Medicare drug card program set to go June 1

Complexity leads experts to predict problems

April 17, 2004|By Cyril T. Zaneski | Cyril T. Zaneski,SUN STAFF

The federal government has a good deal for low-income seniors: $600 for prescription drugs this year and next.

All needy seniors have to do is enroll in an optional discount drug card program for Medicare beneficiaries that begins June 1 and ends when Medicare's prescription benefit is launched Jan. 1, 2006.

That might sound simple enough, but the discount card program is extraordinarily complicated. And despite a planned promotion blitz by government agencies, advocacy groups like AARP and discount-card sponsors, experts fear that the program's complex signup procedures might prevent poor and disabled Medicare beneficiaries from getting $1,200 worth of medicine and discounts of up to 25 percent off retail pharmacy purchases.

What makes the program so complicated? Consider that:

Seniors in Maryland must weigh competing offers from as many as 16 companies offering 26 different discount cards and choose one that offers the best prices on medications that they take regularly. The number of cards and sponsors vary by ZIP code. In all, there are 28 federally approved sponsors and 49 discount cards.

There is no standard application. Each discount card sponsor has its own application form.

Card sponsors can make weekly changes to drug prices and discount medication lists, but beneficiaries are locked into card choices until the end of the year. Federal officials say they will monitor changes for "bait and switch" activities.

"There are 1,500 different drugs - tens of thousands when you consider the differing doses," said Bruce Stuart, executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland. "There is no practicable way anybody can make that kind of comparison."

Many advocates for the elderly, such as Deane Beebe of the nonprofit Medicare Rights Center in New York, are outraged that Congress was more interested in crafting a program for private companies that operate it than making benefits accessible to poor seniors who tend to be hardest to reach with government aid. The program offers the $1,200 benefit and waives the $30 card fee for single people who earn less than $12,569 a year or couples who earn less than $16,862.

"When Congress passed a tax cut, they just sent everybody a refund check," Beebe said. "Maybe they should have just sent everybody a check to help them buy the drugs they need. Because the way this program is structured, we're going to be losing most vulnerable people - the poor, the sick, the infirm. They are least able to shop around."

The Medicare-sponsored discount drug card program was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

The Bush administration crafted the Medicare overhaul and maneuvered the measure through Congress late last year in an effort to add what administration officials hoped would be a popular prescription drug benefit to the 39-year-old health insurance program for people age 65 and older and some people with disabilities.

But the drug benefit's price tag - now expected to exceed $530 billion over a decade - angered conservative Republicans. The administration's efforts to shield that cost projection from Congress infuriated lawmakers who had been told in November that the benefit would cost $400 billion. And consumer advocates complain that the law's prohibition of government price negotiations with politically wired pharmaceutical manufacturers will toss fuel on raging drug price inflation and provide little relief for strapped seniors.

The administration and the companies that will manage the drug benefit - pharmacy benefit managers, HMOs, insurance companies and others - argue that competition among private Medicare providers will help keep prices down.

"By availing itself of the very best that the private sector has to offer beneficiaries, the [Medicare law] has expanded choices and benefits for seniors in a way that maximizes private-sector competition," Mark Merritt, president of the pharmaceutical benefit management companies' trade group, told the House Ways and Means Health Subcommittee last month.

The prescription discount card program is the bridge to the full Medicare drug benefit. But it's not for everybody.

Medicare beneficiaries who have prescription discount cards from drug manufacturers or AARP might not find it worthwhile paying as much as $30 a year for the Medicare-approved card.

For example, Bayla S. Weisbart, 65, a volunteer at the Bykota Senior Center in Towson, does not plan to apply for a card. Retired after managing a clothing store that she and her husband owned in New Hampshire, she saved $1,500 to $2,000 on her $4,000 annual medication bill last year using an AARP discount card and shopping carefully for pharmacies that offered the best prices on the five medications she takes daily.

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