Big pharma wins- disabled, poor, elderly lose/Medicare Medicaid

[Guest guest]

Judge Rules That Court Lacks Power To Protect Drug Access For 6.2 Million

Impoverished People With Medicare, USA

02 Jan 2006

A federal district judge in Manhattan ruled this afternoon that federal

courts lack the power to order the continuation of existing drug benefits to

people with Medicare who are losing Medicaid drug coverage this weekend.

The decision says that people denied medicine must contest that denial,

individual by individual, before the Centers for Medicare and Medicaid

Services prior to seeking court protection.

Click here to see the text of the Court's decision. The plaintiffs, eight

consumer organizations from Maine to California, will bring an immediate

appeal of that ruling.

M. , the president of the Medicare Rights Center, one of the

plaintiffs in the case, made the following statement:

“Nothing in this ruling suggests that the oldest, poorest and frailest

Americans are safe. On January 1st the neediest Americans face potentially

catastrophic disruptions in their access to needed medicine. In the real

world, people cut off from life sustaining medicine cannot survive the delay

of an agency appeal. The responsibility for the health and safety of these

frail Americans rests squarely with the Bush Administration.”

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 high-quality, affordable

health care.

http://www.medicarerights.org

http://www.medicalnewstoday.com/medicalnews.php?newsid=35588#

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/3/2006 10:39:00 AM

For those of you who are having trouble trying to figure out the new

Medicare drug system, don’t feel like you are the only one. Everyone I have

talked to has concerns.

Much to consider with new drug plan

Bill Horne

Folks, it is time to take a closer look at the new Medicare drug plan. I

hadn’t thought too much about the drug insurance changes until I started

hearing that our politicians were telling us that the plan was easy to

understand and all we had to do was sign on the dotted line.

I am not an expert on this subject. I have attended only one seminar and

done some personal research. The following is my opinion and people should

do their own research.

I was not very far into my investigation when I read this statement by Dr.

Mark Siegel writing for The Nation, “The only elderly and disabled who will

profit from it are those who are lucky enough to own shares in the companies

that supply the drugs.” I thought, uh-oh, here is a doctor who thinks that

the new Medicare drug plan is all about the drug firms making money and not

about helping his patients.

The plan seems to divide the Medicare users into two groups. The first group

includes people with incomes below $12,000. It seems like this group will

have complete drug coverage. Of course, this is mostly the same group that

had complete coverage under the old Medicaid program. So, although there

could be several disruptive changes, it seems that this group could still be

covered.

The second group is all those who have an income in excess of $12,000. Here

is where it gets more complicated. Actually, it is more complicated for

everyone.

Each senior could be required to evaluate or consider 40 different plans.

These plans will contain different combinations of the items that will be

important to each person. For example, all 40 plans could have different

premiums, different co-payments, different deductibles, different

pharmacies, and different formularies.

“Formularies” is just a fancy word for lists. In this case, a list of the

drugs that each plan covers.

When you look at the previous paragraph you will see that there are five

major decision areas to each plan. There are going to be somewhere in the

area of 40 plans.

So, there will be several thousand possibilities, or pieces of information,

that each senior will have to consider.

Let’s take a look at each overall area and then the plan. Please don’t throw

your arms in the air and give up. We will work through this, step by step.

And, if you are not a senior, you might want to familiarize yourself so you

can help a senior.

Premiums are the first item to consider. Each plan could be different, and

the premium charge will have to be considered along with drug costs,

co-payments, deductibles, and the number of different medications needed.

Formularies are the lists of drugs that are offered by each plan and are the

second of the items to be considered. These lists will very likely be

different for each plan. Each Medicare customer, and that is what we are now

– customers, will need to search through the plans to be sure that all of

their medications are on the list of the plan they choose. As near as I can

tell, the companies have an open or living contract here. In other words,

they can change the drugs on their lists at anytime. It looks like we, on

the other hand, can only change plans once a year.

It would seem possible then that if our plan of choice dropped one of our

major medications, we would be forced to pay for that medication out of

pocket until we could change to a new plan. However, we would be stuck

paying premiums and not be covered for the medication that we needed.

Number three is co-payments and they could be different from plan to plan

also. This area would be very important when a person is taking multiple

prescriptions and should be considered in the cost of the total plan. But,

even the best plan that each of us could come up with may be changed by the

company. They can increase the cost of medication anytime they want. We

don’t want to forget, that by law, we are not allowed to negotiate the price

of the drugs. We must pay whatever the drug firms feel like charging.

Also, when considering co-pays, each of the 40 plans will have different

levels of co-pays. And, the amount that we have to pay will be different for

each level. In other words, if we have three or four prescriptions, the

co-pays could be different for each one – and probably will be.

