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Many Seniors Won't Be Able to Afford Drugs Under Medicare's New Plan

Posted on: Saturday, 14 January 2006, 00:00 CST

By Joy Buchanan, Daily Press, Newport News, Va.

Jan. 14--Low-income Medicare beneficiaries who get their drugs for free through pharmaceutical companies' charity programs are about to lose that benefit, and they'll have to reach deep into their pockets to pay for their drugs.

Medicare's new prescription drug benefit, known as Part D, renders beneficiaries ineligible for most drug companies' prescription assistance programs. The programs provide free, brand-name drugs to low-income people who have no other drug coverage.

Every drug company has different cut-off deadlines, but most of the programs will terminate benefits for Medicare beneficiaries by May 15, the deadline for signing up for Part D without a penalty.

Though many advocacy groups estimate that Part D will save many seniors hundreds of dollars on annual drug costs, there is a group of seniors that are falling through the cracks and the drug company safety net no longer will be available to them. That could affect more than 17,000 people in Virginia.

Among them is Robert Sweat of James City County whose income is so small that he reuses his disposable insulin needles to save money.

Disabled by epilepsy and diabetes, Sweat, 57, lives in an assisted-living facility. After paying his rent, he has just $272 a month left to pay for necessities and seven different medicines he needs to take daily. He gets most of his drugs for free from the manufacturers. He pays about $25 a month for the drugs and supplies.

But Sweat is covered by Medicare, so he is no longer eligible for the programs. The cheapest Part D plan that covers all of his medicine now will cost him $234 a month more than nine times what he pays now.

"This is going to run me out of me home," he said. "I'm going to have to move out or quit taking my medication."

The poorest seniors including those covered by Medicaid are expected to save 89 percent on their drug costs under the new Medicare drug plan. Middle-income and wealthy seniors could save 28 percent or more on their costs. But people like Sweat, who make too much for Medicaid or Medicare's prescription subsidy and far too little to pay for their drugs outright will be the losers in all of this.

"It started with very good intentions," said Sharon Ellis about Part D. She supervises the medication assistance program at the Olde Towne Medical Center in Williamsburg. Ellis helps dozens of seniors apply for free drugs through the manufacturers. Most prescription assistance programs sponsored by drug companies provide free drugs to patients who earn less than $19,140 a year.

The drug companies' guidelines are more generous than the federal government's. To qualify for Medicare's low-income drug subsidy, a person must make 150 percent of the federal poverty level, or about $14,355 or less a year.

"We have people who make $500 a year too much to get the extra help," Ellis said. "Their drug costs are going to jump and those people are going to stop taking their medicine."

The drug assistance programs are not going away, but Medicare beneficiaries no longer will have access to them.

The Pharmaceutical Research and Manufacturers of America, an industry group, says the companies had little choice but to withdraw the benefit from seniors. The Office of the Inspector General provided guidelines to ensure that the companies were not billing Medicare for expensive brand name drugs given to beneficiaries. The guidelines also discouraged exploitative, coercive or promotional activity and would require increased scrutiny of the drug companies' programs.

The rollback on benefits for Medicare beneficiaries comes just months after the pharmaceutical industry launched a program to help poor people sign up for the charity programs. Since then, 1.2 million people were enrolled. As of last week, 25,214 Virginians signed up for drugs through the program, but it is not known how many were eligible for Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, say there is no legal reason why the companies cannot continue to provide free drugs to Medicare beneficiaries.

But it might not matter what the drug companies do. Seniors who get their drugs through the companies still have only until May 15 to sign up with Part D without a penalty.

Still, it might be too early to tell how badly people will be affected, said Tricia Neuman, director of the Medicare Policy Project for the Kaiser Family Foundation. "This may be one of the unintended consequences of the legislation," she said. "It's the folks just getting by and not paying anything that will come out paying more. But it's too soon to know if people are worse off."

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Copyright (c) 2006, Daily Press, Newport News, Va.

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Source: Daily Press

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