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).

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.

A pivotal year

Although we have not posted for sometime, the upcoming and much anticipated inauguration of President-elect Obama and a new Congress means that healthcare certainly will become a major national issue and it is time to restore a sense of urgency to activities.

In the 'lapse', much has already been accomplished:
--Advocates of importation of prescription medicines have regrouped and are planning strategies in support of importation, likely under the auspices of a revised Dorgan-Snowe impetus led by Senator Olympia Snowe (R-ME) and Senator Byron Dorgan (D-ND) . The National Council of Consumer Organizations, a part of the National Council on Aging, is leading the effort with respected senior advocacy leaders Peter Wyckoff, the former executive director of the Minnesota Senior Federation, and Paul Severance, founder of United Senior Action of Indiana, as co-chairs.
--The importance of access to prescription medicines as part of a regimen of critical health care is gaining increased attention from media. Reports are that the Associated Press is preparing a feature on the savings that could be provided for seniors if the Obama Administration acts to provide not only price negotiation for prescription medicines, but would support importation to provide even more options for America's elderly and additional competitive pressures that would lower prices.
--Hard-pressed local governments, facing fiscal crises are finding that there are alternatives to layoffs, cutting services or attempting to increase taxes through significant savings. One example is Montgomery County, NY which has saved more than half-a-million dollars since using the services of CanaRx, an internationally based prescription medicine plan developer and administrator offering access to maintenance medicines from Tier One Countries.
--A number of advocates to reduce prescription medicine prices through importation will assemble during the FamiliesUSA annual meeting in Washington, DC January 28-31. At that time, a number of meetings will be held with Congressmen and Congresswomen, and staffers.
--A number of contacts have already been made with staffs and Congressional-Senate offices to evaluate the support for co-sponsorships. With the new Democratic majority, odds of Pharma success in poison-pill provisions regarding certification by the Secretary of Health and Human Services, is lessened. Also, former Senator Tom Daschle (D-SD), selected by the Obama Administration for the Secretary of HHS, has been a suppporter of importation.
--Additionally, a number of contacts has been made with groups that have supported importation and access to safe, affordable prescription medicines in the past, as part of the Coalition building to work for success in the 111th Congress.

Democrat Platform supports prescription medcines from outside U.S.

The Democrat Party, which launched its nominating convention Monday, August 25, has gone on record in its Platform to include access for Americans to prescription medicines from 'developed' countries.

Significantly, it is included as a part of a broad and comprehensive approach to the total American health care system, a stance that more and more people, advocacy groups and policy-makers are beginning to accept, rather than limiting examinations of healthcare reform to a particular agenda.

The statement follows:
...lower drug costs by allowing Medicare to negotiate for lower prices, allowing importation of safe medicines from other developed countries..."

When a copy of the GOP position becomes available, it will be posted. One can only hope that we might be presented with an historic opportunity in which both major political parties will make the bold steps necessary to bring about true comprehensive healthcare reform.

Investor validates role of prescription medicines to improved healthcare

by Daniel Hines
Publisher, TodaysSeniorsNetwork.com

The potential benefit of continued access to safe, affordable prescription medicines for U.S. citizens as a part of any signficant gains to be made in the American healthcare system has been identified by contrarian investor Robert Kleinschmidt in the August issue of Kiplinger's.
Kleinschmidt has made his fortune by identifying opportunities to invest in unpopular groups of stocks. In the Kiplinger's article, Kleinschmidt identifies pharmceutical stocks as such an opportunity.

His rationale: "The consensus will change when there's widespread recognition that drugs are part of the solution for healthcare as opposed to bieng part of the problem...if you think medical costs are a high percentage of the economy now, imagine what they would be if you couldn't solve a lot medical problems with a pill and had to solve them some other way..."

He continues that using pills is a "cost-effective way" of keeping people out of hospitals and by keeping them healthy, deters the need for more expensive operations and use of medical devices.

The conclusion is obvious: Access to safe, affordabale prescription medicines--including those from licensed, safe sources outside the U.S.--can, as noted in an earlier blog entry (Prescription Meds from outside U.S. offer lifeline to Part D and Medicare), addressing the healthcare needs of the U.S. in their totality is crucial to improved health for all Americans. To segment various issues--reimportation, making Part D a part of regular Medicare Administration, SCHIP, fighting privatization of Medicare, restoring fiscal integrity to Medicare and Medicaid, or prescription medicine safety--and identify them as 'the issue' of a particular group is both short-sighted and self-defeating.

