Medicare Drug Benefit Punishes the Poor

Finally the real impact of the Bush Administration Medicare drug benefit has come out. It effectively punishes the indigent who are dual eligible for Medical Assistance and Medicare. All dual eligible recipients will find their formulary for medications narrowed significantly. While this will not affect everyone, those who are disabled with mental illness may find they can no longer continue the one version of the medication that has worked for them. They may have to face taking medication that causes permanent side effects including neurological movement disorders like Tardive Dyskenisia. On top of that, the cost of these medications will increase not decrease for the dual eligible.
This is typical of the Republican habit of blaming the indigent while lining the pockets of the pharmaceutical companies and is unconscienable.
Contact your legislator today to head off this mess.


FACT SHEET on the New Medicare Prescription Drug Benefit
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 establishes a new prescription drug benefit for Medicare beneficiaries starting in January 2006. Medicare beneficiaries may include children, adults (18-64) and seniors. This voluntary drug benefit will provide financial assistance to Medicare beneficiaries to purchase prescription drugs. Persons who are dually eligible for Medical Assistance (Medicaid) and Medicare will receive their prescription drug benefits through the Medicare program—not through MA. Medical Assistance will not be able to provide any additional prescription benefits or to supplement the Medicare program in any way.
The New Medicare Prescription Drug benefit will change the way co-payments for prescriptions will be calculated. The $20.00 per month maximum on prescription co-pays will not apply to those covered by the Medicare Prescription Drug Benefit (even if they also receive Medical Assistance). The exclusion on co-pays for anti-psychotic medications will not apply.
The Prescription Drug Plans under Medicare are allowed to choose which drugs they will pay for in each therapeutic class. This means that newer drugs are often in the same classification with older drugs (e.g. with antidepressants, tricyclics and SSRIs are in the same class). All 20 of the newer anti-convulsant medications (mood stabilizers) are in the same class. All of the newer atypical anti-psychotics are in the same class. Thus access to prescriptions may be much more limited than it has been (in some cases, access may be limited to the older (less expensive) drugs that may have more side effects or may not work as well).
In addition, the Medicare law only requires that two drugs from each class be made available to enrollees. Thus persons may not have access to the drug (or combination of drugs) that works best for them.
The average prescription cost for persons under 65, who received at least one mental health drug during FY2004 and receive both MA fee for service (not PMAP) and Medicare is $458.00/month.* This number includes prescriptions for any other health problems the person may have. As access to the needed array of medications is restricted, persons may not be able to live in the community and may need longer term hospitalizations or nursing home care, resulting in higher health care costs to both Medical Assistance and Medicare, in addition to associated costs (e.g. foster care of children).
Impact on Low Income Persons
Low income persons who receive MA and Medicare will be affected in several ways
• $20.00 maximum co-payment per month no longer in effect
• exclusion of atypical anti-psychotics from co-payments no longer in effect
• the amount charged for co-pays will depend on the persons’ income level ($1 & $3 or $2 & $5)
• may be unable to get the drugs they need
• may be negatively impacted by increased hospital days, civil commitment, loss of home, loss of kids into foster care
*Total number of unduplicated persons under 65 is 32,656. 57% of the drug costs are for psychiatric medications. Psychiatric Medications were defined as anti-psychotics, anti-depressants and anti-manic classes of medications. In addition a selection of other medications were included that are often used to treat mental health disorders.
IMPACT on MINNESOTA
During its most recent fiscal year, Minnesota's Medical Assistance (MA) program paid close to $205 million for prescription drugs of all types for individuals who had at least one prescription for mental health, and who were also on Medicare. Of the $205 million, $102.5 million came from state funds and $102.5 million from federal funds.
The Medicare law includes “clawback” provisions that require states to make payments to Medicare for the projected savings to MA due to Medicare’s new coverage of prescriptions. It is unlikely that states will save any money through this new coverage. In fact, some states anticipate that it will cost them money because of increased administrative responsibilities.
Minnesota will only be able to intervene through paying for these prescriptions out of the general fund.