Asclepios
A Little Help Here, Now
May 1, 2008 • Volume 8, Issue 18
Even with the hundreds of billions of dollars that taxpayers are paying
insurance companies to provide drug coverage under the Part D benefit, many
people with Medicare continue to find their medications unaffordable. Millions
of older adults and people with disabilities, especially the very sick, continue
to skip doses, split pills or skimp on necessities like food because of the cost
of their drugs, according to two recent studies in the Journal of the
American Medical Association.
The two principal reasons Part D has failed to deliver as promised
are
- the cost of drugs is still high;
- Part D has a built-in coverage gap, or “doughnut hole,” when people
with Medicare must pay the full cost of their medicines.
A recent survey of Part D prices by the Kaiser Family Foundation of the
10 brand-name drugs most prescribed to older adults is instructive. An
individual who took just six of those medicines, which help reduce blood clots,
cholesterol, high blood pressure and other conditions common among older adults,
would enter the doughnut hole in May and stay there, paying the full price of
their drugs and their premiums, through September.
Clearly, fundamental reform, such as giving people with Medicare the
option to obtain drug coverage directly from Medicare, is needed.
It is equally clear, however, that Congress will not enact, and this
administration will not sign, such reforms.
What Congress and the administration might do, if we put enough
pressure on them, is help more people with Medicare living on low, fixed incomes
get the Extra Help they need with their drug costs.
The Extra Help program pays Part D premiums, lowers copayments and,
most important, provides coverage through the doughnut hole, for people with
Medicare living on less than $1,301 per month ($1,751 for a couple). Hundreds of
thousands of these low-income folks, however, are disqualified from Extra Help
because they have modest nest eggs saved for their retirement.
The Senate has before it now proposals to modestly increase the amount
of savings people with Medicare can keep and still qualify for Extra Help and
make other, long overdue, improvements to Extra Help and the Medicare Savings
Programs, which help low-income people afford Medicare’s premiums and cost
sharing for medical care. Please write
and urge your senator to help more low-income people with Medicare afford
their prescription drugs and medical care.
Medical Record
“I'm on dialysis. My disability income is $364 too much
annually to qualify for the Extra Help program. I hit the doughnut hole within
three months this year. Now I'm supposed to come up with $3,000 for the meds I
need to survive. I've had to borrow money for my prescriptions. I will likely
end up back in the hospital due to lack of medications. Medicare will end up
footing my hospital bill. Previous stays have resulted in bills between $20,000
and $50,000. Guess they'd rather pay the huge hospital bills than come up
with a reasonable prescription plan” (Story
submitted to the Part D Monitoring Project,
Medicare
Rights
Center,
April 2008).
“Overall, our findings suggest that the intensive medicine
needs and financial barriers to access among the sickest beneficiaries may not
have been fully addressed by Part D” (“Cost-Related
Medication Nonadherence and Spending on Basic Needs Following Implementation of
Medicare Part D,” Journal of the American Medical Association,
April 2008).
“Even if a drug is listed on a plan’s formulary, utilization
restrictions may limit a beneficiary’s access to the drug. Plans may require
step therapy or prior authorization before covering a drug, or may limit the
quantity covered. Plans may also place drugs on a non-preferred tier, associated
with higher cost sharing” (“Medicare
Part D 2008 Data Spotlight: Ten Most Common Brand-Name Drugs,” Kaiser Family
Foundation, April 2008).
* * * *
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.
Register for a FREE copy of this great
resource.
* * * *
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 private health plan. With information
about what the issues are with Medicare Advantage plans, we will be able to
demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/partdstories.html.
* * * *
The Louder Our Voice, the Stronger Our
Message
Asclepios—named for the Greek and Roman
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* * * *
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