Fix Part D Hearings Schedule!

[Promoted by Chris]

Millions of seniors and people with disabilities who depend on Part D for prescription coverage will hit the “donut hole”. The donut hole is a gap in coverage. Prescriptions are paid for until the amount of $2250 for the cost of the prescriptions is reached.

According to CMS, if a drug costs $150 and the beneficiary’s co-payment is $40, the full $150 is calculated toward the “donut hole”/coverage gap.

During the time period that a person is in the “donut hole”, he/she is also responsible for the payments on the policy, in addition to the costs for prescriptions until the amount of $5100.00 is paid. This results with $2850.00 that must be paid by a person who is on a fixed income. Millions of people who aren’t aware of the donut hole or its severity will be unable to afford their prescriptions.

continued below
In response to the unfair restrictions re: Part D, specifically, the closing of enrollment and the “donut hole”/coverage gap, a group of seniors went to Congressman Ray LaHood’s office Thursday with empty pill bottles, symbolizing the thousands of prescriptions that will go unfilled because of both.

In addition, the Illinois Alliance for Retired Americans wrote a letter to Congressman LaHood, requesting the deadline be changed.

Nancy Gardner, of the Illinois Association of Retired Persons:

“The penalty of one percent of a month means that by the end of this year they were going to have a 7 percent penalty. That’s what they would have and, not only that, but they aren’t going to be able to get their drugs filled between now and then. They’re not going to have any insurance and a lot of them are the ones that need it the most, the ones that can’t understand it are the ones that need it the most.”

LaHood was unavailable, but a member of his staff did listen to the group’s concerns.

In addition, a second group, Citizen’s Action Council, echoed their concerns.

Third, Americans United announced will hold 18 ‘Fix Part D Hearings’ in 14 states. Members of Congress and their staff will receive testimony from seniors, the disabled, and other experts on Part D. Real ways to fix it will be offerred. Americans United, along with state affiliates of national partner USAction, will also show video produced by the national health care consumers group Families USA.

The video is titled “The Problems with the Medicare Drug Program – and How to Fix Them”. It will be narrated by Walter Cronkite. Members of Congress will be asked for their support on Americans United’s plan to fix to Part D, which is briefly explained below.

Americans United Plan to Fix Part D

Reduce the cost of prescription drugs by requiring Medicare to negotiate lower prices from drug companies,
Close the “donut hole” referring to the gap in coverage for annual costs between two thousand two hundred fifty dollars and five thousand one hundred dollars which will result in millions of seniors being denied coverage each year while they still pay monthly premiums
Allow seniors the choice of obtaining their prescription drug plan directly from Medicare–instead of from a private insurance company.
Prohibit insurance companies from dropping drugs after a plan stats if people are prohibited from switching plans
Re-open Part D enrollment and waive the late enrollment penalty until Part D is fixed.

Jeremy Funk, spokesman for Americans United:

“It’s important that Congress hear concerns directly from their senior and disabled constituents who have either been locked out of the Part D program until next year with no coverage and those who will soon find themselves within the program’s massive coverage gap while still paying costly monthly premiums. They need to hear first hand from people hurt by the costly and corrupt nature of the program and they need to support meaningful fixes to make it simple, affordable and guaranteed. Part D was written by and for the special interests. There’s no other reason why Medicare would be prohibited from negotiating lower prices with the drug companies. There’s no other reason why seniors are forbidden from getting a drug plan directly through Medicare. There’s no other reason why the private insurance plans are allowed to drop coverage for specific drugs at any time while seniors are locked into their plans.”

SCHEDULE
Fix Part D Hearings’ Schedule

AZ 6/1 5:00 PM Speakers: Nick Nyhart – Executive Director of Public Campaign

Hope Hall, Grace Lutheran Church, 1124 N 3rd St, Phoenix

CT New Briton

FL 6/1 2:30pm, Palm Harbor Community Center, 1500 16th St., Palm Harbor

IA 6/20 1:00 PM, Waterloo Public Library,Waterloo

IN 6/5 10:00am
Town Hall
North United Methodist Church, 38th and Meridian Streets, Indianapolis

6/8 10:00 am
Town Hall
The League for the Blind and Disabled
5821 S. Anthony Blvd.
Fort Wayne

