Sunday, March 12, 2006


Medicare Drug Benefit Cuts Lifeline For Many

I'm wrangling by way through Medicare Part D, like millions of others. It's a mess. It was designed to be a mess, I believe, and to essentially make kajillions of dollars for the pharm companies—a little payback for their donations to certain politicians I won't even bother to name.

There are, however, uncounted thousands, maybe millions, who are falling through those old familiar cracks, the holes in the safety net, out the back door into oblivion.

Billions for resource wars, zilch for health care

Subject: Medicare Drug Benefit Cuts Lifeline
Date: March 11, 2006 12:24:11 PM PST
News & Observer - North Carolina
March 10, 2006

Medicare drug benefit cuts lifeline

The standard Part D benefit requires enrollees to
meet a $250 deductible, then pay 25 percent of the
drug's retail cost.

Once drug costs hit $2,250, Part D then requires
enrollees to cover the cost of their medicines in
full until they have paid $3,600 out of their own
pockets. Only then does coverage resume, with
Medicare paying 95 percent of members' drug costs.

The rules are hurting people, especially those on
expensive drugs, who are not poor enough to
qualify for low-income assistance under Part D
but not affluent enough to afford their
out-of-pocket expenses under the Medicare drug
plan. Medicare is the federal health insurance
program for the elderly and disabled.

By Sabine Vollmer and Jean P. Fisher, Staff Writers

James Hayes has been living with HIV, the virus that
causes AIDS, for more than 24 years. Now he has to
choose between the drugs that keep him alive and a
lifetime of debt.

The reason: the prescription drug benefit, or Medicare
Part D, that took effect Jan 1.

Hayes, who lives near Boone and is on Medicare,
receives about $40,000 worth of drugs for free through
patient assistance programs offered by drug makers to
the poor and uninsured. But now that Medicare enrollees
are eligible for drug coverage, many pharmaceutical
companies are closing those programs to Medicare
patients and urging them to sign up for Part D.

Hayes estimates that under Part D, his annual out-of-
pocket expenses for medicine will increase to at least
$7,000 -- much more than he can afford when his sole
income is a $2,200 monthly disability check.

"I can sign up for it, but I can't afford it," he said.
"The best financial strategist couldn't figure out how
to make this work."

People with HIV/AIDS are not the only patients hurt by
the changes. Anyone on Medicare who now receives free
or low-cost medicine through a patient assistance
program may lose access to free drugs. Many are not
poor enough to qualify for low-income assistance under
Part D but not affluent enough to afford their out-of-
pocket expenses under the Medicare drug plan.

People with HIV/AIDS are particularly vulnerable. They
take multiple drugs. There are few alternatives, no
low-cost generic options, and most are very expensive.
Hayes' most costly drug, for example, is Fuzeon, which
retails for about $1,800 a month.

The Henry J. Kaiser Family Foundation, a health policy
research group in California, estimates that about
35,000 Americans living with the human immunodeficiency
virus might be unable to afford their medicines under
Part D.

The Kaiser Family Foundation doesn't break down where
those most affected by the Part D changes live, but
HIV/AIDS advocates say North Carolina has more than its
share. HIV/AIDS sufferers here are forced to turn in
greater numbers to patient assistance programs because
strict income limits keep many out of the state's AIDS
drug assistance program. The program provides free
medicine to patients through state and federal funding.
Patients in North Carolina must have an annual income
of $12,250 or less to get assistance.

Government blamed

Drug industry leaders say the federal government has
made it difficult for them to help poor patients.

The U.S. Department of Health and Human Services' fraud
and abuse unit indicated in November that companies
that continue to give free medicine to people enrolled
in Part D might be investigated for violating federal
anti-kickback laws.

The government fears drug companies might provide free
medicine to steer patients toward more expensive drugs,
which would increase Medicare's cost.

The argument makes little sense where HIV/AIDS is
concerned, since no generics or low-cost options are
available, said John Coburn, a senior policy analyst
with Health & Disability Advocates. The Chicago group
is advocating for HIV/AIDS patients who stand to lose
access to patient assistance programs.

In January, the agency that runs Medicare issued a
detailed statement that seems to clear the way for
pharmaceutical companies to keep patient assistance
programs open to Medicare members.

It said drug companies can continue to give free
medicine to Part D enrollees, as long as the value of
the free drugs isn't counted toward patients'
deductibles and other out-of-pocket costs. In other
words, needy patients could sign up for Part D, then
not use it for their most costly medicines.

One drug maker, Merck, announced this month that it
will continue to help certain patients enrolled in Part
D. Individuals with special needs could have annual
income of up to $39,200 and still receive free

But working around Part D isn't appealing to all drug
companies. Some appear unwilling to give away medicine
when insurance exists to pay for it.

"The mission, historically, of patient assistance
programs is to provide assistance to patients who have
nowhere else to turn and, most often, have no health
insurance options," said Ken Johnson, a spokesman for
the Pharmaceutical Research and Manufacturer's

Still some drug makers are in talks with Medicare and
hope to come up with mutually acceptable ways to help
needy Part D enrollees afford their drugs, he said.

But there isn't much time. Eligible Medicare members
who fail to enroll in Part D by May 15 will pay higher
monthly premiums for life.

"It's time to get beyond all this and start coming up
with solutions," said Coburn of Health & Disability
Associates. "The one solution that is not acceptable is
for [HIV/AIDS patients] to end up in May with no drugs,
and that's where we're headed."

Patient tells his story

James Hayes plans to wait until the last minute to sign
up for Part D. But he is also helping to raise
awareness of the patient assistance program problem.

Hayes will talk about his situation as part of a town
hall meeting today at the Duke University School of

The 45-year-old takes up to 17 drugs a day, 15 of them
to keep the HIV in check and treat the side effects of
the AIDS medication. Three of his pills are made by
Abbott Laboratories, a Chicago company, and
GlaxoSmithKline, a British company that conducts most
of its HIV/AIDS drug research at Research Triangle

Hayes has already received a letter from GSK stating
that, after May 15, he will no longer receive two of
their drugs -- whether he signs up for Part D or not.

A spokeswoman for Abbott said the company will continue
to help patients who do not enroll in Part D but may
consider helping those who do sign up on a case-by-case
basis. A Roche spokesman said the company will continue
to supply Medicare patients with Fuzeon.

Patty Seif, a spokeswoman for GSK, said the company
wants to work out a way to help Medicare patients with
special needs but hasn't fleshed out the details.

Hayes has considered dropping some drugs to be able to
afford others under Medicare Part D, but he said he
fears the health consequences.

"I have lost weight [down] to 70 pounds. I have gone to
sleep at night not knowing whether I would wake up
again. I have been to where I could barely breathe," he
said. "I have no intentions of going off these drugs."

Without help from the drug companies, Hayes said he
will have no choice but to max out his credit cards.
He'd rather put his livelihood at risk than his life.

Staff writer Sabine Vollmer can be reached at 829-8992


portside (the left side in nautical parlance) is a news,
discussion and debate service of the Committees of
Correspondence for Democracy and Socialism. It aims to
provide varied material of interest to people on the

Comments: Post a Comment

<< Home

This page is powered by Blogger. Isn't yours?