Fourth is deductibles and, like other areas, they can be different from plan

to plan. The good thing here is that the companies can only change the

deductible rates on an annual basis.

The last item to be considered is what “they” call the pharmacy network.

What this means is, after you figure out the best plan for yourself from the

items above, you may not be able to use your favorite pharmacy. Each plan

will have its own list of pharmacies to choose from.

One other financial matter to be considered is the possibility that a person

who does not need any medication today and decides not to take any of the

plans, but in the future will need to have a plan, must pay a penalty. There

is a penalty of 1 percent per month up to 60 months if you do not choose a

plan now. So, if you go five years without a plan and then decide to buy

into a plan, you will pay 160 percent of the normal premium cost as a

penalty. This does not apply if you have had another insurance from, for

example, a company where you work or your company’s retirement plan.

I asked a lady who is 88 years of age what she was going to do and she said,

“I threw all that stuff away.” She also said, “I like what I have so I am

not going to change.”

Well, she is being forced to change. She just did not understand.

For those of you who are having trouble trying to figure out the new

Medicare drug system, don’t feel like you are the only one. Everyone I have

talked to has concerns.

I talked to a person who manages an infirmary and was told that they had

sent their “insurance expert” to four seminars in an effort to learn what

would be best for each of their patients. Their expert still isn’t sure.

Folks, I hope that I have helped and not confused things even more. But the

more I learn about this new Medicare plan, the more concerned I become. The

new plan is not about people. More pointedly it is not about helping our

seniors. It is about funneling money to drug firms. It is about stopping us

from buying in bulk. And, it is about stopping us from buying our

medications in Canada and Mexico.

For certain, it is about stopping us from forming groups and negotiating

drug prices. It is about dividing us so that each of us stands alone. All 40

million of us will have our own plan.

I sincerely hope this plan will help some of our Medicare users. But it

looks like this is a subsidy for drug firms and the 40 or so insurance

companies. It also looks like it will help the large chain pharmacies, which

are already hiring people and gearing up for the increases in their

businesses. This could be the deathblow for the small, locally owned

pharmacies because they will not be on the lists. All these companies, drug

firms, insurance companies, and pharmacies have to make a profit and that

profit will come directly from our pockets.

The World Trade Organization won’t allow us to subsidize our farm families,

but they sure are quiet when we subsidize large drug firms.

Bill Horne is a professor of economics at Southern State Community College

and a columnist for The Times-Gazette.

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Now, as the year of reckoning arrives, the true cynicism of Bush’s program

is becoming evident to each senior citizen (or adult child of senior

citizen) who attempts to fathom what Bush and the industry lobbyists

wrought.

For starters, coverage is woefully inadequate. You pay a $250 deductible and

then a 25 percent co-pay on the first $2,250 of drug benefits each year,

plus roughly another $450 a year in premiums. So if your prescriptions cost

$2,250 a year, or about $190 a month, for prescriptions, you pay $1,200 a

year all told and the plan pays just $1050.

That’s pretty shabby. But then, the truly bizarre feature of the plan kicks

in. Coverage simply disappears, until you have spent nearly $3,100 out of

pocket. This is the infamous " hole in the donut. " Coverage kicks in again

only after a total of $5,100 in prescription costs.

A great many seniors will never get the coverage because the plan is a bad

bargain, and they just won’t sign up. Of if they do sign up, they will run

out of the ability to pay enough out of pocket before qualifying for needed

benefits. Even with these disgracefully skimpy benefits, the plan is

expected to add over half a trillion to the federal budget over the next

decade.

Why would anyone have designed such an insane program?

Because the political purpose was never to deliver good benefits. One

administration goal, running the program through the private insurance

industry, conflicted with the imperative of a clear, cost-effective plan.

Seniors must evaluate innumerable competing private plans, each with subtle

differences in costs and benefits that make an impenetrable program even

less fathomable, and raise total costs because each of these private plans

tacks on a profit. This was a case of privatizing something done far more

efficiently through a direct government program.

The second administration goal, fattening the drug industry, led to a

provision explicitly prohibiting the government from negotiating bulk price

discounts from drug companies, as the Veterans hospitals do. As a result,

according to a study by Families USA, drug prices obtained by the VA are

about 48 percent less on average than those expected to be charged to people

enrolled in the Medicare drug program. Among the twenty most widely

prescribed drugs for seniors, for instance, a year’s supply of Protonix (for

ulcers) costs the VA $253, but the seniors in the Bush Medicare program,

which prohibits such bulk discounts, pay a sticker price of $1,080. That

will give you ulcers! A year of Zocor, the cholesterol-reducing drug, costs

the VA $251. Seniors in Bush’s drug plan get whacked for $1,323.

It was these inflated costs that necessitated some gimmick to keep down the

overall cost to taxpaypers. Hence the notorious donut hole.