Senate's Medicare Drug Plan will Limit Senior's Choice of Medication

St. Paul, Minnesota - Seniors should not rush to embrace the Prescription Drug and Medicare Improvement Act of 2003 that is soon to be voted out of the U.S. Senate's Finance Committee.

"This is drug coverage by committee. A bureaucratic process will determine which drugs are available and who gets them. Not every medication will be covered, covered medications can be denied, and private drug coverage may no longer be available," says Twila Brase, president of the Citizens' Council on Health Care.

The actual bill, which may be voted on as early as Monday, June 16, is not available to the public. CCHC provides the following limited list of concerns taken from information provided in the 90-page online summary:

  • LIMITED ACCESS: Drug formularies (limited lists of drugs) would be allowed. Any drug that is not on the health plan's drug formulary would be excluded from coverage. Plans using formularies would be required to establish a "pharmacy and therapeutic committee" to develop the formulary. In addition, any drug that did not meet Medicare's definition of "reasonable and necessary" could be excluded from coverage.


  • DEDUCTIBLE DISCRIMINATION?: It is unclear how the $275 deductible and the $3,700 cost-sharing limit is reached. Only with Medicare approved drugs or with all medications purchased by the senior citizen?


  • COERCIVE ENROLLMENT: Although the new Part D of Medicare (Drug Coverage) would be voluntary, there will be penalties for delayed enrollment. Those financial penalties have yet to be determined.


  • PRIVATE DRUG COVERAGE TO DECREASE: The bill encourages the companies and groups that currently offer private drug coverage to seniors to drop such coverage. It allows seniors to enroll without penalty after the initial enrollment period if the group health plan, state pharmaceutical assistance program medicaid, veterans program and Medigap terminates the enrollee, ceases to provide drug coverage, or reduces the value of their drug coverage.


  • NO DRUG COVERAGE IN MEDIGAP?: Enrollees of the new Medicare drug plan would not be permitted to buy Medigap drug policies. This may encourage Medigap plans to drop all drug coverage.


  • MANAGED CARE AND PRIVACY CONCERNS: Entities offering drug coverage will be required to have a cost-effective drug utilization management program, a program to reduce fraud, abuse, and waste, and a medication therapy management program, which among other requirements must increase adherence with prescription regimens and "detect patterns of overuse and underuse of drugs".


  • ACCESS DENIED?: Once enrolled, Medicare recipients may be forbidden to purchase any covered medication that a health plan, pharmaceutical benefit manager, or state program denies. With the exception of Advanced Beneficiary Notices, current law forbids private payment for any covered service that Medicare denies.

"If the summary is an accurate reflection of the proposed bill, this bill would guarantee that seniors will have less access to medication and more micromanagement of their health care," Brase emphasized.



Media Contact:

Twila Brase, President and Co-founder
Office: 651-646-8935