Medicare Card "Fixed" the Problem? Guess Again

Thursday, April 13, 2006

Medicare Card "Fixed" the Problem? Guess Again

Earlier this week, during an appearance in Missouri to tout the new Medicare drug benefit, President Bush chatted with a pharmacist named Jodie Baker:
PRESIDENT: “… Listen, there were people literally choosing between the electricity bill and pharmaceuticals.”

BAKER: “Yes, or food.”

PRESIDENT: “And that's not right in this country. And this program fixed it."
No, it did not. Although it’s true that the Medicare drug benefit card is cutting costs for many seniors, it is a total whopper to claim that the program has “fixed” the fundamental problem of rising prescription drug costs.

For starters, most of the seniors who are participating in the Medicare drug card program were already covered under other Rx plans. Many seniors have still not signed up for one of the program's plans.

Even for those who participate, the drug prices under the Medicare drug benefit card lag behind the prices negotiated under other government programs.

For example, late last year, FamiliesUSA released an analysis in which it compared the prices of 20 widely prescribed drugs under the new Medicare drug card to the prices negotiated by the Department of Veteran’s Affairs. The DVA’s prices were lower on 19 of the 20 drugs. The gap in median prices was a whopping 48 percent.

Prices charged to consumers could be cut more if the administration allowed drug re-importation from Canada, or if the federal government created a national purchasing pool.

Access is also an important issue even though it gets overshadowed by the debate over cost. Although there are many different plans from which seniors can choose under the Medicare drug card, different plans cover different drugs. Suppose you take Prilosec to treat stomach ailments and use Flovent to control asthma. Finding a plan that provides coverage for both of those medications may be very difficult.

For some people, switching to another drug that is covered may be inconsequential. For others, such a switch can take a toll on their health because other drugs may not work as well or may cause dangerous side effects.

Even worse, you may find a plan that covers the multiple drugs you take only to see that situation change within a matter of weeks. Why? The private insurers who operate the Medicare drug card plans are free to change the drugs they cover and the pharmacy network they use to dispense these drugs — and they can make these changes throughout the year.

Participants have far less freedom; they can only change plans during the “open enrollment” period.

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