The impact of Medicare D(isaster) is taking another turn, as some independent pharmacies are now facing the possibility of closing, refusing to participate in Medicare D(isaster), or bankruptcy.
However, their concerns are not adequately being addressed. Instead, it appears the policies and legislation that have been addressed in the past and are currently being debated, attempt to fix Medicare D(isaster). This does not address any of the issues that many are having with it.
As stated in this article, a survey completed by pharmacists found
…a troubling trend for consumers: A high percentage of Medicare customers find out their list of covered drugs has changed. Sixty-one percent of pharmacists said customers’ “formularies” had changed after they signed up. In two-thirds of cases, the changes were not beneficial to consumers.
According to Dave Olig, an independent pharmacist/business owner
the original drug lists might have been designed to lure customers, who sign up for a year of coverage.
He continued
“In the retail world they call that bait and switch…And I fear that’s going to happen.”
(The “bait and switch” technique is illegal in some states.)
more below
Olig spoke to the Democratic Senate Policy Committee, chaired by Sen. Byron Dorgan, D-N.D., to discuss the problems of the Medicare D(isaster).
It is now being suggested (again) that the enrollment deadline of May 15 be extended to allow more to enroll and for Congress to fix Medicare D(isaster)
Olig stated that
Medicare should define a standard program, with options for different deductibles and co-payments a[and that] program [be] understandable.
He also feels that Medicare D(isaster) doesn’t need to be completely scrapped, however, it does need a major overhaul.
Sen. Byron Dorgan, D-N.D., stated
“I think pressure is building on Congress and the Bush administration to get this straightened out…My hope is in the coming weeks we’ll be able to pass legislation to get it straightened out.”
Also, it is worth repeating that the republicans have repeatedly refused to any enrollment extension in the past.
However, there in increasing pressure by the Democrats for an extension of the May 15 deadline. During earlier congressional hearings, an extension was frequently mentioned. Now, there is some bipartisan support, from a couple of Republican lawmakers on the House Energy and Commerce Committee.
Rep. Sherrod Brown, D-Ohio,
“How can anyone blame seniors if they’ve been either too perplexed or too wary to enter the fray?”
Rep. Michael Bilirakis, R-Fla.
“We should all have an open mind on some of these things, particularly in that area.”
It appears that there may be success in gaining a fix to Medicare D(isaster), as some of the organizations that fought the privatization of Social Security appear to be joining forces again.
Americans United–a group that rose from the ashes of Americans United to Protect Social Security–is leading a coalition to reform Part D. In addition to participating in the AU coalition, the liberal advocacy group Campaign for America’s Future is teaming up with Moveon.org, the Public Campaign Action Fund and USAction to educate voters in key districts about the real costs of the Medicare boondoggle. Last week, several prominent groups–including the AFL-CIO, AFSCME, Consumers Union, Families USA, the National Committee to Preserve Social Security and Medicare, U.S. PIRGS and USAction–met with Senate Minority Whip Dick Durbin to begin plotting on how to best force action. On the House side, a unified Democratic Party is organizing more then 100 Medicare “town halls” in the upcoming weeks.
It’s a start!
xposted at dkos and mlw
And thanks to North Dakota Democrat and idredit.
So, I’m reading about how the Democratic candidate for Senate here in Mo is having meetings about Medicare and is surprised by the anger.
Which is good. Right now she’s advocating steps to fix the program rather than just scrapping it — but at least she’s listening to people. Which is better than Talent who is an advocate of the program — no problem here, move along.
And the republicans?
Thought you might like to see this kid
Thanks mary. One of the things that I have been noticing is a gradual change in attitudes. That shift is something that I am going to have to compare to what was said earlier…
Good link!
Old age can be terrifying without your government trying to make you look stupid in order to line corporate pockets. Thank you Claire McCaskill next senator from Missouri.
