Drug aid program threatened

Prescription subsidy for elderly, disabled might lose its funding

More than 25,000 affected

Plan's administrator, CareFirst, might cut its contribution

January 25, 2002|By Jeff Barker | Jeff Barker,SUN STAFF

The future is uncertain for a popular new program providing thousands of elderly and disabled Marylanders with a measure of relief from the high cost of prescription drugs.

The same state legislators who conceived the plan last year are scrambling to recoup a threatened loss of funding that could prevent the program from surviving through the middle of next year, as originally planned.

"We've got to at least maintain what we have and hopefully find nickels and dimes to make it better," said Senate Finance Committee Chairman Thomas L. Bromwell.

But the original funding is in danger of drying up, jeopardizing a program that provides up to $1,000 worth of pharmaceutical drugs a year to each of the more than 25,000 participants who pay $10 a month to get them. More than 10,000 of the beneficiaries live in the Baltimore area.

Bromwell and other legislators were given little state money by the governor's office when they fashioned the aid package last year, so they relied on the private sector. The program, administered by CareFirst BlueCross BlueShield, is funded mostly with money from the insurer.

In return for covering otherwise uninsurable people with various illnesses, the state gives CareFirst and two other carriers a discount on hospital rates. In July, Maryland began reducing the discount from 4 percent to 2.5 percent - and uses the resulting pool of money to help fund the $22 million drug program.

The drug program's problem is that CareFirst might phase out its coverage of the hard to insure. CareFirst, which is trying to convert from nonprofit to for-profit status, says it's concerned about the cost of continuing to insure such people. Although it plans for now to continue to enroll those who couldn't otherwise get insurance, it says it's not sure how much longer it can participate without burdening other clients through higher premiums. "We have no intention at this time of pulling out, but things could change," said CareFirst spokesman Jim Day.

If CareFirst were to drop out of the program for the hard to insure, the state would be left without a primary partner to help pay for - and run - the drug subsidy program for seniors. People may enroll if they are eligible for Medicare and their income is up to 300 percent of the federal poverty line - $34,830 for a couple or $25,770 for a single person.

"If CareFirst converts to for-profit, then the drug program could fall apart," Robert E. McCoy, a retired college business professor from Annapolis, said during an interview yesterday. McCoy leads United Seniors of Maryland, an advocacy group.

CareFirst said yesterday that it wants to work with the Assembly on crafting new programs for prescription drug users and the uninsured - but it doesn't know what role it might play in those programs. "We want to find a solution so individuals who are uninsurable have access to care," said CareFirst lobbyist Fran Doherty.

Doherty, McCoy and Ernie Crofoot, another activist for senior citizens, were among a handful of witnesses who appeared before a House Economic Matters Committee hearing yesterday on the future of the drug program.

Crofoot, a retired union official, said he is frustrated by the federal government's continued failure to create an outpatient drug benefit under Medicare, the health program for the elderly and disabled. Maryland's subsidy program, which began in July, was intended as a stopgap until Congress delivered a national remedy - but now, even the state's short-term fix is threatened.

"We have to look at the real problem," Crofoot said. "Something has to be done about the price of drugs. Somebody has to grab hold of this thing and say, `Mr. Drug Company, you are greedy.'"

About 200,000 Maryland Medicare recipients lack prescription drug coverage, and about 837,000 Maryland residents don't have health insurance of any kind.

Besides creating a new insurance program, the General Assembly also provided $2.5 million last year for MedBank, a nonprofit service that provides a limited amount of free drugs, made available by pharmaceutical companies. Gov. Parris N. Glendening's budget for the next fiscal year provides $3 million for that program to continue.

Economic Matters Chairman Michael E. Busch said he hopes the drug insurance program can continue as well, although perhaps in a revised form.

Busch and other House leaders are considering legislation to create a new "insurer of last resort" program to cover the uninsurable and help seniors afford drugs. Losses from running the program would be subsidized by adding an assessment on hospital rates of 1 percent - an increase to be broadly absorbed by anybody using a hospital.

Busch said he is optimistic that some remedy will be approved.

"I don't think anybody wants to vote to take drugs away from seniors, especially in an election year," he said. "And besides, people want to do the right thing."

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