MD Longbranch Senior Center, Silver Spring

ME 5/31, 10:00 am, Hammond Street Senior Center, Bangor

MN 5/31, 10:00 am, Senate Hearing Room 112, MN State Capitol, St. Paul

MO 5/31, 1:00 pm, Palestin Senior Activity Center
3325 Prospect, Kansas City

6/1, 7:30 PM, Daniel Boone Library – Friends Room,
100 W. Broadway, Columbia

6/1, 11:00 am, Ferguson Municipal Public Library
35 North Florissant Road, St. Louis

NY, 7/10 Saratoga Springs

PA 6/1, 1:30pm, Pennwood Library, 301 S Pine Street, Langhorne

6/2, 1:30pm, Chester County Library – Struble Room
450 Exton Square Parkway, Exton

WA 6/10, 12:00 PM, Part of White House Conference on Aging
Seattle Labor Temple – Main Hall, 2800 First Ave.
Seattle

WI 6/2, Paper Valley Hotel, 333 W College Ave, Appleton

WV 5/31, 3:00 PM Panel:
State Rep Don Perdue – Chair of House Heath & Human Resources
Larry Matheney – WV AFL-CIO Sec/Treasurer
Gary Zuckett – WVCAG

Cross Lanes Unity Apts, 101 Unity Lane, Cross Lanes

7 Comments

Street Kid on May 25, 2006 at 1:21 am

if anyone has a part d story that he/she would like to share, please email it to partdstoriesatgmaildotcom

I fully intend on telling mine, as I have completed testimony that will be included in the next Federal Register. I have given my name, and if others wish to use a screen name, great. If they wish to use their real name, or just a first name, great.

also available in orange. epm, and MLW

NG on May 25, 2006 at 8:56 am

Many conservatives advocate market principles to “cure” our nations health care system ills. However, pure market principles allow the sucker born every minute concept to trump public welfare. This is just unacceptable in healthcare, and thus PROPER government protective involvement and regulation will be needed in this area, AND NOT THE KIND PROVIDED BY REPUBS AS SHOWN IN THE MEDICARE DRUG LAW.

Check out this story in Health Affairs . From the press release for this article

Researchers Find That Premiums And Coverage Vary Widely Among Medicare Drug Plans

Bethesda, MD — The average premium charged by Medicare Part D stand-alone prescription drug plans (PDPs) is $37, according to an analysis published today on the Health Affairs Web site.

That’s well above the $19 average drug premium charged by local Medicare Advantage (MA) HMOs, the successors to Medicare+Choice plans, say Austin Frakt and Steven Pizer of the Veterans Affairs Boston Healthcare System. It’s also well above the $22 drug premium charged by the regional preferred provider organizations (PPOs). which, like PDPs, were introduced into Medicare by the Medicare Modernization Act of 2003. About half of the PDPs have no drug deductibles, as compared with three-quarters of HMO plans.

Frakt and Pizer say that PDPs are the only drug coverage plans available in large numbers to all beneficiaries. Each PDP operates in one or more of 34 regions across the country, and there are 1,429 PDPs overall, an average of 42 per region. Six insurers offer fifteen different PDPs nationwide. In contrast, there are only sixty-two PPOs across the country, each one operating in one of twenty-six regions. Local MA HMOs, which operate county by county, far outnumber both PDPs and PPOs, but the 11,646 HMO plans operate primarily in urban areas.

All PDP regions offer at least twenty-seven PDP options, and a few regions have more than fifty options. There is a great deal of premium variation within regions. In one extreme example, region 25, the maximum premium for low-deductible PDPs — those with deductibles below $250 — is $100 per month, or twenty times that of the $5 minimum premium for such plans in that region. In a more typical example, the maximum premium for a high-deductible PDP in region 17 is $38 per month, while the minimum is $13.

Despite this broad variation within regions, there is relatively little variation across regions in terms of average premiums and other PDP characteristics. For instance, the mean percentage of the 100 drugs most commonly used by Medicare beneficiaries that are covered is constant across regions at about 93 percent for both high- and low-deductible plans. And in every region and nationwide, low-deductible PDPs outnumber high-deductible PDPs by more than about two to one.