WaPo
The issue of cost has not been adequately addressed yet. What the repubs don’t say is that many seniors were paying less for rx’s before Medicare D(isaster) and that the confusion re: it has actually increased health care costs, insurance costs and so on.
and for the sociologists, something of a test of the tried and true fact that giving people a chance to “vent,” to air their grievances in the presence of a figure they perceive as one of authority and power, who maintains an expression of concern, listens sympathetically and validates their frustrations verbally and with body language, provides a psychological benefit sufficient to offset the subsequent unchanged reality.
In this particular situation, timing is key. If the initial death wave can be staved off until after the elections, chances are better that the various politicians will benefit from their strategies.
However, there is also the chance that some victims, both senior and junior, may take on an obstructionist and defeatist attitude, maintain a very narrow view, refusing to appreciate the work of the staffers and inflexibly harping on the single question of:
Will be able to get my pills?
There may even be some increased participation from low income sectors not normally so politically active, and they too may be of a rejectionist turn, focusing only on the narrow question of their income versus the new cost of their medication:
How am I supposed to pay $800 for a month’s worth of pills?
Politicians must be extremely tactful in these cases, one could argue that there is no easy way to explain to some individuals that the question of their personal financial situation is beyond the scope of the project, and it will be especially difficult to help some constituents understand that while yes, it is true that obtaining their medication may not be the exact and immediate outcome of the current effort, it is a great honor to be able to serve them, and that their support, and of course, financial contributions to this and future campaigns, are still very much needed.
That is when you politely admire their tailored suits and say, “BULLSHIT!!!!
I am on my husband’s Home Depot’s medical family plan, which is not cheap but every little bit helps.
Well, my kidney doctor finally convinced me to try to stop smoking so gave me a legal precription for wellbutrin. BUT MEDCO of UnitedHealth Care medical plan will not fill the prescription for ‘smoking cessation’. They want the doctor to change the diagnosis to depression and then they would fill the prescription(this drug program still charges about 40% co-pay). I am not DEPRESSED. I am angry as hell, outraged and ready to FIGHT somebody.
THEY want us sick, addicted and in debt
Check this diary out HomeSecRuleBreak: Pay Off Your Credit Cards, Get Investigated
Stop this fucking world, I want to get off….
That can lead to some additional impacts down the road.
Even as efforts are ongoing to remove the social stigma of mental or emotional illness, insurance companies tend to apply their own kind of stigma.
Some people who really do suffer from depression avoid seeking treatment precisely to avoid future problems with insurance, for instance, if an individual changes jobs, being officially listed as someone who has been treated for depression could affect the extent to which the new employer’s insurer would cover him and/or his dependents.
It wouldn’t matter whether the “treatment for depression” consisted of a prescription for wellbrutin to help someone stop smoking. All that counts is the Medical Information Bureau code.
If you can afford it, it might be better to just pay for the wellbrutin out of pocket, and if possible, even pay to visit a different doctor for the prescription, just to do what you can to try to keep the code indicating that you received the prescription off the insurance company’s records.
They still might pick it up from the other doctor, who would send it in to the Medical Information bureau also, but there is a chance that it might not get matched up to the file the insurance company uses.
Never knew that.
some parents complain that their troubled teen received thirty days of care at a facility, and on day 30 were declared cured and sent home.
Once home, however, it soon becomes apparent that the child is not “cured” at all, but the insurance company will pay for 30 days.
Mental and emotional illnesses can be tricky. Some form of therapy, outpatient or inpatient may be required for an extended period of time, and even once “cured” patients will be advised by any competent practitioner not to hesitate to return, even if only for one visit, if they feel the need.
Insurance companies are in business to collect premiums, not pay out expensive claims over an extended and indefinite period of time.
In some ways, mental and emotional illness are viewed as any chronic disorder. Someone with diabetes or heart disease, etc. may encounter the same problem if they change jobs. The new insurer may offer coverage, but excluding any treatment related to the heart disease. Since most treatment sought by someone with this condition will be related to it in one way or another, and even things that might seem unrelated might be seen by the insurance company as related, thus the coverage offered is essentially useless to the patient, but of course the company hopes he will accept the opportunity to pay the premiums anyway.
