Seniors Pay High Price for Gap in Benefits Coverage

Since the Medicare Part D drug benefit was unveiled, it has proven to be even more confusing and inefficient than its critics predicted. Even seniors who have been able to register for the program must still struggle with a $3,000 gap in benefits coverage and a hefty monthly premium.

Already the government has had to change the program: The Centers for Medicaid and Medicare Services reversed an earlier decision prohibiting new Medicare prescription drug plan recipients from participating in free or subsidized drug programs sponsored by pharmaceutical manufacturers.

But we can’t stop there. The reversal fails to count the full value of these prescriptions toward seniors’ $3,000 obligation, an expense that could put many in the poorhouse.

The Bush administration claims that its new benefit is a good deal for people who are not eligible for Medicaid. Yet most individuals will pay not only a $250 deductible, but also 25 percent co-insurance on the next $2,000 in covered drug costs. And add roughly $32 a month per person for a monthly premium.

In addition, the new Medicare plan requires each senior to cover 100 percent of the costs over $2,000 until catastrophic coverage kicks in at $5,100.

We can and must close the holes that may ruin seniors’ fiscal health as they try to preserve their physical health.

Private companies are already taking action. A group of pharmaceutical companies announced a plan called “Bridge Rx,” which will help seniors trapped in the $3,000 hole afford their medications. Seniors will get drug discounts of at least 50 percent in exchange for a 15 percent co-pay.

Washington should also act by letting those who qualify for subsidized pharmaceutical manufacturer programs like Bridge Rx – but who concurrently pay a monthly Part D premium – count the full value of their medications’ formulary price toward the $3,000 gap.

The purpose of the Medicare prescription drug program was to help seniors, not generate revenue for insurers and pharmacy benefit managers. It’s time to deliver on the promises that were made.