That's why it is encouraging to see some new trends beginning to take place. Kleinschmidt's observation a succinct appraisal of the very real and important benefit to be attained--and not just for investors--but for all Americans.

Congressman Dennis Kucinich (D-OH) has introduced legislation that would incorporate a broad base of issues into policies, including but not limited to reimportation, that could improve the administration of Medicare, provide tremendous cost-savings and ease the strain upon the Budget, and improve the health of untold numbers of Americans.

Hopefully, the pharmaceutical industry will realize that as this occurs and Americans through the reduced costs made possible by such an approach, it will sell more prescription medicines, increasing their sales volume and profitability. And, in so doing, it will help validate Kleinschmidt's contrarian philosophy.

Increased awareness of prescription medicine abuse

G.Anthony Howard, the president and CEO of CanaRx Services, Inc., a leading pharmacy plan developer and administrator has hailed the increased awareness in the U.S. of prescription medicine abuse as a beneficial development that will contribute to improved safety in the ordering and disbursement of prescription medicines.

“That is why we applaud all those local, state and Federal agencies that are working to identify and punish ‘bogus’ pharmacies and others who illegally disburse prescription medicines,” Howard says.

“The role of prescription medicines in enhancing and protecting the public health cannot be denied when they are used for the purpose for which they were designed, and disbursed under the highest professional standards of safety and efficacy.
“By identifying those sources whose practices make prescription medicine abuse possible, we are confident that the increased public awareness will help resolve such abuse.”

Howard says that CanaRx works with more than 100 local governments in the U.S. to provide access to safe, affordable prescription medicines through voluntary plans for employees and retirees of the participating governmental bodies.
“CanaRx has always applied the highest standards and strongest procedures of oversight to guarantee not only the safety and efficacy of medicines distributed in plans with which we work, but to make sure to the greatest extent possible that there is no opportunity for abuse or the medicines being obtained being used for purposes other than their intended legitimate medical reasons,” Howard continues.
“CanaRx welcomes such increased awareness. We also view it as an opportunity to further explain our commitment to safety and efficacy, a commitment that has enabled us to establish a record of practicing the highest standards of safety and healthcare professionalism,” Howard concludes.

Kucinich sees role for medicines from outside U.S. in resolving Medicare cost, coverage crisis

Posted by Daniel Hines,
Publisher www.TodaysSeniorsNetwork.com

In one of our recent entries, we made a case that prescription medicines from outside the U.S. could provide a life-line for the budget problems of Medicare and Medicare Part D. We also criticized the agenda of selected groups that did not even want to consider such a possibility, a move that led one group to object that 'dialogue' about the development of positions should be kept within the framework of the group and not made a matter of public debate. We disagree and contend that a consideration of the potential budgetary benefit of access to prescription medicines deserves inclusion in any policy considerations affecting Medicare and especially Part D. It is a proposition that should be included in any discussion or debate about Medicare and Part D. Exclusion of such consideration is akin to cutting off one leg of a three-legged stool.
All of which is prologue to our pleasure to see that at least one Congressman agrees with us as Rep. Dennis Kucinich (D-OH) has introduced legislation that would completely revamp Medicare Part D to include a role for prescription medicines from outside the U.S. There will be those who will poo-pah the support of Reprsentative Kucinich, citing that he is a perpetual Presidential aspirant who, like former President Jimmy Carter, says he has seen UFOs. But this is also the same man who opposed the violation of the Constitution in our entry into an undeclared war in Iraq, who has championed price relief for low-income families who face not being able to pay heating bills this winter, and who authored and co-sponsored legislation to create a national health care system, preserve Social Security, lower the costs of prescription drugs, provide economic development through infrastructure improvements, abolish the death penalty, provide universal prekindergarten to all 3, 4, and 5 year olds, create a Department of Peace, regulate genetically engineered foods, repeal the USA PATRIOT Act, and provide tax relief to working class families.
And, he has served in Congress since 1996. Before that, he was elected the youngest Mayor of Cleveland in the city's history.
The role that Congressman Kucinich plays is similar to the historic role of populists who, like the Man of LaManch, dream the impossible dream, and work to introduce ideas and proposals that eventually become public policy.
By identifying the linkage of the fiscal problems of Medicare Part D at least in part to the pricing practices of the pharmaceutical industry , and seeking relief with his new proposal, Representative Kucinich offers an opportunity to improve not only Medicare and Part D themselves, but to provide necessary fiscal relief to an overburdend system--all the while, enhancing the health and well-being of Americans that is possible through access to safe, affordable prescription medicines.