Actually, most psychiatrists are quite sensitive to these issues, and only send information with an insurance claim.
Ductape does point out some of the worst case possibilities for coverage, however what he relates is a bit worse that waht happens to most people with group coverage. What more typically happens is that health insurance covers office visits and hospitalization at half the rate of other medical issues, with strict limits on the number of visits per year, and lifetime limits on hospitalization that are ridiculously small. However, drug treatment is usually covered as any other medication. However, insurance companies have their formularies – that is, they get to cherry pick for “regular” health insurance, just as they do if they participate in Medicare D. If what you doc wants you to have isn’t in their formulary, they will usually require 1) that a drug in their formulary fail (and possibly that more than one fails), and 2) your doc has to write up a lengthy justification of the particular med he/she prescribed in any case. Some of the newest antipsychotic meds are truly horrendous in expense. These are not what anyone with depression would be given, unless they had more serious difficulties in addition to depression.
There are also big differences in how insurance companies view types of depression. Major depression is viewed as episodic, lifting completely with meds, e.g. something you can get over. However, Bipolar is viewed as a chronic, life-long problem that is very difficult to control in some cases, not something to be rid of. These aren’t the only types of depression diagnoses, they are just the most commonly known ones, and I am certain they are seen differently.
If you go do a new job, it is common that any previous medical condition is not paid for treatment for some period of time – this is not just a problem for mental health. And some very small group policies do not cover specific, deemed “high cost” things, e.g. diabetes and its complications (which covers about anything that could happen to a diabetic), old athletic injuries, pregnancy,etc. Some companies just won’t pay for some period, and then they pick up coverage. Others won’t pay until you go without any claims for some period of time – a much harder standard to meet, impossible if you have a chronic illness. Yes, insurance is a horror that needs to be rebuilt from the ground up.
If you do buy your own wellbutrin, be sure that your doc specifies that the generic form is ok (if you were being prescribed the plain old wellbutrin – the newer extended release form is likely still under patent protection). The cost differential can be enormous.
The horror of the “prior authorization.”
That’s the one where the drug is denied and the substitutes (and potentially the patient’s health) have to fail.
They have made the process so bulky, so time consuming and difficult that many doctors will not even attempt to do a prior authorization unless the situation is so critical that it could be considered a case of life or death.
And then, of course, there is the risk that the insurance company will conclude that if the patient is all that sick, the most cost effective treatment will be to simply allow them to expire, rather than keep making claims.
And you are correct that not all of them are as bad as the situation I described regarding mental health issues. But it is important to find out just exactly what your insurer’s policy is before the need arises.
Unless they already have a chronic condition, most people don’t delve too deeply into all this stuff, they find out the co-pays for routine care, maybe specialist fees, etc but that’s about it.
Not that knowing all that stuff is much help. If you don’t like the provisions of your employer’s policy, because America is a democracy, you have the freedom to decline it and purchase your own insurance, or simply pay for any medical treatment you need out of your own funds.
What next? Damn insurance carriers!
Thanks for the link. All I can say is WTF will be next?
My hair was already standing on end from your diary, and now this link above… will leave it in a permanent spike!!
I just caught the title and thought, No!! I’ll read this one later…but I did recommend it.
http://www.commondreams.org/news2006/0301-06.htm The Green Party has come out and issued a statement-part of their platform I believe-advocating for a National Single Payer System..article also mentions how the bankruptcy bill should be done away with.
I of course think Sen. Dorgan is completely wrong when he says Medicare needs fixing, not completely scrapped..it does need to be completely obliterated and sent to hell where this ‘plan’ belongs-as I’ve mentioned before you can’t put lipstick on a pig and expect the pig to be transformed into Cinderella.
I agree that all that you mentioned should be scrapped! Thanks for another good one!
Finally got around to giving this a thourough reading…been having to do a lot of running around lately…Anyway, it is great for another single payer diary, when I get a chance to write one. I’ve got infor that I read and re-read, and somehow it all times together, then I am ready to rock and roll…still reading and thinking though.