Prescription Ills-Seniors in managed-care plans may pay much more for drugs

[Guest guest]

Prescription Ills

Seniors in managed-care plans may pay much more for drugs

lie sits in her kitchen, trying to figure out how she is going

to be able to afford co-pays for her leukemia medication under the new

senior drug plans.

MARTY BICEK/THE BEE

By KEN CARLSON

BEE STAFF WRITER

Last Updated: December 21, 2005, 05:06:50 AM PST

While it's touted as a cost-saving program for seniors and the disabled, the

Medicare prescription drug program is going to cost substantially more for

people enrolled in managed-care plans.

About 38,000 Medicare beneficiaries in Stanislaus and San Joaquin counties

buy health benefits through Kaiser Permanente's Senior Advantage or

Pacificare's Secure Horizons plan.

Those residents are being hit with increased premiums and co-payments. And

some, such as lie of Ceres, will pay a lot more for lifesaving

medicines.

, who has Senior Advantage, said she paid $30 a month this year for

Gleevec, a drug that she takes for leukemia. The medication has put the

cancer in remission and she needs to keep taking it.

But it will cost her $3,700 next year, and her costs for medicines will go

from $640 to $4,024, her family says.

said she doesn't have the money.

" As senior citizens, we were all pumped up about how much we were going to

save with the Medicare drug program, " she said. " It is not saving me

thousands of dollars; it is costing me thousands. "

In 2004 and 2005, Senior Advantage provided unlimited coverage for gen-eric

medications, and covered the brand drug Gleevec as an exception. (The retail

price for Gleevec is upward of $2,700 for a month's supply.)

But Senior Advantage in 2006 is modeled after the new standard Medicare drug

plan, and that means has a coverage gap.

The Senior Advantage co-payments for generics will be $30 for a 100-day

supply, triple the previous co-payment, and $40 for a 30-day supply of brand-

name drugs.

If the cost of the drugs reaches $2,250 in a year, subscribers have to pay

full price until their out-of-pocket expenses total $3,600.

Above that, a " catastrophic coverage " is triggered, requiring monthly co-

payments of $3 for generics and $10 for brand drugs.

Senior Advantage members also are being hit with a premium increase from $50

to $96 a month, while the Secure Horizons premium is going from $54 to $68.

" Where is the savings? " asked Olson, a Modesto retiree who takes

medication for his heart. " It is taking an extra $500 a year out of my

pocket. "

Deductibles will be lower

Members of Senior Advantage and Secure Horizons, which also has the coverage

gap, were warned they would lose their regular health benefits if they

purchased one of the 48 Medicare drug plans available in Northern California.

Beside coverage for medicines, the health plans provide subscribers with a

network of doctors and hospitals and lower deductibles than the standard

Medicare program.

When Congress approved the Medicare prescription drug program, it created a

standard plan for insurers that would offer drug plans in different regions

of the country.

Jack Cheevers, a Medicare spokesman in San Francisco, said the managed-care

plans were required at least to match the standard plan, but can offer

enhancements, too.

" They can cover all or part of the coverage gap or offer lower premiums and

deductibles, " he said.

Some of the stand-alone drug plans do not have the coverage gap. Those plans

generally have higher premiums than others, Cheevers said.

One plan offered by Humana, which does not have a coverage gap, covers 400

milligram Gleevec for a $60-a-month co-pay. The premium is just over $50 a

month.

Kaiser lists benefits

Hanson, director of Medicare and state programs for Kaiser, defended

the changes made to Senior Advantage.

In the last two years, the plan did not cover brand drugs, and it provides

catastrophic coverage for people whose medication costs exceed $3,600 a

year, she said. Senior Advantage also doesn't have a $250 annual deductible

found in the standard Medicare drug plan.

" On the whole, it is an improved benefit, " she said. An estimated 15 percent

of members would be affected by the coverage gap, she said.

She added that the increase in co-payments isn't so high for members opting

for Kaiser's mail-order pharmacy.

said she is applying to Kaiser's charity care program, but it

appears her annual retirement income of $21,000 is too high to qualify. The

family also is asking the drug's manufacturer for a break.

Geoffrey Cook, a spokesman for Norvatis Oncology, maker of Gleevec, said

that nonprofit groups offer assistance for people who can't afford the drug.

He cited research costs as the reason for the drug's cost.

Cheevers said financial assistance is available for low-income residents who

can't afford the coverage gap. Another option for someone like is to

purchase a more affordable drug plan and fall back on traditional Medicare

health coverage.

If dropped out of Senior Advantage, she would lose her Kaiser-

affiliated doctor. Under Medicare, her copayments for hospitalizations could

be $1,000 in a year. And her share of the costs for seeing physicians and

specialists would be higher.

The managed-care plans also have coverage for glasses and routine eye and

hearing exams.

Barbara Neer, a retired medical assistant in Modesto, said the new drug

program has been confusing even with her background in health care.

She and her husband, , have struggled to find out if the medicines

they take are covered by their managed-care plan.

" They are doubling and tripling the cost, plus it is confusing for the

majority of people, " Neer said.

Bee staff writer Ken Carlson can be reached at 578-2321 or

kcarlson@....