PRESS RELEASE

For Immediate Release

Thursday, June 12, 2003

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Citizens' Council on Health Care

1954 University Ave. W., Suite 8

St. Paul, MN  55104

http://www.cchconline.org ======================================

CONTACT:Twila Brase, R.N., President

PHONE:  651-646-8935

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Medicare Drug Plan will Limit Senior's Choice of Medication

(St. Paul, Minnesota) - Seniors should not rush to embrace the

Prescription Drug and Medicare Improvement Act of 2003 that is soon

to be voted out of the U.S. Senate's Finance Committee.

“This is drug coverage by committee. A bureaucratic process will

determine which drugs are available and who gets them. Not every

medication will be covered, covered medications can be denied, and

private drug coverage may no longer be available,”  says Twila Brase,

president of the Citizens' Council on Health Care.

The actual bill, which may be voted on as early as Monday, June 16,

is not available to the public. CCHC provides the following limited

list of concerns taken from information provided in the 90-page

online summary:

* LIMITED ACCESS: Drug formularies (limited lists of drugs) would be

allowed. Any drug that is not on the health plan's drug formulary

would be excluded from coverage. Plans using formularies would be

required to establish a “pharmacy and therapeutic committee” to

develop the formulary. In addition, any drug that did not meet

Medicare's definition of “reasonable and necessary” could be excluded

from coverage.

* DEDUCTIBLE DISCRIMINATION?: It is unclear how the $275 deductible

and the $3,700 cost-sharing limit is reached. Only with Medicare

approved drugs or with all medications purchased by the senior

citizen?

* COERCIVE ENROLLMENT: Although the new Part D of Medicare (Drug

Coverage) would be voluntary, there will be penalties for delayed

enrollment. Those financial penalties have yet to be determined.

* PRIVATE DRUG COVERAGE TO DECREASE: The bill encourages the

companies and groups that currently offer private drug coverage to

seniors to drop such coverage. It allows seniors to enroll without

penalty after the initial enrollment period if the group health plan,

state pharmaceutical assistance program medicaid, veterans program

and Medigap terminates the enrollee, ceases to provide drug coverage,

or reduces the value of their drug coverage.

* NO DRUG COVERAGE IN MEDIGAP?: Enrollees of the new Medicare drug

plan would not be permitted to buy Medigap drug policies. This may

encourage Medigap plans to drop all drug coverage.

* MANAGED CARE AND PRIVACY CONCERNS: Entities offering drug coverage

will be required to have a cost-effective drug utilization management

program, a program to reduce fraud, abuse, and waste, and a

medication therapy management program, which among other requirements

must increase adherence with prescription regimens and “detect

patterns of overuse and underuse of drugs”.

* ACCESS DENIED?: Once enrolled, senior citizens may be forbidden to

purchase any covered medication that a health plan, pharmaceutical

benefit manager, or state program denies. Current law forbids private

payment for any covered service that Medicare denies.

“If the summary is an accurate reflection of the proposed bill, this

bill would guarantee that seniors will have less access to medication

and more micromanagement of their health care,” Brase emphasized.

BILL SUMMARY:

http://finance.senate.gov/sitepages/leg/Chairman%27s%20Mark%20%20Final

%206-10-03.pdf

CCHC is an independent non-profit free-market health care policy

organization located in St. Paul, Minnesota.

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A free-market resource for designing the future of health care

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Citizens' Council on Health Care

1954 University Ave.W., Suite 8

St. Paul, MN  55104

651-646-8935 phone

651-646-0100 fax

http://www.cchconline.org

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