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At Last, a Solution
October 25, 2007 • Volume 7, Issue 42In January, hundreds of thousands of low income people with Medicare will learn at the pharmacy counter that they have been switched to a new Part D prescription drug plan that doesn’t cover drugs that they need.
For many of these individuals, it will be déjà vu, reminding them of the winter of 2006, when they were abruptly dropped from Medicaid drug coverage and dumped into a Part D plan run by an insurance company. The disruptions in drug regimens were so widespread that 37 states had to step in with back-up emergency Medicaid coverage.
Why are we repeating this fiasco?
The complicated answer is: 1.6 million low income people with Medicare are enrolled in a Part D plan that will charge a premium in 2008 that is too high to qualify for a full subsidy. Current law requires that these individuals be randomly reassigned—without regard to whether the plan covers their medicines—among the Part D plans with premiums low enough to qualify for a full subsidy.
The short answer is: Congress wrote the Part D law with the profits of insurance companies and drug manufacturers in mind, not with the interests of people with Medicare at heart.
Insurance companies like random reassignment because it gives each of them an equal shot at the government subsidies that come with every person enrolled in their Part D plan.
Drug makers like parceling out people with Medicare among multiple Part D plans because it diminishes what little power insurance companies have to negotiate lower drug prices. Best of all, drug companies like the privatized delivery of Medicare drug coverage because it prevents the federal government from using the buying power of 43 million people with Medicare to negotiate lower drug prices.
Fortunately, some key lawmakers have a plan to redress this iniquity. This week, Representative Jan Schakowsky, Democrat of Illinois, Representative Marion Berry, Democrat of Arkansas, and Senator Richard Durbin, Democrat of Illinois, introduced legislation to give people with Medicare the option to obtain drug coverage directly through Original Medicare.
Under a Medicare-administered drug benefit, the government would use the best available medical evidence to decide which drugs should be covered and would negotiate the lowest prices possible, just like the Department of Veterans Affairs does for our veterans. People with Medicare would receive a stable, guaranteed benefit, not a plan that changes what drugs are covered each year. Low-income people with Medicare would have a permanent home for their drug coverage instead of being dealt out to insurance companies on an annual basis.
It will be an uphill battle to overcome the opposition of the drug companies and the insurance industry and make this bill law. We have to start now. Please write and urge your senators and representative to co-sponsor the Medicare Prescription Drug Savings and Choice Act of 2007.
Medical Record
“Under current law, Medicare beneficiaries are stuck with confusing, costly plans designed by insurance and drug companies. What seniors deserve is an affordable, straightforward drug benefit.... This legislation will give them the choice of a drug plan operated directly by Medicare – just like all other Medicare benefits – and require the administration to negotiate on behalf of seniors to bring down the exorbitant costs of needed medications.” (Senator Richard Durbin, “Senator Durbin and Representatives Schakowsky and Berry Fight to Cut Costs for Prescription Drugs,” October 23, 2007).
“A Medicare-administered prescription drug benefit has the potential to lower drug prices for people with Medicare and to reduce the overall cost to Medicare of drug coverage. A national, evidence-based formulary for a Medicare drug plan can help guide doctors to prescribe in a way that improves health care outcomes, reduces costs, and facilitates a fair and efficient appeals system.” (Medicare Rights Center and Consumers Union, The Best Medicine: A Drug Coverage Option Under Original Medicare, October 2007).
Ms. F was enrolled in a Part D plan for the first year of the drug benefit. During the Open Enrollment Period (OEP) of 2006, Ms. F contacted her Part D plan to inquire about changes to the plan in 2007. Plan representatives informed her that although the premium would rise almost 150 percent, the benefit package would not change. Ms. F asked for the plan's benefits in writing, which she received in January 2007, after the OEP had ended. To Ms. F's dismay, the entire benefit package had changed, and would cost Ms. F more than the full price of her essential medications. Ms. F decided she would not have chosen the plan had she received the information during the OEP. Ms. F notified the insurance company, which refused to terminate her coverage. Ms. F submitted a complaint to both the plan's administrators and to Medicare. (Story submitted to the Part D Monitoring Project, Medicare Rights Center, August 10, 2007).
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Medicare Part D Appeals Help for Advocates Is Here!
MRC’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
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Medicare Part D Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://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 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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The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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