At a recent town hall-style meeting for seniors on Medicare, Congresswoman Lois Capps, D-23rd, asked who among the Oxnard-area crowd had signed up for their Medicare Part D prescription drug benefits. A third of the audience raised their hands.
“Part D” went into effect in January of this year, ostensibly to provide greater prescription cost coverage to seniors and the disabled. But as Mark Nichols of the California Alliance for Retired Americans explains, the benefit package offers “about 47 options, with tiers,” complicating the decision-making process for those eligible. Added to this is the threat of higher premiums for those who miss the May 15 deadline to enroll.
“We think too much flexibility was given at the expense of beneficiaries,” said David Lipschutz, a staff attorney for California Health Advocates who also spoke at the panel meeting last Thursday. Further, he noted that not all Part D plans contract with all pharmacies, and that prior authorization, which requires permission from the plan for coverage of certain drugs, was an obstacle for many patients. Additionally, there is the risk of getting “locked into” a specific program: Once enrolled, it is extremely difficult to change plans and, in most cases, a patient can only do so once a year.
Capps recalled Lipschutz’s testimony before Congress on the issue: “He showed how inconsistent this program is with the level of respect that people with disabilities and seniors deserve.”
To that end, Lipschutz introduced his summary of Part D benefits by saying, “Just know: This doesn’t make sense.” What followed was a step-by-step explanation of a standard Part D package: In all plans, the deductible is no more than $250. The beneficiary must pay 25 percent of the next $2,000 in drug expenses, and the plan covers the rest. Next is “the doughnut hole”: Ensuing expenses from $2,251 to $5,100 in total must be paid entirely by the patient. After what Lipschutz referred to as “the catastrophic limit” — or $3,600 in out-of-pocket expenses — Medicare kicks in again, this time paying 95 percent of remaining costs. Lipschutz added that this plan was designed to help people with very high drug expenses.
Dana B. Nelson of the California Pharmaceutical Association said that pharmacists were having difficulty with the plans themselves, and outlined what he viewed as “The ugly, the bad, and the good” of Part D. He noted that a survey of pharmacies throughout the state showed that two-thirds are still having problems processing Part D patient claims, 25 percent reported prior-authorization issues, and 55 percent reported continued difficulty being able to identify to which plan a patient belongs. Additionally, 52 percent said that patients’ lack of knowledge regarding their plan was the biggest obstacle. While Part D had its benefits, Nelson concluded, it currently “increases a pharmacy’s workload.”
Capps came to the podium with several actionable ideas, while allowing, “We needed to add a drug benefit to Medicare; we just didn’t do it the right way.”
She charged that there were two outside forces that had played too large a role in the development of prescription costs: insurance companies and drug companies, and that too much power had been given to them. Consequently, she said, they could switch their plans around, while recipients were unable to do the same.
Addressing the problem of the cut-off date, she announced that on April 20, 48 senators had sent a letter to Senate Majority Leader Bill Frist, asking him to extend the deadline. The resulting bill, HR 3861, would grant eligible Medicare recipients seven and a half more months — or until the end of the calendar year — to enroll in a Part D option without the threat of increased premiums.
In attendance at the panel were pharmacists, representatives from the Social Security Administration, and counselors from the Health Insurance Counseling and Advocacy Program. All agreed that the new prescription plan options were overly complicated, and that a May 15 deadline wasn’t feasible for most recipients.
“I’ve heard some compare it to a timeshare presentation,” explained Nichols of the fast-approaching Part D deadline, “with apologies to timeshare presentations.”