my Part D plan, WellCare, that my doctor only needed to fill out a form and Byetta would be added to the allowed list, which it has not. I have been denied coverage for this medication. I have also had to get prior authorization for my asthma meds, Singulair and Spriva. It took over a month to get the authorization, during which time I became ill. I am constantly charged copayments on syringes, insulin and Albuterol, which I did not have to pay before Part D. I get charged copayments for generic meds, which are supposed to have a $0 copayment. I have called the insurance company and have been told that my many prescriptions cost too much, and I will have to pay copayments on everything. I have tried to work with the pharmacy to get all of my prescriptions. They now look at me like I am a problem when I go to pick up a prescription” (story submitted from East Wareham, Massachusetts, Medicare Rights Center Part D Monitoring Project, May 2006).
“Focus group participants described calling plan customer service lines to ask whether their medications were offered by the plan. Many reported difficulty getting answers from this source” (“Report to the Congress: Increasing the Value of Medicare,” MedPAC, June 2006).
Fast Relief: Part D Monitoring Project
The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.
Submit your story at www.medicarerights.org/partdstories.html
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The Louder Our Voice, the Stronger Our Message Asclepios — named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly action alert designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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