Media Finally Catches On To Loss of Patient Assistance Programs

[Dr Ron]

From The Democratic Daily--see original post for links:
http://blog.thedemocraticdaily.com/?p=2147


Much of the factual information posted here comes from the news media, but sometimes we are ahead of them. In discussing the Medicare prescription drug program, I have warned multiple times (starting last fall, and most recently here) that the program would lead to higher costs for many people on Medicare due to no longer receiving free medications from pharmaceutical companies through patient assistance programs. AP caught on to this today. Most of these people do qualify for assistance which provides the Medicare benefits at a discounted cost, but I am finding that many patients are winding up with higher out of pocket costs than previously due to stricter criteria for these benefits than were present in the patient assistance programs.

Now that the media has caught on to this, perhaps they will start to put together the full picture as to how prescription drug program was designed to be a financial windfall for the pharmaceutical and insurance industries rather than to benefit Medicare beneficiaries. Besides receiving payment for medications which they previously provided free through patient assistance programs, pharmaceutical companies are also receiving increased income due to the inability of Medicare programs to negotiate lower fees. The bulk of those signing up for the program previously qualified to receive their medications through Medicaid programs which did negotiate lower prices. The insurance industry benefits from subsidies to Medicare HMO’s which cost more than the government-run program to provide health care, despite cherry picking healthier patients.

[wiley]

1. This is a MAJOR TRAGEDY, another Republican FAILURE

This is "only" 6 million people who have been traumatized. Check out http://www.kff.org for more conservative estimates of the magnitude of this crime.

http://www.kff.org/medicaid/dualsrx.cfm
Resources on Dual Eligibles and Issues Related to Their Transition to the New Medicare Drug Benefit

With the new Medicare prescription drug benefit available as of January 1, 2006, over 6 million low-income seniors and people with disabilities who are enrolled in both Medicaid and Medicare—also known as dual eligibles—have been transitioned from Medicaid drug coverage to new Medicare drug plans. While there are many policy issues related to the overall establishment of the new drug benefit, the mandatory transition of dual eligibles has created a special set of challenges for the federal government, states, and beneficiaries.

If the characteristics of dual eligibles are examined, it becomes evident that they will need special attention when being enrolled in the new Medicare benefit:

* Nearly three-quarters (73%) have $10,000 or less in income
* 61 percent have less than a high school education
* More than one-third (37%) are disabled
* More than one-third (34%) have a mental impairment
* More than one-quarter (27%) have diabetes
* Nearly one-fifth (19%) reside in a long-term care facility

A collection of information and publications on dual eligibles, their current drug coverage, and issues related to their transition to the new Medicare benefit follows:

[Dr Ron]

4. Bigger problems for those who didn't qualify

Duel eligibles were automatically placed on Medicare Programs when the system worked so they are actually not the ones with the worst problems.

The main problems for them were that there were glitches in the system so that not all got placed on programs correctly, and some are being placed in programs which might not cover all their current medications. The real concern for the duel eligibles is that their meds were previously covered at discount prices, but now are covered at full price, increaseing health care costs (and pharmaceutical company profits).

The problems with decreased education or mental impairments is a more serious problem for those on the borderline. There are many people who qualify for assistance to get on Medicare programs at reduced or no price, but they are not able to handle signing up and picking a program. It would have been much simpler if it was an addition to the existing Medicare program. It has been so difficult for many to sign up that for many we've wound up sitting them down in front of a computer at the office and doing it for them. I wonder how many are not getting benefits simply because they can't handle the system and they don't have anyone to help them sign up or complete the forms for financial assistance.

[hootinholler]

2. .

[SoCalDem]

3. The sad fact about this.

Papers may KNOW about this..(they probably "knew" before), but medicine for old people is not a "sexy" story. It IS a story for investigative reporting..a multi-part series in the paper, BUT that;s just the kind of journalism that's not done much anymore..

In another time, 60 Minutes would have been all over this.. Dateline would have done several episodes on it.. 48 hrs would have taken it on...PrimeTime Live would have worked up a story..Nightline too..

Of course those venues have moved on to infotainment and in-house product promotion so they no longer care much for news..

Sorry Granny..

[Dr Ron]

5. Just saw a great example

I just saw someone who previously received her more expensive medications thru patient assistance. Now she has one med with a $60 copay (which I'm changing to another med) another two with a $30 per month copay, and the rest are at a much more reasonable $7 per month.