MEDICARE PART D IS A MESS

THE MESS THAT IS MEDICARE PART D - PERSCRIPTION DRUG COVERAGE


I really was not ready to get into some of the issues facing our country, but I had an experience with a neighbor that bothers me a lot so I might as well write down my thoughts while they are on my mind. For those that are not faced with needing the new Perscription drug plan FORCED on the elderly and the disabled, yes folks, they are not given the opportunity to choose if they want to be part of it, they are forced to be in the program and if they don't choose a plan themselves, well then, the government chooses one for them and enrolls them, without their signature or personal decision. Did you know that? Unless you are part of the unfortunate who need help with Perscription drugs, you wouldn't even know about it, but it's a fact.

My experience with trying to help my neighbor left me wondering what the heck is wrong with Medicare and what ARE they thinking when they make up these new laws and then force feed them to the least fortunate, giving them no say in the matter. My experience with my neighbor is but one of many examples. Allow me to explain:

My neighbor is not old enough to be considered elderly, she is disabled. Prior to the new Perscription drug portion of Medicare was enacted, we had set her up to pay for a perscription plan which provided between 30% and 50% deductions off the cost of her medications. Although this was a hardship for her, she was managing and never had to worry if a medication her doctor wanted her to take would be covered. They all were, she received her deduction from her plan and payed the balance.

Along came Medicare Part D, the Perscription Drug Plan which you might think would allow her to have a few extra bucks in her pocket book each month now wouldn't you? Well it isn't so. Allow me to explain. She really didn't want to sign up for Medicare Part D but received letters telling her if she didn't sign up for one of the plans, they would choose one for her, forcing her into the program. There were literally hundreds of Perscription plans to choose from and when you called the companies, the people who answered the phones were abrupt, cold, and unhelpful. I know because I helped make those calls. So we ended up calling Social Security and asked for assistance in choosing the proper plan for her. We listed the perscriptions she was taking and asked which Perscription Drug plan covered these medications. She was advised to sign up for one in particular and Social Security signed her up and she received her card. She also received a total of 4 letters explaining to her that due to her income per month she qualified for the extra $600 in help per year so she would not have any co-payments until that $600 was used up. What they failed to explain, if a drug is not on a particular Perscription Drug company's "formulary" (a list of covered drugs), then she would have to call and ask for a form be sent to her doctor so her doctor could justify the reason for perscribing a particular medication not covered.

I can personally attest to the fact we called well over 100 times requesting the form be faxed to her doctor for a medication she HAD to take that was not covered by the plan. No form was ever submitted to her doctor. We were forced to have her keep paying for the OTHER non-medicare Perscription Drug plan so she could receive at least 40% off the drug.

Now this Medicare Perscription Drug plan sends her a monthly statement of the payments they have made for perscriptions they have covered. Interesting to note, they are paying practically nothing for drugs she was paying quite a bit more for even given the reduction she received through her other Perscription plan she was paying for. An example: One drug she used to pay for cost her $20.00 per month which included a 45% deduction in price through her other Perscription plan. The monthly statement from the MEDICARE PART D company that is supposed to cover her is only paying $1.78 per month for the VERY SAME DRUG. This shows us that this particular Perscription Drug company plan is being payed BILLIONS of dollars by the Federal Government to be a part of their Medicare Part D Perscription Drug Plan. Companies are of course eager to be part of this new Perscription Drug plan so highly touted by the Federal Government. They are making billions of dollars and are also dictating to doctors what drugs they will cover and the better medications, that those with money can afford are not covered, forcing fixed income people to only benefit from generic older drugs for which there are newer and better ones available.

Medicare Part D - The Perscription Drug Plan covers only 3 of the medications my neighbor takes. The most expensive one, which happens to be a "controlled substance" is not covered, despite constant calls and pleas by those of us who care about her situation so she is forced despite being eligible for a $600 added benefit, to pay for a SEPARATE perscription plan in order to afford this medication. Her doctor wants to put her on another medication, but it also is not covered by her Perscription Part D company. Yet, I personally checked and EVERY SINGLE company that is part of the Medicare Part D program covers the full cost of medication for ILLEGAL drug withdrawal. Now, can someone explain to me, why they would cover medication for those who take ILLEGAL DRUGS yet fail to serve the truly law abiding citizen in need? The drugs they cover for those who were taking ILLEGAL DRUGS such as cocaine and heroin to help them withdraw, despite their abuse of that very same drug which is a "controlled substance" also are FULLY covered by Medicare Part D, yet a drug my neighbor needs, perscribed legally by her doctor is NOT covered. Out of all the medications she takes per month, her Perscription Medicare plan only pays the Pharmacy a total of $4.50 per month. Multiple her case a million times over and the subsidy they are receiving from the Federal Goverment to cover her medications amounts to billions of dollars, yet they control what she is allowed to take, and what drugs her doctor is allowed to perscribe for her. There is a brand new drug on the market, therefore it is a Brand name and not a generic drug, which would benefit her greatly, but it will not be covered by her Medicare Part D plan so she will have to pay for it through the other Perscription plan she pays for out of her own pocket.

