Monday, February 23, 2009

Seniors' cutbacks in medicines shows problems with Part D

In our most recent post, we pointed out that we--and many others that work on behalf of the health and well-being of seniors and families--have a growing sense of uneasiness arising from the proposed language of the bill to be introduced by Senators Snowe (R-ME) and Dorgan (D-ND)--an unease caused by the failure of the proposed language to continue access of untold numbers of Americans to physician-prescribed medicines from licensed pharmacies in Tier One countries, whose oversight of pharmacies meets or exceeds those of the U.S.

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).

Saturday, February 21, 2009

Proposed Importation bill needs citizen input

As any visitor to this blog or our website knows we have been a long-standing supporter of importation legislation that provides the greatest access for Americans to purchase physician-prescribed prescription medicines produced at FDA-Approved facilities from licensed, registered pharmacies in Tier One Countries (those with oversight standards of safety and efficacy that meet or exceed those of the U.S.).

It has been a long-standing goal of most supporters of importation that Americans be able to continue to make such purchases directly from those pharmacies, formalizing the movement that was spurred by American seniors, who have demonstrated over the past 10 years that, when presented with pertinent facts about vital medicines and pharmacies in Tier One countries, they are able to make decisions that have enabled them to enjoy safe, effective medicines at tremendous savings that simply would not be available otherwise.

In the many incarnations of prescription medicine importation legislation proposed since 1999,while the primary language, under the sponsorship of Senator Byron Dorgan (D-ND) and Senator Olympia Snowe (R-ME)has called for direct purchases from Canadian pharmacies, their bill, popularly called Dorgan-Snowe has limited the rights of Americans to directly purchase physician-prescribed medicines from other Tier One country pharmacies in countries such as Australia and New Zealand,

Yet, while limiting such direct purchases, Americans would be able to purchase those same medicines from Australia and New Zealand at any U.S. pharmacy that might choose to purchase those same medicines for resale from a wholesaler or pharmacy based in either Australia or New Zealand. The result: The U.S. pharmacy becomes a middle-man supplier, unable to provide the savings that would otherwise be generated by direct purchases. And,there is no guarantee that ANY of the savings might be passed along to U.S. consumers.

Still, I and others supported the importation push because there were those who supported the right of individual purchase, and it was hoped that such provisions could be incorporated into any legislation that might be adopted.

With the change in Administrations in Washington, and the overwhelmingly Democrat majorities in the House, plus the bi-partisan support for importation as a tactic to lower prescription medicine prices in this country, it was hoped by many advocates that any legislation proposed would reflect the fact that the safety and efficacy, as well as the savings possible from access to pharmacies in Tier One countries have been adequately demonstrated, and that those responsible for drafting the proposed language would make sure that it reflected policy that would take full advantage of the benefits of access to safe, affordable medicines for the greatest number of Americans--including no restrictions on the right of Americans to purchase medicines directly from licensed, registered pharmacies in Tier One countries.

Instead, the new proposed language for the Dorgan-Snowe bill imposes such limitations while at the same time, telling Americans that if they want those same medicines from the same countries to which they are otherwise being denied access, they must purchase them from U.S. pharmacies, with no guarantees of savings.

For those thousands of Americans who have come to rely upon purchases of their medicines from those countries, this is a unacceptable situation because it threatens the health of U.S. citizens, and creates a situation which likely will only add to the costs of their medicines at a time when increasing numbers are facing dire economic times. Also, the fact is that the safety record of prescription medicines from licensed, registered pharmacies is exemplary.

Added to this is the fact that there are many other questions about the scope of the bill's proposed language and its impact upon mail-order and Internet-based pharmacies based in Canada that we believe require that the time be taken by the writers of the bill to seek additional input for consideration in the shaping of the final proposed language.

The new Administration of President Obama has pledged to bring a new openness and transparency to Washington and policy-making. The sponsors of importation have garnered many allies and friends over the years, and, I consider myself among those. But the fact is that this is not only an opportunity to ensure that any legislation will reflect the positive influence that can come from inclusion, but will address many concerns that are arising even among supporters. The fact is that this is as one supporter said,"not an ideal bill", but that he was willing to accept it because he believes it reflects several items that supporters have sought. While that might be true, the passage of a bill is not, in and of itself, the ultimate goal. Rather it is the health and cost benefits that can be provided to Americans across the country. The current proposal is fraught with many challenges.

We have written to staff of Senators Snowe and Dorgan, as well as staff in Congressman Marion Berry's (D-AR) office and Congresswoman Joanne Emerson's (R-MO) office to offer a list of considerations and questions that many feel need to be addressed in any legislation. Representatives Berry and Emerson will provide the leadership in the U.S. House, as Senators Dorgan and Snowe will do in the U.S. Senate. We hope that they will respond favorably to the request for seeking input from a number of sources.

In the next few posts, we will examine each of the points/questions presented to staff.

Note: For the record, in the interest of transparency, I have worked on this issue with senior advocacy groups across the nation for the past seven years. I also have been a communications consultant with Canadian pharmacies and others whose products and services are of benefit to the health and well-being of American citizens.