Medicare Consumer Advocacy Update

Asclepios Your Weekly Medicare Consumer Advocacy Update Mind the Gap August 28, 2008 • Volume 8, Issue 35 Mind the Gap New research confirms what many people with Medicare, as well as their caregivers and counselors, know already. The sudden shock of paying full price for prescription drugs in the Part D coverage gap causes many older adults and people with disabilities to stop taking the medicines they need to treat serious, chronic conditions. Researchers for the Kaiser Family Foundation estimate that 3.4 million people with Medicare reached the coverage gap in 2007, and had to pay the full cost of their drugs for at least three months. People who hit the gap, or doughnut hole, between April and July spent about half the year paying both premiums and the full cost of their medicine. After July, almost all enrollees could count on spending the remainder of the year in the gap, never accessing the catastrophic coverage that kicks in after enrollees spend $3,850 out of their own pocket. (The out-of-pocket threshold increased to $4,050 this year; it rises to $4,350 in 2009.) Looking at people undergoing treatment for eight conditions, including diabetes, hypertension, Alzheimer’s Disease and depression, the report shows that 15 percent of Part D enrollees who reached the gap stopped taking their medication. Only about one-third of those who qualified for catastrophic coverage later in the year resumed drug therapy. About half of Part D enrollees taking medicine for diabetes hit the coverage gap. Of these, one in 10 stopped taking their medicine, risking potentially serious consequences to their health. The Part D coverage gap is a serious public health problem that is getting worse every year. By 2017, Part D enrollees are expected to face a gap of over $6,000 in their drug coverage. There are two steps the next administration and Congress can take to address this problem:

• Congress should expand eligibility to Extra Help, which provides coverage through the doughnut hole and helps pay premiums and cost sharing. Currently, people with Medicare earning just over $15,612 ($21,012 for a couple) cannot qualify for assistance.
• Congress should work to lower drug prices by providing the option to receive drug coverage directly through Original Medicare, instead of through the private companies that have failed so miserably in lowering drug prices.

Medical Record “I have multiple diseases and I find that I am in the doughnut hole long before the year is up! Why can't the program be run like the VA with no cut-off on medications that are covered? ” (Story submitted to the Part D Monitoring Project from Odessa, FL, March 2008)

“Ten percent of patients taking medication for diabetes stopped taking their medication when they reached the gap, and an additional 5 percent stopped taking one of multiple drugs they were taking in the class. Terminating use of drugs used to manage diabetes could pose serious and immediate health concerns.” (The Medicare Part D Coverage Gap: Costs and Consequences in 2007, Kaiser Family Foundation, August 2008)

“The failure of Part D plans to negotiate price concessions from manufacturers on par with those achieved by government programs results in higher costs to taxpayers and higher premiums and cost-sharing for people with Medicare drug coverage,” (The Best Medicine: A Drug Coverage Option under Original Medicare, Medicare Rights Center, November 2007)

* * * * Medicare Part D Appeals Help for Advocates Is Here!

MRC ’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.

Download a FREE copy of this great resource. * * * * Medicare Part D Monitoring Project

The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Submit your story at http://www.medicarerights.org/partdstories.html.

* * * * The Louder Our Voice, the Stronger Our Message

Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.

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The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get high-quality, affordable health care.

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