We called for a greater role for input by seniors, family-oriented organizations, the disabled, labor and others to ensure that the proposed language addresses some serious shortcomings.
Now, we have come across an article that represents another issue that needs to be addressed--the incorporation of importation provisions purchased directly from Tier One countries to be an element in Part D plans. We were among the first to call for such a policy.
The fact is that without such direct purchases, the hoped-for savings of importation should the legislation be adopted without an open, public discussion, simply will not be as great as is needed to generate downward pressure on pricing strategies of pharma nor to meet the prescription needs of millions of Americans. Ironically, the legislation imposes a 'middle-man' in the form of U.S. pharmacies who may purchase the same medicines from the same pharmacies to which Americans might be denied access for resale to U.S. citizens.
The record of safety and efficacy of purchases from Tier One countries, spurred by America's seniors, has been demonstrated over the past decade. The argument can be made that the imposition of an additional layer of administering such orders by U.S. pharmacies will only add to the price paid by U.S. citizens with no guarantee that even the reduced savings will be passed along to the patient.
The Doughnut Hole has always been a flaw in the flawed Part D program. Many participants simply will not 'work their way out' of the Doughnut Hole and are forced to pay for more expensive medicines...or do what is described in the following story--which is to do without...The story follows:
Medicare Part D Beneficiaries cut back on Prescription Drugs by 14% after reaching 'Doughnut Hole' Coverage Gap, study finds
[Feb 03, 2009] Adding coverage for generic drugs during the "doughnut hole" in the Medicare prescription drug benefit could help offset a decreased use of medications during the period, according to a study published Tuesday on the Web site of the policy journal Health Affairs, the Pittsburgh Post-Gazette reports.
Under the Medicare drug plan, beneficiaries have an initial $250 deductible for prescriptions, then a 25% copayment until they reach $2,250 in payments.
At this point, the doughnut hole takes effect and requires that beneficiaries pay full price for drugs until costs have reached $5,100, after which catastrophic coverage takes effect and about 95% of costs are covered by Medicare.
According to the study, Medicare drug benefit beneficiaries decrease their use of medications by 14% upon reaching the coverage gap.
For the study, University of Pittsburgh Graduate School of Public Health Assistant Professor of health economics Yuting Zhang and colleagues examined the drug buying habits of more than 11,000 Medicare beneficiaries.
The researchers found that about 25% of beneficiaries reached the coverage gap and about 4% reached the $5,100 threshold, making them eligible for catastrophic coverage.
According to the study, those reaching the doughnut hole were typically people with chronic illnesses who filled an average of five prescriptions each month.
Along with cutting back on medications, these beneficiaries also stopped using an average of one in five prescriptions during the coverage gap.
However, those with generic drug coverage did not reduce their use of medications after reaching that phase. Generic drugs typically cost about one-fourth as much as brand-name treatments.
The report states that "one can assume not only that the lack of coverage in the doughnut hole had adverse health consequences but also that it could have increased costs for hospital and physician services."
The authors suggest that beneficiaries' contribution to the first phase of the plan could be slightly increased to offset the added expense of generic coverage (Twedt, Pittsburgh Post-Gazette, 2/3).