This story is not unique. It can be seen in patient after patient. It forces doctors to read the "forumlary" of a particular company before perscribing needed medication to a patient, therefore dictating how a doctor treats that particular patient in care. They may WANT to perscribe a much needed NEW medication on the market, but are restrained from doing so, so as not to unduly burden the patient financially. Not only that, the "formulary" each company has changes monthly and the patient is told, well you will know if we are covering it when you go to pick it up at the Pharmacy. Well if it is not covered, the patient is then left not being able to get their medication, suffering embarassment at the pharmacy by having to say, I'm sorry, I can't afford to pay for it and go away without their new perscription. I have seen this happen over and over again.

For those that work, and have great medical coverage, little is known to them about the issues surrounding Medicare and Medicare Part D so to them it is not an issue. But to millions of Americans who are elderly or disabled this is a major issue and needs to be addressed and fixed.

Those that serve the elderly and the disabled have been lobbying Washington for quite some time to fix the issues related to the Perscription Drug plan. My take? Take the Perscription Drug Plan away from the PRIVATE companies and make it part of Medicare. As the Federal Goverment would be able to negotiate the price of the medications with the drug companies, not give subsidies to private companies and save the taxpayers billions of dollars. Dollars that could be used to address another major issue facing the poor and fixed income citizens such as lack of housing and other services. Services to the disabled have been cut back dramatically especially those serving those with Mental disabilities. The reality is folks that those with Mental Disability can function fully in society with the help of doctors and medication, but these services have received cutbacks continually over the past few years under Bush's administration. Those who service people in need and the disabled in your very own communities are struggling to provide basic service to the most needy, while President Bush spends billions per week on his "folly", the war in Iraq. Elderly who need the program "Meals on Wheels" as they are physically unable to cook their own food, are forced on waiting lists to be able to receive their daily delivery of a hot meal. These elderly built this country and are now forced into a poverty they should not have to suffer.

The wait for those on fixed income, be it Social Security or Disability, land on LONG waiting lists for subsidized housing. Why? Because no money is being put into building more subsidized housing for those in need. You ask why people are homeless? They are forced on waiting lists, somestimes some of these lists are years long until your name comes up, and you can't afford regular market rentals, so you are forced into housing for the homeless or just be on the streets. Remember next time you pass by homeless people on the streets that not ALL of them ask to be there. Because they are homeless, they don't have an address where they can receive Social Security benefits, and most don't even know how to apply for these benefits, and most certainly have no address to give to receive the benefits.

Also think about our Veterans who come home disabled. They too will be forced on long waiting lists to get into housing that is subsidized for the disabled on fixed incomes. Veterans who have served our country honorably are forced into homelessness by the very country they have served because they also have to go on a waiting list for available housing. For the Veteran, they do have access to free medications through the Veteran's Administration because they have great bargaining power with the drug companies to be able to provide free medication to Veterans. The Federal Goverment should look into how the Veteran's Administration incorporates drugs for their Veterans as a model for Medicare Part D. There is absolutely no reason to "farm out" perscription drug coverage when Medicare has just the same type of bargaining power as the Veteran's Administration and could incorporate drug coverage within the Medicare program itself.

I could go on about the disparity that exists in the waste of billions of dollars in programs that don't work and will discuss more in future posts. But since I had just finished visiting my neighbor and discussed a perscription she needed but was not covered by her Part D company, I felt the need to "vent" a little. More to come.

Can someone explain to me where the priority is here?

Much of what I have just written about brings to mind the time spent by Senator Obama serving the poor in his community after graduating from college. It gives me hope as he has seen for himself the needs of the fixed income citizen and will have an understanding of the issues they face. This can only benfit ALL citizens if he is our new President. As he has been there and seen it for himself. I am tired of those that would run for President who have absolutely no clue as to what those on fixed income and the lower middle class face on a daily basis. They are too far removed from the realities of these issues and certainly can't fully understand what they are dealing with. Senator Obama chose to serve the poor in his community. I feel this serves as one of the TRUE assets Senator Obama brings to the table. His knowledge and understanding of what the poor and lower middle class face can only enhance his understanding of the needs of the American people.