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Medicare Part D
High Drug Prices and Insufficient Benefits for Seniors
When Mike graduated from pharmacy school in 2005, he quickly found employment working in a Rockford hospital as an overnight pharmacist. Mike’s job at the hospital consists mainly of entering orders, answering questions for nurses, and helping physicians determine the appropriate dosage for prescriptions. In his current position, Mike has no contact with patients. That has not always been the case, though. While he was putting himself through school, Mike worked as a pharmacy technician at an Osco Drugs in the suburbs of Chicago. Mike saw first-hand just how difficult it is for Illinois’ seniors to purchase the prescription drugs they need.
In one especially heart-breaking case, Mike watched an older man sink deeper and deeper in debt each month due to the cost of his wife’s prescription drugs. The couple was uninsured and the man’s wife was taking anti-rejection medication. Mike never asked what sort of transplant the man’s wife had undergone, but reports, “It’s safe to say that she’d probably die pretty quickly if she didn’t take her prescription.” Faced with this grim reality, the man opted to pay for part of the $1200 prescription each month and put the rest on his credit card.
This is an extreme example, but during his tenure at Osco Mike noticed a disturbing trend. Oftentimes elderly customers with several prescriptions each month would not be able to afford them all — even if they had some sort of supplemental coverage or discount. Mike explains, “A lot of them had this 20% discount plan, which is really a drop in the bucket. I remember one old lady in particular who told me she couldn't get all of her meds, and wanted to know which one was safest to not take.” The woman ended up holding off on her Lipitor as opposed to her pain medication, Alzheimer medications or antibiotics. As a health care professional, Mike did not like to see this woman go without any of her needed medications. However, placing himself in the consumer’s shoes, he admits, “When Lipitor costs $100 a month, I think a lot of people would rather face the risk of a heart attack than shell out this money every single month for something that doesn't even make them feel any different.”
Mike found that Medicare Part D, touted as the solution to seniors’ drug woes, is in reality, “just a huge mess.” First, the sheer number and variety of plans is enough to make anyone’s head spin. “Trust me, Mike says, “pharmacists don’t even have a clue what’s going with Part D, and we’re supposed to be the ones helping people sign up for it.” A big part of the problem is that every privately contracted company will cover some medications, but not others, and some at one tier, but not another tier — and there is no easy way to find out without calling each company and asking them about specific drugs. Secondly, Mike calls attention to the infamous "donut hole" where there is no coverage from $2500-5500 in drug spending. Mike has found that oftentimes seniors are not aware of the donut hole and thus unprepared to pay the $3,000 out of pocket required before their coverage will kick in again. According to Mike, it would be simpler and more efficient to have just one government-run plan. Not only would it be easier for seniors to sign up for and understand, but it would also eliminate the need to give taxpayer money to insurance companies.
Some of our nation’s lawmakers, including Illinois Senator Dick Durbin, are in agreement with a lot of what Mike is saying. As a first step, Durbin has introduced legislation that would require the government to offer a nationwide Medicare-delivered prescription drug plan. While this plan would not replace the myriad of private options, it would at least allow seniors to choose a plan with a uniform nationwide premium and preferred drug list. Moreover, this act would also authorize the government to use its bargaining power to bring down the price of drugs for seniors on the plan. If all seniors were on the same plan, the government would have even more leverage and thus be able to secure even greater savings for seniors and the taxpayers who ultimately subsidize the system.
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