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One third of Medicare beneficiaries have no prescription coverage

Given the recent advances in modern medicine, prescription drugs have never been more important than they are today. Prescription drugs serve as complements to surgical procedures, substitute for surgery, reduce future health risks and abate many chronic health conditions. Yet the people who rely on them the most, older adults, increasingly find themselves uninsured or with coverage that is becoming both cost-prohibitive and limited in scope. The current Medicare program does not cover most outpatient prescription drugs. An estimated one-third of all Medicare beneficiaries (approximately 12 million people) have no prescription drug coverage at all. And, many beneficiaries who do have coverage still incur substantial out-of-pocket drug costs.

Obstacles to obtaining drug coverage:

Employer-sponsored coverage -- the biggest source of coverage-is available only to those whose employer offers it, and coverage is declining. Medicare+Choice plans are offered only in certain areas, plan withdrawals are increasing and drug benefits may decline over time. Individually purchased supplemental coverage with drug coverage is costly, has high cost sharing, and may be denied to certain individuals. Medicaid drug coverage is available only to the very poor, and does not reach many low-income beneficiaries whose income exceeds eligibility levels. According to the Kaiser Family Foundation, 40 percent of Medicare beneficiaries without prescription drug coverage (nearly 5 million people) have incomes at or above 200% of poverty ($16,700 single/ $22,500 couple.) It is often individuals with middle incomes, particularly those with chronic conditions who depend on regular drug therapy to manage their illnesses, that are the hardest hit with high out-of-pocket costs for prescription drugs.

Because women generally live longer and are more likely to suffer from prolonged chronic illness, women on Medicare spend nearly 20% more for prescription drugs than men. And -- with women's poverty rates twice that of men, prescription drug costs take a bigger bite out of women's limited income.

In addition, rising prescription drug costs are expected to result in even higher premiums for prescription drug coverage, a reduction in the rate of retiree drug coverage, and higher cost-sharing for drug benefits. Each of these factors will further increase beneficiaries' out-of-pocket prescription drug spending. As long as Medicare does not have a prescription drug benefit, beneficiaries are increasingly likely to face financial barriers to obtaining appropriate medications.

Many Medicare beneficiaries are unable to access the prescription drugs they need to maintain good health. At a time when many new prescription medications are available and being prescribed by physicians as an integral part of a comprehensive treatment plan, millions of Medicare enrollees cannot afford their high cost.

Principles for a prescription drug benefit:

The National Association of Area Agencies on Aging (N4A) supports the inclusion of the following principles in all Medicare Prescription Drug benefit proposals brought before Congress. The majority of these have been adapted from principles developed by the Leadership Council of Aging Organizations:

Benefits

• Medicare should guarantee access to prescription drugs as a part of its defined benefit package under the Part B program.
• Medicare's drug benefit should provide comprehensive coverage, including the most current, effective and individually appropriate drug therapies.
• Medicare's contribution toward the cost of prescriptions must keep pace with the increase in the cost of drug products and not be tied to budgetary caps.
• The addition of a Medicare drug benefit must not reduce access to other Medicare benefits.

Coverage & Affordability

• The Medicare prescription drug benefit should be available to all Medicare beneficiaries regardless of income or health status. Sufficient subsidies should be provided for low-income beneficiaries to ensure their ability to utilize the benefit.
• The Medicare prescription drug benefit should be voluntary and provide safeguards against the erosion of current drug coverage provided through other sources.

Administration

• The new Medicare prescription drug benefit should be administered in a consumer-centered way and carefully monitored to assure overall high quality health care.
• The Medicare program should include appropriate cost-containment measures while effecting considerable cost savings resulting from bulk purchasing.

Quality and Education

• The Medicare Program should strive to prevent the overuse, underuse, and misuse of prescription drugs.
• The legislation should require that educational programs be provided to beneficiaries about the over-use/abuse of prescription and over-the-counter drugs, and adverse drug reactions (i.e. alcohol taken with prescriptions.)

Source: RefillPill.com Editors' Choice