This past Tuesday, Michael Levitt visited Peoria as part of the nationwide effort to inform the public about the benefits of Medicare D(isaster).  When visiting the Central Illinois Area Agency on Aging, Levitt encouraged about 60 attendees to sign up for the Medicare D(isaster) as soon as possible, said Nancy Bell, the agency’s pharmaceutical manager.

Bell continued

“He [Leavitt] stated that Medicare was helping people, that a lot of people were saving money because of the program…He set up a laptop and people were applying while he was here…He was urging senior citizens and the disabled to sign up.”

However, Leavitt appeared to be to intent on signing people up for Medicare D(isaster) policies and neglected to mention a few very important things that are listed below.
Many who receive their rx’s under Medicare D(isaster) will now be forced to have their rx’s changed to lower cost generics, or in some instances, a different medication altogether.  The medication that is covered under Medicare D(isaster) may or may not be as effective as the one that a person’s treating physician had prescribed or wishes to.  However, as it is covered, a change in rx’s may be the only recourse for some who are low-income.

Another thing that was not reported as being mentioned by Leavitt is the fact that the largest insurer in Philadelphia is making changes to their list of covered drugs, effective June 1, 2006.  Other insurers across the country will likely follow suit.  As of today, Medicare knows what these changes are, is not saying and has refused requests from The Inquirer to list the companies making changes and the drugs they are removing from their preferred lists/formularies.

According to Olympia Snowe,

“It is critical that we get complete information on how plans perform – such as how often drug formularies changed, and how such processes as ‘prior authorization’ and requests for exceptions are handled…That is essential to conducting oversight of the program.”

Richard G. Stefanacci, founding executive director of the Health Policy Institute at the University of the Sciences in Philadelphia, criticized this action, as those who dislike the changes in the formularies may appeal to continue to recieve their former rx’s.  Drug changes can affect care. One antidepressant may work on some, not work on others, and, others still may have a reaction that varies in severity.

Stefanacci continued,

“Patients do the right thing and pick the plan, and the plans change…It definitely bothers me.”

The provision in the legislation that allows for the changing of the formularies in the Medcare D(isaster) policies upsets Larry Colfer, 80, a retiree.

Colfer signed up for the Medicare drug plan in November, as soon as he could. he checked which one covered the five medications he takes a day and double-checked w/his pharmacist to determine what each drug would cost and made sure it fit his budget.  Despite that, he did not know that the formularies on each plan could change repeatedly.  After all of his research, he does not want to repeatedly investigate all of the Medicare D(isaster) plans repeatedly.

“Why should I have to be stuck with that?  If they change their plan once a month, then I should have the right to change plans too.”

 Colfer opined.

Although the first three month of this year were percieved as a trasition to Medicare D(isaster), the transition period ended on March 31. Bill Vaughn, a health lobbyist and senior policy analyst earlier cited a 2004 government study from the Medicare Payment Advisory Commission that transferring an enormous number of files from one insurance carrier to another takes approximately SIX MONTHS.

Despite that, as mentioned by Steven D in his diary re:  TALKING POINTS, there have been no extensions of the enrollment period, provisions for negotiations for a lower price, and no prohibitions one of the insurance carriers changing the formularies (to determine what rx’s are covered).  Instead, the republicans follow the lead of the Salesman-In-Chief and distribute talking points/marketing ploys to assure their vulnerable and, in some instances, too-trusting constituents.

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