Democrats Outline Proposed Changes to Medicare Drug Benefit

[CAL/AAEM News Service]

Democrats Outline Proposed Changes to Medicare Drug Benefit

Source: California Healthline (http://www.californiahealthline.org)
Date: February 16, 2006
 

Some House and Senate Democrats on Wednesday proposed several legislative
changes to the Medicare prescription drug benefit that they said would ensure
beneficiaries could obtain medications with fewer problems, CQ HealthBeat
reports. Speaking at a press conference in Washington, D.C., Rep. John Dingell
(D-Mich.) and Sens. Richard Durbin (D-Ill.) and Debbie Stabenow (D-Mich.) said
Democrats will hold "hundreds" of meetings with beneficiaries across the U.S.
to highlight problems with the drug benefit and explain how they would amend
the program (Reichard, CQ HealthBeat, 2/15).

Durbin said Democrats are looking for a Senate bill to which they can attach
the proposed changes (Chayes, Chicago Tribune, 2/16).

The Democrats propose that Medicare drug plans be required to provide
beneficiaries with a 60-day supply of any drug that is not covered by the plan.
Plans also would be required to provide a 60-day supply of medication when a
pharmacist cannot confirm a beneficiary's enrollment in a Medicare drug plan.

In addition, the proposed legislation would create a standardized appeals
process, with medications provided during the appeal (CQ HealthBeat, 2/15). The
legislation would prohibit drug plans from eliminating medications from a
formulary once a beneficiary has enrolled or "from raising the cost of the
drugs in midyear," according to the Tribune (Chicago Tribune, 2/16).

Beneficiaries could change drug plans if a plan did not cover needed
medications. The proposals also would require Medicare to reimburse family
members, charity organizations and states that covered the costs of medications
for beneficiaries unable to obtain drugs because of administrative problems
with the drug benefit, and pharmacists could bill Medicare directly for
prescription costs for beneficiaries whose enrollment could not be confirmed
because of administrative issues (CQ HealthBeat, 2/15).


Comments
Durbin said, "We think that we can come together, even on a bipartisan basis,
to make this program work for the people across this country." He said the drug
benefit "has become a costly, complicated mess that wastes tens of billions of
dollars in handouts to pharmaceutical companies and insurance companies."

Stabenow said, "This isn't a political issue. We're talking about whether
people get medicine that will save their life."


Bush Speech
In a speech on Wednesday in Dublin, Ohio, President Bush said legislative
changes to the drug benefit are unnecessary. "When you have that big a shift,
you can imagine there's going to be glitches," Bush said, adding, "But, by far,
the vast majority of people are signing up to a program that's making a big
difference in their lives" (Chicago Tribune, 2/16).


Energy and Commerce Hearing
In related news, members of the House Energy and Commerce Committee on
Wednesday questioned HHS Secretary Mike Leavitt about the drug benefit,
CongressDaily reports (CongressDaily, 2/16). Leavitt said problems with the
drug benefit can be corrected through administrative action (CQ HealthBeat,
2/15).

However, Leavitt added that he would work with Congress to address issues with
the drug benefit, including concerns about the May 15 enrollment deadline. He
said the deadline would encourage beneficiaries to enroll in the drug benefit.
"If we do (enrollment) indefinitely, people will not feel the need to
investigate this," he said (CongressDaily, 2/16).

Committee Chair Joe Barton (R-Texas) said, "Some sense political advantage in
condemning the [drug benefit] and can't bring themselves to admit that free
markets actually work." Barton said there have been problems with the drug
benefit but added that "critics have tried to make patients believe that they
are not smart enough to understand the new Medicare drug benefit, that it
provides inadequate coverage and that signing up isn't worth their time because
it cannot save them any money. The critics are simply wrong." Barton told
Leavitt that the committee will hold "the first of what will likely be several
hearings" on the drug benefit on March 1 (CQ HealthBeat, 2/15).


House Budget Committee Hearing
In other Medicare news, U.S. Comptroller General David Walker, head of the
Government Accountability Office, told members of the House Budget Committee
that the drug benefit should be re-examined as part of a larger restructuring
of the way the federal government spends money on health care programs, the
Washington Times reports.

Walker suggested increasing the focus on disease prevention, mandating a
limited growth rate for government-sponsored health care programs, developing a
base of essential health care services and requiring payments for extra
services, according to the Times. After outlining his overall recommendations,
Walker said, "I would add to that ... relooking at Medicare Part D." Walker
said the federal government would have to invest $8.7 trillion in today's
dollars to pay for the drug benefit program over the next 70 years or more. He
said the costs could be reduced if Medicare was authorized to negotiate drug
prices with pharmaceutical companies, a strategy used by the Department of
Veterans Affairs.

However, Douglas Holtz-Eakin, an economist at the Council on Foreign Relations
and former director of the Congressional Budget Office, said negotiating with
pharmaceutical companies would not save much money for Medicare because it
serves a different population than the VA. Holtz-Eakin said the drug benefit
should remain unchanged. "It's a couple of months old," he said, adding, "It's
going to take awhile for this to shake out" (Fagan, Washington Times, 2/16). 

For more information, please visit:
http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=118768





Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/


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