The high cost of prescription medicines used to be a hot-button campaign issue. Electioneering politicians would empathize loudly with senior citizens who had to choose between buying groceries and paying for pills.
You won’t hear about prescription drug prices during the coming election season. That’s because Congress passed legislation called the Medicare Prescription Drug, Improvement, and Modernization Act. It went into effect in 2006 and defused much of the uproar about seniors not being able to afford their medications.
How well is Medicare Part D working? This prescription drug plan was supposed to ease the burden for senior citizens who take multiple medications for chronic conditions.
Many have benefited. According to research published in the Journal of the American Medical Association (April 23/30, 2008), only about 10 percent of eligible seniors now remain without any prescription drug coverage.
In the basic Part D plan, the individual pays a monthly premium. The deductible ($275 in 2008) is paid by the insured before any cost savings kick in. Then, the person pays 25 percent of his prescription bills, up to $2,510 (2008).
So far, so good. But once drug bills reach that limit, many of the insured fall into a big black donut hole. Researchers found that only 40 percent of seniors knew about this coverage gap ahead of time.
In the donut hole, people cover every last penny of their prescription drug costs out of their own pockets, unless they have purchased a plan that offers assistance. (Plans are not required to cover the gap, and charge higher premiums for doing so.) They emerge from the donut hole only after a total of $5,726.25 has been spent at the prescription counter. Usually, more than $4,000 of that comes out of the person’s own pocket.
Hitting the donut hole can come as quite a shock. We heard last fall from a woman who had been treated for breast cancer: “I have exceeded my Medicare drug coverage limit and must now pay the full amount for my Arimidex prescription.” That runs $200 to $300 per month for a medicine to keep the cancer from recurring.
People who have very high drug bills may well emerge from the other side and benefit from the catastrophic coverage that kicks in at that point. They shell out only a small co-pay, $2.25 for generic and preferred drugs or $5.60 for other drugs, with the rest of the tab picked up by the plan.
Part D was supposed to make it possible for senior citizens to afford the drugs their doctors prescribe, but one study found that the poorest and sickest Medicare beneficiaries were still skipping some medicines because they were concerned about costs.
Another study found that those who were least knowledgeable about Medicare Part D were also most likely to do without other necessities such as groceries or electricity.
Medicare Part D means that politicians will not be talking about seniors dining on dog food or bussing to Canada to smuggle in blood pressure pills because of the high cost of prescription drugs. But many Medicare citizens will be feeling the pinch by Election Day. Part D may have calmed the controversy, but it hasn’t solved all the problems, particularly for those most in need.
