A Prescription Program Partly From Hell

[Guest guest]

A Prescription Program Partly From Hell

Millions of elderly and disabled who should benefit

from the Part D Medicare Prescription Drug plan no

doubt will be grateful when the plan's bizarre

complexities are worked out so most of them can get

access to the program, which doubtless will take a

while.

Even then, however, the plan will continue to have

many pernicious aspects. High on the list is the

notorious " doughnut hole " or gap in coverage between

$2,250 and $5,100, which, after policyholders pay

deductibles and copays, could cost those with high

prescription costs as much as $3,600 out-of-pocket in

a single year. That's more than enough to deny needed

prescriptions to many if their income is low but not

low enough to qualify them for the plan's " Extra Help "

provision that exempts the very poor from the doughnut

hole. (Also exempted are MassHealth (Medicaid)

recipients and poorer Prescription Advantage members.

Some high-cost private plans also cover the doughnut

hole.)

We used the word " pernicious " above quite advisedly to

describe many other features of the plan which are

deleterious to taxpayers and the plan's beneficiaries.

For instance, the Congressional " point man " for Part D

(the so-called " Medicare Modernization Act " ) when it

passed in 2003 under the leadership of President Bush

was Representative Tauzin (R-La.), who quickly

left Congress after its passage to become president of

the lobbying arm of the pharmaceutical industry. The

fact the bill actually forbids Medicare from using its

enormous purchasing power to negotiate with

pharmaceutical companies for lower prices (as do some

other federal agencies) can reasonably be seen as a

product of that industry's pernicious influence in

Congress and the Administration. The result was the

rejection of immense savings the plan might have

realized.

The privatization of the plan through many scores of

health insurance companies, HMOs and other, usually

profit-driven entities is another clearly pernicious

feature, partly because it is the source of the

immense confusion that is depriving many seniors and

the disabled of their drugs as pharmacists (including

in Shelburne Falls) and state officials try to sort

out which plans each of the Part D eligibles come

under or may come under. The eligibles themselves

often don't know which plan to choose because

accessing information on the many plans takes computer

expertise many of them do not possess, if they even

possess computers. Much of the confusion stems from

the fact the private entities offer widely varying

plans in terms of what drugs are covered and what

premiums, copays and deductibles are charged. One

result in some states, the New York Times reported

Saturday, is that many seriously mentally ill patients

are being deprived of medications that stabilize their

condition, and thus they must be taken to hospitals

for emergency treatment at a far higher cost to

taxpayers. Several states have declared public health

emergencies.

The privatization feature has other serious flaws,

prime among them higher costs, because 1) overhead is

much higher for the private entities than it would

have been if the plan had been written so that

Medicare, with its much lower overhead, had simply

been given the job of running the prescription plan

all by itself and 2) because the private entities are

spending untold millions of dollars on advertising,

each for its own particular plan. All of these costs

will be paid by taxpayers through federal subsidies

for the private plans or by recipients through higher

prices. An interesting sidelight here is that

Scully, a former hospital industry lobbyist who was

appointed by President Bush to head up Medicare,

threatened to fire his chief actuary if the actuary

blew the whistle to Congress in 2003 on the true

projected cost of the program, which, now that the

truth is known, is expected to add much more to the

already overweening federal deficit than the earlier

official projection.

Finally, the plan largely privatizes the prescription

drug functions of state-operated Medicaid plans, such

as MassHealth in Massachusetts, and of state pharmacy

assistance programs, such as the Massachusetts'

Prescription Advantage program. Many states were

moving toward their own arrangements, including

multi-state ones, to save money by negotiating with

pharmaceutical companies for lower costs for all state

programs that covered prescriptions, including the two

above as well as state employee health plans and

others. (A bill in the Massachusetts Legislature, " the

prescription drug fair-pricing bill, " would also have

extended the benefits of the lower prices to all in

the state who lack prescription coverage.) But

privatization under Part D of the largest state

prescription program, Medicaid, may throw a monkey

wrench into these plans, and state Representative

Denis Guyer (D-Dalton) was particularly acerbic in his

comments on what he saw as Part D's subversion of

states' rights, which supposedly are sacrosanct to the

GOP authors of Part D.

Some conservatives blame Part D problems on what they

regard as the general fecklessness of federal programs

(partly true, of course, when President Bush appoints

incompetent cronies to high federal positions) but

most of the problems clearly stem principally from the

pernicious influence on the President and the Congress

of the pharmaceutical and health-insurance industries

in the formulation of the plan in 2003. We are hoping,

although without high expectations, that President

Bush in his State of the Union message January 31 may

offer some realistic long-term remedies for Part D's

problems beyond the short-term stopgap measures he

already has put forward. In the meantime, we suggest

to the many Part D-qualified people who are still

confused that they call the SHINE (Serving the Health

Information Needs of Elders) program for help at

1-.

Meanwhile anyone interested in learning about the

pernicious machinations of the drug companies could

not do better than to read a book, The Truth About the

Drug Companies, by Marcia Angell, M.D., former editor

of the New England Journal of Medicine.

Dick Gilluly

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Regards,