11-27-06, 12:00 pm

It has been almost a year since the implementation of Part D, a prescription drug benefit plan for seniors as part of the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. So far, drug and insurance companies are pitching a shutout against the most vulnerable population among us, seniors. The prescription drug policy, to date, has been nothing less than chaos for seniors across the country.

One month prior to taking effect (December 2005), media reports revealed that the Bush administration had withheld valuable information concerning the actual costs of the new legislation, leaving the country in the dark about what will be the real cost to taxpayers. Be assured, however, that the private sector actuaries had a reasonable idea of what their profits would be.

That same month, the administration reported that some 21 million seniors would have prescription drug coverage on the first day of implementation in January. But, at the time of this announcement only one million seniors had actually enrolled. Of approximately seven million of the most vulnerable low-income seniors, only about one million had been enrolled after the first week of the program. By April 2006, only about two million were actually receiving low-income subsidies for prescription drugs. Furthermore, during the early weeks of the program, human service workers who assisted seniors with signing up reported that the 2006 Medicare Handbook provided misleading information and had created much confusion among seniors. Complete bureaucratic chaos reigned during the first weeks. Computer systems responsible for merging the beneficiary data from CMA (Center for Medicare and Medicaid), SSA (Social Security Administration), the 50 states and prescription drug plans for use by pharmacists failed. Pharmacies, in many reported instances, could not determine who was actually covered. There was mass confusion and anger among seniors and their families on discovering that a particular drug needed wasn't covered by their chosen insurance plan. Another problem was the overcharging of low-income patients who thought they had qualified for program subsidies according to the law. Congressman Dennis Kucinich (D-OH), in a letter to Director Mark McClellan of the Center for Medicare and Medicaid Services (CMA), complained that many of the low-income seniors in his district were being forced to pay up to hundreds of dollars for drugs, instead of the $1 to $5 co-payment specified in their contracts.

What became so appalling to many during the early days of implementation was the fact that drug companies, according to the law, had the authority to change the costs of a drug on their list, or remove it from the list whenever it pleased. Now, it is obvious that either of those decisions would be profit driven, or what was in the best interest of the company and not the welfare of seniors. Seniors on the other hand did not have a choice. Once a plan was chosen they had to stay with it unless there were some extraordinary circumstances. Every senior would need a lawyer to figure out the circumstances. Some seniors after signing up for a plan soon discovered that it did not cover all of the drugs needed. Now they are stuck with it until the next sign up period.

Shouldn't that senior have a choice to seek a new plan immediately that meets her/his drug need?

Before the end of the first month low-income seniors were leaving pharmacies without their drugs after being told they would have to pay co-payments of $100 to $250 more. Matters became so bad for seniors that the Republican Governor from Arkansas and Chair of the National Governors Association Mike Huckabee called for a public health emergency. Twenty other governors declared public health emergencies and undertook actions to cover prescription drug costs for low-income seniors. President Bush in an attempt to respond to the growing crisis issued an order to insurers that they must provide a 30-day supply of any drug that a senior was taking prior to the law; and no senior should be made to pay or charged more than a $5 co-payment. The insurance companies continued to exacerbate the problem. In April insurers sent out letters notifying thousands of seniors who had properly enrolled that they may get kicked out of the system because their premiums had not been paid. The response from many seniors to the letters was we have already paid. Part of the problem is that it sometimes takes two months to process claims; an example of the computer failures aforementioned.

The deadline for seniors to sign up for the new drug program was May 15, four months after implementation. With all of the problems being encountered by seniors, from eligibility rules, confusion regarding the appropriate plans, misleading information in the Medicare Handbook and/or other instructional materials, and computer failures, some Congressional leaders began calling for an extension of the sign-up date from May to the end of the year. This would have given seniors additional time to figure out the bureaucratic maze, and allow the government, insurance and drug industries to 'get their act together.' But, under threats from Republican leaders to repeal the entire prescription drug program, Congress voted not to extend the deadline. Why not just humiliate the seniors some more?

Windfalls and Profits for Corporate America

Although some of the administrative and/or bureaucratic problems with implementation have been reduced, some seniors have been able to receive some coverage (meager) from the new law, but major problems continue, especially for low-income seniors. But so far, and it is expected to continue, the real benefactors are the insurers and pharmaceutical companies.

