Medicare Part D takes a salvo of criticism

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By Sean J. Miller | Thursday, October 5, 2006 12:05 AM CDT | () comments

The Medicare prescription drug benefit passed by Congress in 2003 is complicated, wasteful and must be reformed, members of Citizen Action Illinois, or CAI, said at a seminar Wednesday in Rock Island.

“We know at the very least the program is costly and confusing,” said Lynda DeLaforgue, co-director of CAI, a public advocacy organization. “It was really designed for (the benefit of) pharmaceutical and insurance companies rather than seniors.“

CAI has organized such seminars across Illinois to inform people about the program and advocate for its reform. About 40 people attended Wednesday’s seminar at the Laborers Local 309 Hall in Rock Island.

One of the main problems with the program is that Congress did not allow it to negotiate with pharmaceutical companies for lower prices on prescription drugs, DeLaforgue said. “We can’t use the buying power of 45 million Americans to get the best price,” she added.

The Veterans Administration’s prescription drug program negotiates with pharmaceutical companies and does get a better price for its beneficiaries, she noted.

The Medicare prescription drug benefit, also called Part D, relies too heavily on private insurance companies to deliver its services, she said. That makes it more complex than a government-administered program.

“In 2006, there were 42 (drug) plans in Illinois,” she said. That number is expected to grow to 56 in 2007.

“We don’t think this is a way to have a health-care program for the long haul,” she said. “We need a simple benefit under Medicare that is allowed to negotiate to get the best price.”

To get that, “it’s going to take some shakeup and some new leadership in Washington,” she said.

Medicare Part D, which took effect Jan. 1, was designed to benefit the elderly and the disabled. The program initially was estimated to cost $395 billion over the next decade. However, that number is expected to increase.

But the program does not cover the full cost of a recipient’s medications, DeLaforgue said.

The basic benefit in Illinois has covered the initial $2,250 of a recipient’s annual drug costs in 2006, she said. The recipient has to pay out-of-pocket for costs between $2,251-$5,100. The benefit then resumes covering a percentage of the drug costs after the recipient has paid $5,100.

DeLaforgue said that gap in coverage is called “the doughnut hole.”

The coverage gap can be catastrophic for some people, said Steve Pittman, director of the Illinois Alliance for Retired Americans. “When people hit that coverage gap, they stop buying medicine,” he added.

Jim Hughes, 70, of Davenport, said it was difficult to choose the right plan under Medicare Part D.

Prescription drugs cost him and his wife about $1,750 a month, he said, so they enrolled in a Blue Cross Blue Shield plan in December.

The monthly premiums for the plan — which has no deductible and no “doughnut hole” — are about $2,000 for him and his wife, he said.

“It’s not the best plan for me,” he said, but he is unable to switch until the end of the year because of Medicare restrictions.

Medicare Part D “is too complicated. It’s too costly,” he added.

Rebecca Pruitt, an Illinois assistant attorney general in the Consumer Protection Division, said senior citizens should be wary of fraud when choosing a prescription plan.

“This program has opened the door for fraud against seniors,” she added.

Contact the city desk at (563) 383-2245 or newsroom@qctimes.com.