PHARMA/POLITICS: When Democrats attack!

When Democrats attack, somehow it doesn’t convey the ferocity of the original series…but with Bush’s approval ratings going up as the price of gas comes down, the Democrats are issuing a Medicare drug report. Yup, they’ve noticed that there is both an election in November and that plenty of Part D participants are in the donut hole. And perhaps it’s about time to take the initiative back from the BS meme that “most people in Part D are happy so it must be a good thing/Republican votegetter, and the donut hole doesn’t really exist anyway.” The donut hole is the most obvious thing to go after, and the one that most seniors are concerned about, so here goes:

The analysis includes a breakdown by state showing how much more money residents would have to pay annually if they switched to a plan that had no doughnut hole. The nationwide average was $458. Residents of New Jersey would have to pay, on average, an additional $298. Residents of seven states would have to pay, on average, an additional $721. Those states are Iowa, Minnesota, Montana, North Dakota, Nebraska, South Dakota and Wyoming.”As this report shows, the opportunity to purchase plans that fill the hole is a mirage,” said Rep. Pete Stark, D-Calif. “Beneficiaries are no more able to afford expensive, full-coverage plans than minimum wage Americans are able to afford a Mercedes.”

On the other hand, they don’t seem to mention getting effective drug re-importation, even though that is banned by the legislation and over 80% of adults are in favor of it. And somehow they’ve managed to get the AP guys confused by the White House spin:

Democrats contend that one solution to filling the doughnut hole would be to let the government negotiate drug prices on behalf of beneficiaries, instead of having fragmented insurance companies doing that. Then, the government could use the savings achieved to do away with the gap. But Nelligan replied that all of the Democratic proposals that have been scored by the Congressional Budget Office had cost projections at least twice as high as the cost of the current drug benefit.

Hmm… it’s hard to imagine something costing more per benefit delivered than the current version of the Medicare Modernization Act, especially when the payoffs to employers, insurers and hospitals are counted in. And wasn’t there something about a certain government agency that already negotiates rather better on drug pricing that the Part D private plans, and yet somehow that information didn’t make it into this article? Oh yeah, there was.

3 replies »

  1. Yes, I know there are much cheaper alternatives out there. But they are not all the same. I was taking Nexium for a year (after having already tried Prilosec and not being able to tolerate the side effects) then BCBSM stop covering the Nexium. My doctor switched me to Protonix and I am getting the same untolerable side effects as the Prilosec. Nexium did not give me any side effects and it worked great for me. Now I do not know what I am going to do.

  2. At a recent conference, United CEO, Dr. William Maguire, stated that as of mid-September, 10% of its Medicare Part D insureds had reached the doughnut hole and another 2% are already through it at into the catastrophic coverage zone where taxpayers pay 95% of drug costs.
    With respect to the savings that can potentially be realized if the government negotiates prices, I think advocates really mean dictated prices and/or price controls and not negotiated prices as that term is normally understood. I think dictated prices and/or price controls could have a significant adverse impact on drug industry innovation and risk taking in the future?
    I suspect that a significant percentage of seniors who hit the doughnut hole could afford a policy that covers it or, perhaps, join a Medicare Advantage plan that includes drug coverage.
    As for the person in the story who takes Nexium, I suggest switching to Priolec or a generic. United HealthGroup won’t even pay for Nexium anymore because of the availability of much cheaper, effective alternatives.

  3. Too bad JD Powers and other consumer surveys have recently found stunning improvement in senior satisfaction with Plan D (at least in Texas, Cali, and Florida). Pretty amazing considering the disaster which was the drug plan roll out.
    It might turn out Democrats are standing on the sidelines screaming, “We can make your plan better!”
    And get a yawn in return.