Asclepios
The Senate's Turn
September 10, 2009 • Volume 9, Issue 36
The health care plan outlined by President Obama last night would close the Part D coverage gap, providing people with Medicare coverage for all of their medicines throughout the year. Even as the gap narrows in the years before it is fully closed in 2019, people with Medicare would receive 50 percent discounts on brand name drugs.
The health reform bill pending in the House of Representatives, America’s Affordable Health Choices Act (HR 3200), would phase out the coverage gap, also known as the doughnut hole, over 12 years and provide similar discounts in the interim. HR 3200 helps pay for the improved coverage by securing price concessions from drug manufacturers.
We don’t know yet what the Senate will do, but an unofficial summary of the health care bill drafted by Senate Finance Committee Chairman Max Baucus, Democrat of Montana, does not include a plan to close the doughnut hole but does mandate 50 percent discounts on brand name drugs in the coverage gap for middle-income consumers.
While the discount program may help people with Medicare better afford some prescription drugs in the short term, it is not sufficient. Closing the doughnut hole will provide people with Medicare coverage for all their drugs, both brand name and generic, at lower copayments that remain consistent throughout the year.
When the Senate Finance Committee marks up its health care bill later this month, it should include a full phase-out of the doughnut hole. People who fall in the coverage gap spend, on average, $4,080 out-of-pocket for the prescription drugs. The high cost of drugs in the doughnut hole force people to skip doses or split pills, putting their health at risk. Please write your senators and representative and tell them that health care reform legislation must close the doughnut hole.
Medical Record
“Medicare Prescription Part D needs to be fixed so people will not run into a doughnut hole that cost them thousands of dollars that they cannot afford on a fixed income. My wife is fixing to be eligible for Medicare Part A and B but will need a drug card to get her medicine. She takes one chemo pill that cost $431.51 a month, not counting high blood pressure meds, thyroid meds, meds for stress and meds to help her sleep so how in the hell are people going to be able to afford medicine at these prices today. Pharmaceutical companies get richer and we get poorer and no one in Washington gives a damn” Story submitted to Part D Monitoring Project, Alamo, Tennessee, September 2009.
The President’s plan begins immediately to close the Medicare "donut hole" - a current gap in its drug benefit - by providing a 50 percent discount on brand-name prescription drugs for seniors who fall into it. In 2007, over 8 million seniors hit this coverage gap in the standard Medicare drug benefit. By 2019, the President’s plan will completely close the "donut hole". The average out-of-pocket spending for such beneficiaries who lack another source of insurance is $4,080.” The Obama Plan: Stability and Security for All Americans, September 2009
“Since 1965, when President Johnson and Congress worked together to create Medicare, older Americans have enjoyed health security. This year, if Congress shows the same resolve and adopts the health care reforms outlined by President Obama last night, all Americans will have the same right to affordable, high quality health care. People with Medicare will also benefit. The President's plan helps shore up Medicare's finances, ensuring it will continue to provide coverage to older adults and people with disabilities. The President's plan also closes the coverage gap in Medicare drug coverage, saving people with Medicare thousands of dollars in high out-of-pocket costs for the medicines they need.” Statement by Medicare Rights Center President Joseph Baker, September, 2009
* * * *
Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’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 would like to hear about your experience, or that of someone you know, enrolled in a 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/issues-actions/tell-your-story.php.
* * * *
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.
* * * *
The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/about-mrc/newsletter-signup.php.
Get answers to your Medicare questions from Medicare Interactive at http://www.medicareinteractive.org.