Like the PDPs in each region, the nationwide PDPs vary greatly from each other as well. For instance, “some plans, like those offered by WellCare, have both restrictive formularies and high premiums relative to other plans like UnitedHealthcare’s AARP MedicareRx,” Frakt and Pizer point out. One-third of the national PDPs, versus only 15 percent of all PDPs and 14 percent of local MA plans, offer coverage in the infamous “doughnut hole,” the gap in coverage that occurs in the standard Part D drug benefit — which plans must meet but also may exceed — between $2,250 and $5,100 in total drug spending.

However, only one national PDP, offered by Humana, offers coverage for brand-name drugs, as opposed to generics, in the doughnut hole. “Humana has adopted a strategy unique among national plans, one that exposes it to risk of adverse selection but that also holds the potential to capture substantial market share,” Frakt and Pizer observe. “More generally, whether the PDP sector receives either favorable or adverse selection will be key to the stability of this component of the Medicare prescription drug program. Recent work suggests that stand-alone PDPs will experience substantial adverse selection but will nevertheless remain stable, as long as subsidies are not cut too deeply.”

Street Kid on May 25, 2006 at 12:11 pm

Thanks!!!! 🙂
Denim Blue on May 25, 2006 at 3:51 pm

“Many conservatives advocate market principles to “cure” our nations health care system ills.”

The current market principle in action is to deny medications to those who can not afford them (the same as with health care in general) in hopes that the problem “goes away” – in other words, that the inconvenient persons needing care die. When they do, the problem is solved.
- Street Kid on May 25, 2006 at 6:26 pm
  
  Understand what you are saying, but, there are a hell of a lot of people who are not going quietly!!
  - Denim Blue on May 25, 2006 at 8:04 pm
    
    Those of us who can will fight for ourselves, our loved ones, and anyone we know of who needs help. But there are so many who don’t have anyone to take up their cause and who don’t have the means, knowledge or even the will to do it for themselves. That’s why what you’re doing is so important – keeping it on the front burner & giving us ammunition to fire at the politicians. Thanks!
    - Street Kid on May 25, 2006 at 9:21 pm
      
      Thanks for the encouragement. I feel alot better now that these hearings will be starting–makes me feel as if I am not doing this alone. Just wish there was one scheduled for MI–I would love to give one of the idiots who voted yes on this empty rx bottles–phenobarbital is not a covered drug under the formularies, and my other anti-convulsants need to be written DAW–Dispense As Written or they do not work.
      
      In other words, through no fault of my own, I need brand name rx’s, NOT generics. Why should I be penalized (by paying a higher price) over something that I have no control over?
      
      I want the same certainty re: my rx’s that I used to have. If it is good enough for a congresscritter, it is good enough for me!

Street Kid on May 25, 2006 at 1:21 am

if anyone has a part d story that he/she would like to share, please email it to partdstoriesatgmaildotcom

I fully intend on telling mine, as I have completed testimony that will be included in the next Federal Register. I have given my name, and if others wish to use a screen name, great. If they wish to use their real name, or just a first name, great.

also available in orange. epm, and MLW
NG on May 25, 2006 at 8:56 am

Many conservatives advocate market principles to “cure” our nations health care system ills. However, pure market principles allow the sucker born every minute concept to trump public welfare. This is just unacceptable in healthcare, and thus PROPER government protective involvement and regulation will be needed in this area, AND NOT THE KIND PROVIDED BY REPUBS AS SHOWN IN THE MEDICARE DRUG LAW.

Check out this story in Health Affairs . From the press release for this article

Researchers Find That Premiums And Coverage Vary Widely Among Medicare Drug Plans

Bethesda, MD — The average premium charged by Medicare Part D stand-alone prescription drug plans (PDPs) is $37, according to an analysis published today on the Health Affairs Web site.

That’s well above the $19 average drug premium charged by local Medicare Advantage (MA) HMOs, the successors to Medicare+Choice plans, say Austin Frakt and Steven Pizer of the Veterans Affairs Boston Healthcare System. It’s also well above the $22 drug premium charged by the regional preferred provider organizations (PPOs). which, like PDPs, were introduced into Medicare by the Medicare Modernization Act of 2003. About half of the PDPs have no drug deductibles, as compared with three-quarters of HMO plans.