While seniors, especially low-income seniors, are struggling to obtain affordable drugs, the drug industry and insurers are reaping great benefits or 'windfalls.' Yes, there is good news for the drug industry as recently pointed out from a research project from Families USA titled: 'Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices.' The first observation was that nothing was being done by the drug plans to control or contain the ongoing astronomical rising costs of prescription drugs. Now, did we really expect the drug plans to have measures for containing costs in a free market economy? Health care in the United States, including prescription drugs, is a major for-profit industry. The new law allows for 'windfalls' or major profits to take place. Let's not forget that the law also provided major incentives to the corporate giants to participate in the program.

Families USA's research projected that drug prices under Medicare Part D are significantly higher than the drugs obtained for veterans through the Department of Veterans Affairs. The major reason is that the Department of Veterans Affairs has the authority to negotiate drug prices directly with the drug industry. But, if you listen to the Bush administration officials, specifically Mark McClellan, the rhetoric is that the discounts under Medicare Part D plans are superior to anything that could be accomplished through direct government negotiations as done by the Department of Veterans Affairs. It has been estimated that this year alone the drug industry will earn in the neighborhood of $2 billion in the form of a 'windfall.' This 'windfall' comes at the expense of the poorest of the poor seniors.

This is the population prior to the implementation of the new prescription drug law that was referred to as 'dual-eligible.' In other words, they were eligible for both Medicare and Medicaid services. Prior to the law they came under the federal/state Medicaid partnership program for low income, or poor consumers. The new law stipulated that this group would be transferred to Medicare for their prescription drugs, but will continue to receive other health/medical services under Medicaid. They were automatically moved into private Medicare plans even when they did not sign up. The new law stipulates that drug prices be negotiated between the drug industry and the various prescription drug plans, or commercial insurers. Under this arrangement the state governments, unlike before the new law, have no role; they become onlookers in the process. Well, what can we expect from an arrangement between drug companies and the commercial insurance industry? The experiences for this group of seniors are now worse than what they were prior to the implementation of Medicare Part D when their prescription drug needs were under the state Medicaid program.

Let's look at another example of corporate greed taking place. In an examination of prescription drug plans under corporate control prices or the top 20 drugs commonly prescribed for seniors, drug prices have increased significantly since the program took effect. For example, Zocor, a cholesterol-lowering drug, all of the plans or 100 percent of the plans had increased their prices; 99 percent of the plans had raised their prices for Fosarmax, a drug used by seniors for osteoporosis; 99 percent of the plans had increased their prices for Lipitor, another cholesterol-lowering drug; 96 percent of the plans had increased prices for  Actonel, Toprol, and Xalatan, drugs commonly prescribed for osteoporosis, high blood pressure, and glaucoma; and 92 percent had increased their prices for drugs such as Aricept, and 89 percent for Plavix, two drugs commonly prescribed for Alzheimer's disease and strokes.

In passing legislation that prohibits Medicare from negotiating and bargaining for lower prices, as the VA does for the veterans, the drug industry is now in a position to greatly benefit from 'windfalls,' while drugs become more and more unaffordable for seniors. The implications for these price hikes are that seniors, most on fixed-incomes, will be called on to pay more of the bill while the drug industry continues to roll up record-breaking profits. So, how does one explain the ongoing public relations campaign by the Bush administration claiming the effectiveness of Medicare Part D, prescription drugs?

Conclusion

Medical care, including prescription drugs for seniors, is a basic human right. Every person, from cradle to grave should have the right to develop to her or his maximum capacity, physically, socially and emotionally. The deciding factor should not be a person's status or social class in life in a free market arena. That seniors are denied or confronted with barriers by corporate greed the opportunity to live a life with dignity is an indication of the country's character. There is little respect for a cohort of Americans on whose backs this country was built. Profits and greed cannot take precedence over human dignity. Until medical care, including prescription drugs, is a basic human right, and all levels of profits are removed, we will continue to see seniors struggling to survive in the wealthiest country in the history of the world. We owe seniors a life with dignity and the opportunity to just grow old gracefully without shame.

The country needs a uniform, comprehensive system of prescription drug coverage, and most important free of influence by a market economy. Seniors do not need to be confronted with multiple prescriptions drug plans and trying to figure out each month if to buy groceries or save for drugs' co-payments. We need a plan similar to the Department of Veterans Affairs but with a cost ceiling, similar to Canada's, for negotiations. It should be the Medicare administration negotiating with drug companies not the private insurance companies. This has to be our most immediate goal where all social actions in the future should be focused.



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