New York Times Examines Prescription Drug Situation for Seniors

The New York Times on March 12 examines seniors' access to prescription drugs, which have grown both "more important" and more expensive in recent years. When Medicare was created in 1965, the Times recounts, the most important benefits were coverage for hospital stays and doctor visits, not drugs. Now, though, more than 88% of all Medicare beneficiaries use prescription drugs, filling an average of about 20 prescriptions each per year. The Times reports that although some seniors have private insurance or Medigap policies that pay for prescriptions that Medicare -- which only covers medications for people in hospitals or nursing homes or "living with a special condition," including some cancers -- does not, studies show 25% to 30% of seniors have no drug coverage. In addition, another 25% to 30% have "unreliable" coverage, including Medicare HMOs that "can raise copayments, cap benefits each year or completely withdraw from a market." According to the Times, there is a "growing frustration" among seniors over "rising drug prices and the seemingly endless debate over how to add prescription drug coverage" to Medicare reforms. Though congressional support for a drug benefit is "almost universal," lawmakers are divided on what such a benefit will entail (Cutter, New York Times, 3/12).

Presidential Solutions
The Times also examines President Bush's proposed prescription drug initiatives:

• Medicare Prescription Drug Card: The administration says that the card could save beneficiaries "up to 25%" on their medications (Cutter, New York Times, 3/12). Bush's plan calls for CMS to grant a "seal of approval" to organizations that prove they can achieve lower prices for large numbers of patients. The sponsors would negotiate discounts with pharmacies and drug makers and then pass the savings on to Medicare beneficiaries who purchase a discount card, which they could obtain with a $25 maximum enrollment fee. The proposal also would require sponsors to offer a discount on at least one drug in every major category of medicine (Kaiser Daily Health Policy Report, 3/1).
• Pharmacy Plus: Under this program, states could expand drug coverage to low-income Medicare beneficiaries through Medicaid (New York Times, 3/13). The coverage would be limited to pharmaceutical assistance only. Through demonstration projects, states could provide prescription drug coverage to seniors with annual incomes up to 200% of the federal poverty level. Illinois has already received approval for such a project, expected to expand coverage to about 365,000 seniors (Kaiser Daily Health Policy Report, 1/29).
• Medicare Low-Income Drug Assistance: Through this program, states could receive "extra" federal dollars to cover prescription drugs for low-income Medicare beneficiaries with incomes up to 150% of the poverty level (approximately $17,000 for a couple).
• New Medigap Plans: The Bush administration is proposing two new Medigap plans that would both offer drug assistance, bringing to five the total number of Medigap plans covering medication (Cutter, New York Times, 3/12).