Frakt and Pizer say that PDPs are the only drug coverage plans available in large numbers to all beneficiaries. Each PDP operates in one or more of 34 regions across the country, and there are 1,429 PDPs overall, an average of 42 per region. Six insurers offer fifteen different PDPs nationwide. In contrast, there are only sixty-two PPOs across the country, each one operating in one of twenty-six regions. Local MA HMOs, which operate county by county, far outnumber both PDPs and PPOs, but the 11,646 HMO plans operate primarily in urban areas.

All PDP regions offer at least twenty-seven PDP options, and a few regions have more than fifty options. There is a great deal of premium variation within regions. In one extreme example, region 25, the maximum premium for low-deductible PDPs — those with deductibles below $250 — is $100 per month, or twenty times that of the $5 minimum premium for such plans in that region. In a more typical example, the maximum premium for a high-deductible PDP in region 17 is $38 per month, while the minimum is $13.

Despite this broad variation within regions, there is relatively little variation across regions in terms of average premiums and other PDP characteristics. For instance, the mean percentage of the 100 drugs most commonly used by Medicare beneficiaries that are covered is constant across regions at about 93 percent for both high- and low-deductible plans. And in every region and nationwide, low-deductible PDPs outnumber high-deductible PDPs by more than about two to one.

Like the PDPs in each region, the nationwide PDPs vary greatly from each other as well. For instance, “some plans, like those offered by WellCare, have both restrictive formularies and high premiums relative to other plans like UnitedHealthcare’s AARP MedicareRx,” Frakt and Pizer point out. One-third of the national PDPs, versus only 15 percent of all PDPs and 14 percent of local MA plans, offer coverage in the infamous “doughnut hole,” the gap in coverage that occurs in the standard Part D drug benefit — which plans must meet but also may exceed — between $2,250 and $5,100 in total drug spending.

However, only one national PDP, offered by Humana, offers coverage for brand-name drugs, as opposed to generics, in the doughnut hole. “Humana has adopted a strategy unique among national plans, one that exposes it to risk of adverse selection but that also holds the potential to capture substantial market share,” Frakt and Pizer observe. “More generally, whether the PDP sector receives either favorable or adverse selection will be key to the stability of this component of the Medicare prescription drug program. Recent work suggests that stand-alone PDPs will experience substantial adverse selection but will nevertheless remain stable, as long as subsidies are not cut too deeply.”
- Street Kid on May 25, 2006 at 12:11 pm
  
  Thanks!!!! 🙂
- Denim Blue on May 25, 2006 at 3:51 pm
  
  “Many conservatives advocate market principles to “cure” our nations health care system ills.”
  
  The current market principle in action is to deny medications to those who can not afford them (the same as with health care in general) in hopes that the problem “goes away” – in other words, that the inconvenient persons needing care die. When they do, the problem is solved.
  - Street Kid on May 25, 2006 at 6:26 pm
    
    Understand what you are saying, but, there are a hell of a lot of people who are not going quietly!!
    - Denim Blue on May 25, 2006 at 8:04 pm
      
      Those of us who can will fight for ourselves, our loved ones, and anyone we know of who needs help. But there are so many who don’t have anyone to take up their cause and who don’t have the means, knowledge or even the will to do it for themselves. That’s why what you’re doing is so important – keeping it on the front burner & giving us ammunition to fire at the politicians. Thanks!
      - Street Kid on May 25, 2006 at 9:21 pm
        
        Thanks for the encouragement. I feel alot better now that these hearings will be starting–makes me feel as if I am not doing this alone. Just wish there was one scheduled for MI–I would love to give one of the idiots who voted yes on this empty rx bottles–phenobarbital is not a covered drug under the formularies, and my other anti-convulsants need to be written DAW–Dispense As Written or they do not work.
        
        In other words, through no fault of my own, I need brand name rx’s, NOT generics. Why should I be penalized (by paying a higher price) over something that I have no control over?
        
        I want the same certainty re: my rx’s that I used to have. If it is good enough for a congresscritter, it is good enough for me!

Fix Part D Hearings Schedule!

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