by Peter J. Nebergall, Ph.D.
Includes photo of Peter J. Nebergall, Ph.D., with cat
There has been a great deal of reportage about the "new Medicare Prescription Drug Benefit. "What is it? How do you get it? Is it an improvement over what you already have?
The last question is most important. If you are of retirement age, or disabled, and eligible for Medicare, you may qualify for this service. If you don't have any prescription drug coverage (or any medical benefits at all -- and there are millions of us), something is better than nothing -- but how much better? It depends. Note: If you receive a prescription drug benefit under Medicaid, Tricare, FEHBP, or any private program, you may not be eligible. If your household income is above $16,862 (but you otherwise qualify for Medicare), you cannot receive the $600 per year subsidy, but can purchase the card.
The Medicare Prescription Drug Benefit is now very much a "work in progress." The "card" became available in June, but is officially "temporary," scheduled for replacement in 2006 -- though we don't know what with. First day to enroll was May 3, 2004. The "rules" are still being fine-tuned. Expect change, and expect the "advisors" to be confused. The "Sign-Up Information Sheet," available for download from the Medicare Web site, is a humongous 34 pages long -- and every paragraph has its list of notes and exceptions.
On paper, it sounds good, at first. Purchase of a Medicare-approved "discount
card" will entitle one to 25 to 30 percent discount off list price for
prescriptions. People in the lowest income ranges are eligible for a $600 per
year prescription subsidy.
As it stands, there are problems. Right now, there are private, low-income drug discount cards (from drug manufacturers Pfizer and Eli Lilly) offering a better deal, with somewhat less stringent income eligibility requirements. Plus, the issuers, the drug companies, allow you to purchase more than one card -- and Medicare does not. It appears, if you are eligible, Medicare will fund your card -- but only one card, under Medicare's rules, and, whether from one of the drug companies or a pharmacy chain (there are a lot of choices), you're locked there for the year (though you may purchase other non-Medicare cards). Choose wisely. For more information, updated almost daily, you might call Medicare: (1-800-633-4227), or inspect their Web site: www.medicare.gov/medicarereform
The Medicare Web site is supposed to allow "comparison shopping" for the best price on prescription medications, but within hours of its establishment, a number of suppliers were quoted (New York Times, May 4) as saying the prices attributed to them were erroneously high. Look for rapid adjustment of the prices quoted on this site, and, if you can, wait a while before you buy in -- give them a chance to get some of the bugs out.
The nonexistence of a single, universal, meaningful drug discount card, is, like the nonexistence of drug price controls or universal health care, a statement of political will -- or lack of same.
A major problem is that the Medicare card's promised discount is "25 to 30% off list," and many drugs, especially at popular discount pharmacies, are already priced well below "list" -- so Medicare card users who have been using already-existing discount plans or private cards, and switch, may pay more, not less, per prescription, than they have been paying. I recommend you make a list of your medications, find out what you have been paying, and ask if you've been paying list price, or some discount. You are responsible for checking whether or not the Medicare card would reduce your expenses -- there is no guarantee. And, as the sign-up literature warns you: "A company can change its discount drug list and the discount prices at any time."
Another problem, immediately obvious when you try to study this new benefit (and you HAVE to study it, if you want to save any money with it) is the incredible complexity. It's too much like Form 1040, folks, WAY TOO COMPLICATED for anyone but a benefits professional to understand -- and the people who need help also need plain-language simplicity. There are 73 different "Medicare-approved" cards already; here it fails utterly.
Unlike the abortive Clinton attempt at national health care, "joining up" in this program is not mandatory. If you already have satisfactory pharmaceutical benefits, you can keep them. If you have a private card (not "Medicare Approved"), you can continue to use it (and note, all discount cards are not and will not be "Medicare Approved.") If you want to keep "traditional" Medicare instead, with its Part A and Part B, you are free to do so. You have to choose what will be best for you, and there's a lot of detail to master before you can make an "informed choice."
The great significance of this program is not its generous benefits -- they aren't. In fact, the new plan is a chaotic, complicated mess. It's just that, for the first time, the wall has started to crumble; the old puritanical resistance against any "socialized medicine" at all has finally failed. I see this hesitant first step as a "door-opener," helping prepare our Neanderthal lawmakers for (eventually) a meaningful, single-payer, price-controlled, national health service.
For that, and perhaps that alone, it is commendable. Now, let's go get to work on a real one!