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Worth Looking Into
March 8, 2007 • Volume 7, Issue 10During the past few months, the Bush administration, drug manufacturers and insurers have been boasting about the initial year of Part D. The program has done nothing but wonders for people with Medicare, they say. The market is working, they brag.
While the Part D cheer squad tells us the benefit was a resounding success in its first year, the experiences of ordinary people paint a very different picture.
All through 2006, countless people with Medicare have sought the help of counselors with the Medicare Rights Center and other advocacy groups across the country for their Part D problems. Over the last year people with Medicare, caregivers and caseworkers shared what they have gone through to the Medicare Rights Center’s Part D Monitoring Project.
They wrote about struggling to afford the costs of coverage and rising drug prices. They wrote about signing up for plans that claimed to have their medicines on their list of covered drugs but didn’t reveal they would have to face confusing prior authorization requirements, quantity limits or, potentially, outright denials of coverage. They wrote about deceptive marketing practices and about getting misleading or wrong information. They wrote about falling blindly into Part D’s absurd “doughnut hole”—where individuals are forced to pay the full cost of their medications while continuing to pay premiums—and not being able to afford it. They wrote about getting the runaround trying to deal with bureaucratic problems with Social Security check deductions. They wrote about being disenrolled from the plan they had chosen without their knowledge or consent.
These same problems have continued into 2007. The stories that have come in through the Part D Monitoring Project in the past couple months are evidence that very little has been done to fix the problems that plagued the implementation of Part D.
Even worse, new problems have arisen in Part D’s sophomore year.
Plans that offered affordable coverage last year have suddenly hiked their prices dramatically. Individuals whose medicines were included on their plan’s formulary last year found that those drugs now have new restrictions or were dropped from coverage completely. People who paid high premiums for coverage through the doughnut hole found themselves with no such option this year. Even those who tried to switch out of their drug plans—exercising the informed consumer choice so lauded by Part D proponents—faced headaches, hassles and misinformation.
This year, Congress must hold hearings and make the Centers for Medicare & Medicaid Services (CMS), drug companies and insurers accountable for the serious problems Part D has created for older adults and people with disabilities. Congress can no longer look the other way while people with Medicare fall prey to marketing abuses, while individuals are denied coverage for needed medicines, while persistent computer problems foul up enrollments and premium deductions, while vital medicines remain priced out of reach.
Read recent stories sent to the Part D Monitoring Project.
Medical Record
“After one month, we continue to see operations run smoothly. Whether it’s pharmacists at the drug store or beneficiaries filling their prescriptions, very few of the problems people encountered at the program’s implementation have been experienced this year” (Leslie Norwalk, CMS Acting Administrator, “Medicare Drug Plans Strong and Growing,” CMS press release, January 30, 2007).
“Part D boosters love to cite the 80 percent satisfaction rate found by recent polls about the benefit, but they ignore other key findings. Seventy-three percent of older adults say that the current benefit is ‘too complicated’ and 81 percent favor lifting the prohibition on Medicare drug price negotiations. Two-thirds of older adults support providing a drug benefit directly through Medicare” (“Myth #2: Part D is working well and there is no need to change it,” Truth Is the Best Medicine, January 2007).
“When I recently went to fill my prescription, I was shocked to be charged more than $60 for a month’s supply rather than $5, the cost under my Part D plan last year. I thought it was a mistake and called my plan. I was told that there was no mistake and that I probably should try to work with my doctor to find a generic. I said that my prescription was the generic and the representative got confused and could offer me no further advice” (Story submitted to the Part D Monitoring Project, Medicare Rights Center, January 26, 2007).
“Well, here I am. I sent in my first mail order for the year and after three medicines, I am in the doughnut hole. I couldn’t believe it. I am not eligible for Extra Help. I’m diabetic, and I am using syringes and needles more than once to save some money, which is not recommended” (Story submitted to the Part D Monitoring Project, Medicare Rights Center, February 20, 2007).
“After experiencing an enormous number of problems with my Part D plan last year, I decided to switch to a different plan this year. When I signed up for the plan, they suggested we use the online formulary to see if our drugs would be covered. One drug was listed on the formulary as ‘generic,’ but when I ordered it, it wasn’t covered. When I complained that the plan had listed the drug on its formulary, I found out that apparently they had replaced the online formulary at some point after the Open Enrollment Period. I have since found out that 9 of the 11 drugs I take have some kind of restrictions or are not covered. Suddenly many of the drugs I’ve taken for several years require ‘prior authorization.’ I am very unhappy with Part D. I spent years getting on a regimen of medicines that give me a quality of life I was missing, and now I have to justify every drug I take and pay the highest co-pays” (Story submitted to the Part D Monitoring Project, Medicare Rights Center, January 17, 2007).
***** 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.
Fast Relief: Part D Monitoring Project
Submit your story at www.medicarerights.org/partdstories.html
*****
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 e-newsletter 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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