Drug benefits in limbo
Costs may jump under new Medicare plan
By MATT FURBER
Express Staff Writer
Since President Bush signed into law the
$400 billion Medicare Prescription Drug Modernization Act in December, senior
citizens and their advocates have been trying to make sense of the bill. The
future of prescription drug benefits is a major question about the most sweeping
changes to Medicare since the federal health insurance program was created in
Hailey Pharmacist Karen Fisher
serves up prescription drugs and her take on the new Medicare discount drug card
that can be used beginning in June. Express photo by Matt Furber
Seniors on fixed incomes may feel the
greatest insecurity about the changes, but Hailey pharmacist Karen Fischer, who
turns 65 this year, is concerned the program will simply make prescription drugs
more costly for everyone.
"There is nothing in the bill that allows
the federal government to bargain with manufacturers," Fisher said. "In 2006,
when (the new Medicare plan) goes into full effect, it is going to cost the
Part of the issue is that the country’s
senior citizen population is growing, which creates a heavier demand for
Medicare benefits. According to U.S. Census estimates, the percentage of Idaho
seniors 65 or older was 12 percent in 1995, and will grow to 21 percent by 2025.
Fisher’s concern is that the demand for
benefits by seniors and the demand for profits by drug companies will far
outweigh support for the program. Until now, seniors have been able get to help
with expensive medications through drug assistance programs sponsored by
pharmaceutical manufacturers. Seniors advocates fear the new Medicare program
could be the end of drug companies’ assistance programs.
Linda Shappee, director of the Blaine
County Senior Connection in Hailey, has helped about 50 seniors gain access to
discounted or free drugs by connecting qualified candidates to drug benefit
programs. The programs have been available through pharmaceutical companies such
as Pfizer, Merch, Bayer and Astra-Zeneca.
Shappee said many seniors, out of a sense
of pride, don’t take advantage of available programs. She added that the
paperwork is cumbersome, and the process is burdensome on busy doctors. Despite
the trouble, there is substantial help still available for seniors.
"It is a lengthy process. All the
information (for free drugs) has to go through the physician. It can take 30
days before the paperwork is complete," Shappee said. "I’m not helping near as
many people as I’d like too. It would be so easy if we as representatives of
seniors could take (a senior citizen’s) information, attach a written
prescription and mail it directly to the drug companies."
One of Shappee’s clients, who wishes to
remain anonymous, said it was initially difficult for her to ask for help
because she had worked her whole life and felt a responsibility to be
self-sufficient. However, the woman, who is an 80-year-old retired aerospace
worker, qualified for a discount drug card based on her income.
For example, she takes Prevacid, a drug
used to combat the effects of acid reflux. The average wholesale price for a
month’s prescription is $486. With her discount the senior gets it for $150.
"The doctor was giving me samples," she
said. "But, finally he said he couldn’t do it anymore."
Free samples are helpful for needy
patients Fisher said, but she also said patients need to learn what drugs really
cost. Reduced drug costs through health insurance plans and assistance programs
benefit patients, she said, but it doesn’t help patients understand who is
picking up the cost.
"If a prescription costs $20, patients
will buy it without question," Fisher said serving customers at her pharmacy.
"At $50 you get their attention."
A customer who paid $60 for a prescription
asked how much of the total cost her insurance company paid.
"Many pharmacies don’t accept (discount)
drug cards," Fisher said. "I may only make $3 above cost. The national average
says pharmacies need to make $7.50 to stay in business."
Fisher said that she does accept some
discount plans because she can make the difference through her cash customers.
Still, there is little room to barter with pharmacy benefit managers who
negotiate prices with pharmaceutical and insurance companies.
Nonetheless, Fisher said, "I don’t think
it hits the bottom line of any pharmacy that much." But as far as Medicare laws
are concerned, Fisher said the legislation is protectionist and does not give
customers access to the free market.
"We can’t buy from Canada where drugs are
cheaper," Fisher said. "The argument is that the FDA (Food and Drug
Administration) can’t guarantee authenticity."
Shappee’s senior started getting her drugs
cheaper last year. She had been paying full price for five years for a number of
She also qualifies for some free
medications she gets through her physician, and she is familiar with people
going to Canada and Mexico to get drugs cheaper.
"Every time I run out I have to go through
this paperwork again," she said. "But I don’t want to get involved with that
type of thing. The best thing is just to stay healthy."
Shappee is more concerned that programs
available in the U.S. could go away altogether.
"All of these companies have programs for
seniors who fall between the 100 and 200 percent of federal poverty guidelines,"
Shappee said. "Once the new Medicare plan is fully in place, how many of the
companies are going to say no more? What I’d like to see is this program grow.
Medicare will continue to change, but it will never meet demand as the cost of
drugs continues to go up ... the goal is to figure our how to make Medicare and
(private assistance) mesh."
Chris Loder, a spokesman for New
Jersey-based Merck & Co. Inc. said the company’s drug assistance program will
remain the same even with the new Medicare plan.
"In 2003 we supplied 618,000 patients with
5.6 million prescriptions, Loder said. "We will continue our assistance
The new Medicare plan phases in the drug
benefits over the next two years. Details about the interim Medicare program
became available May 1. Until Medicare makes drugs free for qualified seniors in
2006, Medicare recipients can sign up for the new discount card.
Seniors with retirement incomes of about
$13,000 or less (or about $17,500 for couples), who pay a $30 enrollment fee,
will get a $600 drug benefit.
"That does not get most seniors very far,"
Beginning June 7, seniors can sort through
a number of Medicare drug plans and choose the one that best fits their needs.
In January 2005, seniors can change their plan, but whatever they choose they
will be locked in for the year, until drugs become free in January 2006.
Seniors looking for an appropriate
prescription drug plan can shop and compare by calling 1-800-MEDICARE or go to
can also contact the Senior Connection or look online at