Wednesday, May 5, 2004

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 1965.

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 taxpayer billions."

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 drugs.

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 program."

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," Fisher said.

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 www.Medicare.gov. Seniors can also contact the Senior Connection or look online at www.needymeds.com.

The Idaho Mountain Express is distributed free to residents and guests throughout the Sun Valley, Idaho resort area community. Subscribers to the Idaho Mountain Express will read these stories and others in this week's issue.