Tuesday, May 09, 2006

The Bush Mediocre Prescription Drug Plan

Have any of you had a chance to review the President’s Medicare Prescription Health Care Plan? I suspect that most of you have not, unless you are currently uninsured like over 40 million Americans, or you are currently on Medicare without prescription coverage. Or like me, you have an elderly parent who has been paying for medications out-of-pocket for years and who is watching a lifetime of savings dwindle with each prescription refill. Maybe, like me, you are living on disability and have received a letter from your former employer telling you that the plan they are providing you this year is at least as good if not slightly better than the option this President has chosen to put before American taxpayers. They likely have recommended that you stay put with their own plan...for now.

It is the phrase “this year” that is worrisome for me, personally. It implies to me that there is at least a hint that “next year” I will be told to enroll in the Mediocre Prescription Health Benefit Plan endorsed by a thin majority of the Republican Party. Have you heard about the “doughnut hole” in the plan? If not, let me explain, because I sorted through this quagmire with my Mom earlier this year.

First of all, this President and his cronies have once again sided with business over the common man. His plan gives insurers the power to choose which of your medications are covered and which are not. They can change their minds from one year to the next about which drugs are too expensive and which ones they will no longer cover. They may cover one drug in a drug class and force you to choose between paying full price for your own particular prescription or taking another drug than the one you might need. In the case of AIDS medications, that can mean that they will pay for a drug that you can no longer take because of side effects or a drug that is not working for you while the drug that you need is deemed too expensive and is not covered. I find this unethical for patients who have been covered by better insurance in the past.

The overall effect of the plan is seemingly buried in tons of detail that you have to sort through for your own personal situation. The phrase "Baffle Them with Bullshit" comes to mind. First, there is the list of providers. Depending on your state, there are different insurers available. In North Carolina, there are only about a dozen or so plans. I heard from a friend in New York that there are many more plans available there, nearly 50. Next, you have to list all of the medications that you are currently taking for your health status at this time. Here the quagmire really starts to suck you in. If you are not lucky enough to have a pharmacy that will provide you a chart comparing the list of providers to your current list of medications, then you have to call each of the plans individually and find out which plan covers which of your drugs and at what rate. Or you can go to their or the government sponsored websites that provide this information for you. Have you ever watched an elderly person with rhematoid arthritis try to type? It is easiest at this point to shop around for a pharmacy that will do the homework for you and get them to print out a chart comparing the plans to your situation.

So now, assume you have found a pharmacy and you have your chart in front of you and you live in North Carolina. The chart should list the name of each plan and has a minimum of 4 columns. The first is the amount of money per month that you have to pay out-of-pocket just to participate. This is your plan premium and it varies from plan to plan from a low of about $20 to a high of about $85 per month. But be careful, the difference in this premium affects out-of-pocket expenses and drug availability in the next few categories.

The remaining columns list the drugs that the plan pays in full, in part, or not at all and the deductible that you will be required to pay for each of these categories. For example, some older drugs are so cheap that each of these companies will likely include them in their complete coverage plan. In reality, you may pay a few bucks for the drug if you buy it yourself, but if you use your plan, you will be required to pay the deductible for your plan for that drug. In some cases, that might mean paying a much higher price for the drug than its original price. In the middle category of drugs that are partially covered, you will have a higher deductible to offset part of the price of the drug for the insurer. The last category lists your medications that the plan will not cover under any circumstances. It often includes the most expensive and most needed drugs for people with life-threatening illnesses.

So you go through the plan and figure out what you will pay per month for your premium. For each drug you take, you will have to calculate how much you will pay within a particular plan in a month. You add all that money up and you will find out the true value of the Bush plan for each prospective insurer. You do this for each of the plans and then compare the overall costs for your current list of medications. At the end, if you have done so properly, you will have figured out which plan is financially most beneficial to you. For the pharmaceutical and insurance industry, this is all unnecessary. They know in advance that they will bleed the life savings from the pockets of the elderly and sick and the poor and their stock prices will soar to fill the pockets of the international investor class. The only difference for them for now is the rate of the blood flow from your wallet.

But I digress….

