The transition to Medicare D(isaster) officially ended on March 31, 2006. After all of the previous mix-ups and people not being able to get their rx’s, the administration ordered the rx companies to cover a 90 day supply of prescriptions. This was supposedly done as a way to ease the transistion from Medicaid payment of prescriptions into Medicare D(isaster).
The lower cost drugs that were listed on the formularies were intended to hold the costs of Medicare D(isaster) down. However, in many instances, there is not a generic equivilant of a prescribed drug that is needed for a chronic condition. Or, in other cases, the generics or lower costing drugs that are listed on the formularies are not covered under Medicare D(isaster), unless one purchases an “enhanced” policy that will cover them. (Unfortunately the latter option is not financially possible for many who live at or below the federal poverty level.)
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According to the latest figures, roughly 27.5 million U.S. seniors are enrolled in Medicare D(isaster), with 25% individually signing up. The number of seniors using the transitional benefit to pay for drugs while switching to less expensive, and in some cases, less effective rx’s has not been disclosed by CMS.
Medicare D(isaster) allows for a five step appeal process for exceptions if a doctor can demonstrate that a drug that is not on the one of the formularies is medically necessary. And, as stated earlier, many do not know that their rx’s are not covered until they reach the pharmacy and payment for rx’s is denied. As a result of the denials, many have told the pharmacists to keep the rx’s, as they are unable to afford it.
Last Friday, a letter to President Bush stated that Medicare D(isaster) plans have not adequatley informed seniors of formulary requirements.
The letter, written by Senator Edward M. Kennedy and 9 other democrats states:
“We’re very concerned that many elderly and disabled citizens will not be able to obtain the drugs they desperately need if the transition policy ends.”
This describes exactly what happenned during the first three months of the year. However, other than repeated infomercials by the Salesman-In-Chief, little has been done to address the problems of Medicare D(isaster).
Accordng to Mark McClellan,
“Although the initial transition period is ending, the requirement for an effective transition process for all the drug plans is not. We will impose penalties when plans don’t meet the Part D standards.”
McClellan further stated that Medicare would release data on the length of call-center wait times and data relating to the length of the five step appeals process in a few weeks.
What if a Medicare D(isaster) beneficiary, such as a transplant recipient, doesn’t have a few weeks?
available in orange and at My Left Wing.
Really now seriously thinking that Ductape was right! Those who survive this round will be in for God-knows-what the next!
And I may have been wrong in implying that people should not send money to the politicians.
Like this little fellow, having a politician on your side, AND money, may be your hope of being de-selected for elimination:
Kind of an unusual story, considering that Ejlers voted for Medicare D(isaster)–roll call. Also unusual considering the source of some of his campaign contributions in 2002, 2004, and <ahref=”http://www.opensecrets.org/politicians/sector.asp?CID=N00004166&cycle=2006″>2006. (Well, they did decrease a BIT.
Thanks for the link–have a feeling I may need that one!
It’s been my personal experience that some congresspeople are very good at helping – depending on the issue, their seniority, and their willingness to tell the other powers that be to go take a flying leap. I do support such people, IF they have a perspective that I can otherwise tolerate.
Because, of course, this nice service this cuts both ways. When I lived in another state, one of our reps voted for things that made my stomach turn – over and over. . . but his office was one of the most specifically helpful to individuals. That kept him in office, when his votes should have turned him out. Ehlers may be one of those types, too.
It reminds me of Bushola senior voting against funds to reduce garbage dumping in the 5th ward in Houston, even in the face of terrible testimony about a poor toddler who was bitten on the face by rats while he slept on his pallet on the floor. Where there was no garbage sitting around outside, no rats. On the way home from that vote, he called his wife, and asked about donating the family crib to the parents of that child, to keep the baby up off the floor. “Person-to-person help – the heart of compassionate conservatism.”
Had a report from one of my students, who is on a well-spiced array of meds that keep her pain-free, brain working pretty well (following a major car crash a couple of years ago), and other compounding difficulties.
She is now officially on the “5-step” program. Which is to say, she left without at least 2 of the things that she needs to keep her brain working more or less as it should – her words, not mine. (Note: I have her permish to describe her situation.).
My thoughts are this: There are no “5 steps” for her, and many like her – just a giant push off the cliff. Her children are dealing with two of our illustrious congresspersons to get help. I’m not optimistic.
Not many are. The lines at the drugstore are going to keep getting longer, sad to say.
At some point, CMS has to calculate the risk-adjusted bonuses/penalties to be paid to the PDPs. When that happens, we’re probably going to find out that a lot of the plans are financially non-viable. Those plans will then go out of business, stranding the people who have committed to them.
Imagine you signed up for a plan, knowing its formulary. Your doctor prescribes medications for you, taking that plan and formulary into account. Then your plan goes out of business. Poof. Your drugs may not be covered on the other plans in your area.
When Medicare introduced Medicare + Choice (managed care) options, there were lots of plans that initially offered. Now, not so much. Will the same thing happen with Part D?
Under Medicare D(isaster), money is more important than people’s lives.
leads one to wonder why this regime and it’s supporters can dare to claim themselves as “pro-life” or talk about the sanctity of life when all they do is try to hurry the end of life for so many.
All this money for killing could have been spent on healing.
While they cry about stained purple fingers in Iraq, thousands of thousands of Americans are waisting away on couches in pain, in misery – dying for lack of BASIC or TIMELY health care.
Fuck Bush and this country. It is NOT great. It’s obscene how it sits by and watches and allows and ENCOURAGES people to die.
Because they profit from our pain and our suffering.
The Rethugs are truly the party of death and corruption.
This diary and the posts and links here just reminded me again why I HATE these people…hiding behind their ‘moral’, ‘christian’ leaders, while killing the weak and the poor!
Dear Leader and his party will go down in history as the leaders of the American Dark Ages, and a lesson for future school children to learn how governments can go wrong.
They are not at all pro-life. The repubs are pro-death for all but fetal tissue and the affluent.
With head in sand, Medicare Administrator
responds
to article by Knight Ridder on Seniors Struggle to get drug plans to pay..”
Question Dr. McClellan: Why would anyone be required to go through an appeals process in what is clearly a health issue?
Notice McClellan emphasized seniors as opposed to people with disabilities.