NYT: New Medicare Rules on Drugs Balance Access Against Costs (detailed)

[DeepModem Mom]

NOTE: Anyone interested in, or affected by, the new Medicare rules should read the entire article, which provides a detailed description of the changes.


New Medicare Rules on Drugs Balance Access Against Costs
By ROBERT PEAR

Published: January 22, 2005


WASHINGTON, Jan. 21 - The Bush administration on Friday unveiled rules for the new Medicare drug benefit that guarantee patients access to a wide variety of medicines while giving insurance companies potent tools to control costs.

Issuance of the rules is one of the most significant events between Dec. 8, 2003, when President Bush signed the Medicare law, and Jan. 1 next year, when the drug benefit becomes available.

The rules, which were made final after a long, contentious public comment period, will govern all who might be involved in the new program: health insurers, employers, drug manufacturers, pharmacies, benefit managers and up to 41 million elderly and disabled people covered by Medicare.

On many issues, the rules strike a balance between competing interests....


http://www.nytimes.com/2005/01/22/politics/22drugs.html?oref=login

[American Tragedy]

1. Why was the bill set to only take effect in 2006? That's a long time

for something that is so desperately needed by millions of people in this country.

[UL_Approved]

2. The whole point of the new bill:

This is the reason that this is a problem:

Judith A. Stein, director of the Center for Medicare Advocacy, a nonprofit group that counsels beneficiaries, said the rules allowed immense complexity and variation in benefits. Drug discount cards, offered as a temporary source of assistance, were too complex for many elderly people, she said, and the new drug benefit may be even more confusing.

Many states, like New York, New Jersey and Pennsylvania, have programs that assist state residents with their drug costs. The new rules say states cannot select one Medicare drug plan and enroll all their beneficiaries in that plan. Instead, states must work with all available drug plans.

Senator Jon Corzine, Democrat of New Jersey, said this requirement would disrupt a state program that had worked well for three decades.

The GOP wants to eliminate as much coverage as possible. This is like the laws around voting that say people have to vote at the correct machines, but the machines are not marked. More confusion and denial tactics from our favorite party...

[cosmicdot]

3. so, they're adding a 'middle-man' to the bureaucratic process?

are discounts obtained, or are the Rx prices raised by Big Pharma to off-set any assumed 'discount'? Will Medicare patients enjoy the same prices as those with corporate paid healthcare co-play plans?

I'm trying to understand how I'll benefit.

Am I to 'pay' a 3rd party to issue me a card to show a pharmacist which will only be good for Rx listed on a formulary (aka approved drug list by the 3rd party company)? Why can't those with Medicare just show their pharmacists their Medicare card, and a simpler process established, cutting out the extra corporate player, and including all availabe Rx?

My pharmacy currently provides a discount to me simply with my Medicare card.

Why not let me just buy from Canada?


could we hear Dennis Kucinich's proposal?


Patients denied coverage can appeal through a complex, five-stage process. They can ask for a redetermination by their drug plan, a reconsideration by an outside organization, a hearing before an administrative law judge and a review by the Medicare Appeals Council, a unit of the Department of Health and Human Services. A beneficiary who is still dissatisfied can file suit in a federal district court.

~snip~ what think tank came up with this Bu$h** 'reform'?

Beneficiaries who sign up with a drug plan are generally locked in for a year. Insurers can end coverage for a particular drug, or increase the co-payment, if they give 60 days' notice to patients and the government. ~snip~

:crazy:

The United States Chamber of Commerce, the Blue Cross and Blue Shield Association and America's Health Insurance Plans, a trade group for insurers, praised the new rules. Howard G. Phanstiel, chairman of PacifiCare Health Systems, a large insurer based in Cypress, Calif., said the rules showed that the government would be "a good business partner."

well, if the US C of C likes it, it must be good for us /sarcasm

[0007]

4. The million of elderlies that can't remember yesterday will suffer.

"Patients denied coverage can appeal through a complex, five-stage process. They can ask for a redetermination by their drug plan, a reconsideration by an outside organization, a hearing before an administrative law judge and a review by the Medicare Appeals Council, a unit of the Department of Health and Human Services. A beneficiary who is still dissatisfied can file suit in a federal district court."

This is outrageous.