Oh yes, the doughnut hole…There is a nice little feature in this plan that allows the insurers to pay for the meds that they choose at the rate that they choose for a short time, until your expenses reach a certain threshold and then they stop paying completely for a while. This is the doughnut hole. The insurers quit paying for your meds and continue not to pay while you fill your prescriptions. When you have exhausted a substantial amount of your hard-earned money for your medications, the plan kicks in again and payments are made for your meds. Of course, you can always buy a plan that provides coverage in this gap at a higher premium for you. This information was taken from the Medicare Prescription Plan FAQ page, but may only represent an average across all the plans. It is hard to be sure. I have heard that the doughnut hole can amount to as much as $5000 out-of-pocket per year although the government site seems to tell us that you only pay out $1350/year.

By the way, I love the way that this plan is being presented as good news to Americans. “America, Pull up a chair. We’ve got something good to talk about….” See the home page for the Medicare Prescription Plan. Does it remind you of the old “duck and cover” films about nuclear attacks in any way? “After the blast has subsided, come out from under your desk, brush yourself off and go immediately into your bomb shelter.” I particularly like the way it tells you that you can talk about this information at your kitchen table, in your churches, in senior centers, with friends and anywhere you want. In fact, the information is so confounding, you might find yourself talking to yourself about it, but they forgot to allow you to do that.

Now, assume you found your plan and you signed up. You will start to receive some benefit from this plan. If you did not have any insurance in the past, you might find yourself gaining from this plan, for a while, at least. If you formerly had a decent prescription drug plan from an ethical business, then you will probably find this new plan to be lacking. Additionally, you might go through the first year to find that when the time comes to renew the plan that there is no longer coverage for some of your medications and you will have to choose a new plan next year to better suit your needs. Or worse, suppose you fall ill and require a whole series of new and expensive drugs in the next month after you have signed up. If those drugs are not covered by your existing plan, you will have to pay for the drugs until you can find a new plan that will cover them during the next year’s enrollment period.

I do not yet see anything to help people with catastrophic illness in this plan. In my case, with about 20 different prescriptions that have to be filled, I will likely eat my doughnut hole in January of each year after signing on. I may as well start budgeting for a loss of that amount of money, whatever the true cost is, every year. This will likely eat my life savings in a very short time.

The most disturbing trend that I anticipate from this horrible fiasco will come with time. Companies that employ American workers will decide that this plan is the benchmark toward which their insurance coverage should spiral. If you had good insurance before, once this plan is in place, you might well receive a letter saying that to cut costs, your employer has reduced your prescription drug benefits to the lowest common denominator that businesses will support. We might well see good insurance plans be replaced by mediocrity. It makes me lament that our National Motto should be "Anything is better than nothing at all, right?"

It used to be that a company had the intention of offering the best possible benefits packages to their employees in order to retain them. Now, though, it seems that CEOs are making multi-million dollar salaries and taking home enormous stock options while the average Joe is suffering under the yoke of work and trying to remain healthy at the same time. After all, take too many sick days and you get fired and lose all your benefits anyway, right? So you come to work sick and make everyone else there sick too. Nice incentive program…

Finally, like the war in Iraq, the President seems to have misrepresented the cost of this program to push it through Congress. In these two articles, you can read more about his program. An article in Wikipedia states that the original estimated cost of the program of $400 Billion was understated by $135 Billion at the time the bill was considered by Congress and was passed by a slim majority. In an article at Slate.com, Jacob Weisberg describes “Why Bush’s Prescription Plan is such a fiasco.” I recommend you read his article and compare it to the government’s website.

Why do we as Americans take this crap? Why can’t we expect more from the government than the destruction of foreign countries and the rebuilding of their infrastructures when our people are treated to profiteering by capitalism-gone-unchecked? I used to have a Canadian friend who eventually lost his struggle against AIDS. We once discussed the Canadian plan for prescription drug coverage. “I go to the doctor, take my card, and he treats me. I go to the pharmacy, I give them my card, and they give me my meds,” he said. Eh? Doesn’t this sound so much simpler and so much more humane? Oh wait, that smacks of socialism. We are supposed to find fault with socialism. I think that must be stated on one of the government websites somewhere.



Anonymous Daniel Haszard said...

Appreciate your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard www.zyprexa-victims.com

5/30/2006 03:00:00 PM  
Anonymous Anonymous said...

I work at a Canadian mail order pharmacy www.rfdrugstore.com. If you are forced to sign up with plan D, or if you don't want to check out our prices. Sometimes we are better then D, sometimes we're not. If you do go with Medicare though, you can save by ordering from here AFTER you have reached your cap and that'll save you the cost of regular retail pricing. You can also use us for some of your drugs if they are not on your plan's formulary. We are not associated with Plan D, but we can definitely compete with it.

6/16/2006 12:43:00 PM  

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