September 22, 2024
Column

Real promise of Medicare drug benefit

I will never forget the story I heard several years ago from a man who told me he and his wife required seven medications between them, that would have cost more than $400 a month out of their own pockets.

Their solution? He would simply take his pills every other day. When I asked him if he’d checked with his doctor to see if that was acceptable, he said “no.” He didn’t ask because he already knew the answer. He also understood they couldn’t afford to pay for the doses his doctor had prescribed.

For too long, too many of our seniors have been threatened with financial ruin because of skyrocketing drug costs – with average increases of 16 percent annually between 1999 and 2002, a rate seven times higher than the rate of inflation. Clearly, our seniors could no longer wait for Washington to act – and thankfully, on Dec. 7, President Bush signed into law a historic Medicare prescription drug benefit, the first significant modernization of the program since its inception in 1965.

This legislation was not all it could have been, and it was not all it should have been. But in the end, millions of seniors will benefit over the stagnation of the status quo. In Maine alone, there are 58,000 Medicare beneficiaries who never had drug coverage, but that will change with this Medicare prescription drug benefit. The fact is, we no longer could hold our seniors’ futures hostage to a political unwillingness to compromise. The bill that was signed into law provides us with our best available opportunity to secure, for the first time, a legislative foothold to improve the health of our seniors.

How does it work? For the short-term, all of Maine’s 200,000 Medicare beneficiaries will be eligible for Medicare- endorsed prescription drug discount cards on June 1, 2004, which will provide 10 to 25 percent savings. Seniors with incomes below 135 percent of the federal poverty level, or $12,123 a year ($16,362 per couple), who do not qualify for Medicaid or other drug coverage, would receive $600 in immediate assistance each year until 2006.

Starting that year, all Medicare beneficiaries will be eligible for prescription drug coverage through a Medicare-approved plan – with particularly strong coverage for Maine’s 93,000 most vulnerable seniors. Our poorest seniors, those individuals with incomes below the poverty level, or $8,980 a year ($12,120 per couple), will receive a full benefit with no gap in coverage. Their prescriptions will cost $1 for generic or $3 for brand-name drugs with no cost whatsoever once their spending totals $3,600 in drug costs. At least 41,000 Mainers will qualify for this benefit.

Another 34,000 Maine seniors with incomes below 135 percent of the poverty level, or $12,123 a year ($16,362 per couple), will pay no premiums or deductible, and will not have a gap in coverage. Drug cost-sharing is limited to $2 for generic and $5 for brand-name prescriptions with no cost-sharing once a senior has spent $3,600 on prescription drugs.

More than 18,450 seniors with incomes below 150 percent of poverty, or $13,470 a year ($18,180 per couple), will receive a benefit with an income-based premium of between zero and $35, and a deductible of $50 a year – again with no gap in coverage. This group of seniors will pay 15 percent of prescription drug costs once they spend $3,600 with cost-sharing of $2 for generic and $5 for brand-name prescriptions above that $3,600 level.

Finally, seniors with incomes above 150 percent of the poverty level, or $13,470 a year (or $18,180 per couple), will receive a standard benefit. They will pay a monthly premium of approximately $35 and will have, on average, 50 percent of their drug costs paid for. After a $250 deductible, the plan will pay 75 percent of drug costs up to $2,250. Once a senior has spent $3,600 in out-of-pocket costs, the government will pay 95 percent of their drug costs, covering all but 5 percent or $2 for generic and $5 for brand name prescriptions.

While not perfect, passage of this bill was a portrait of what is possible. It was a transformational moment in the history of the Medicare program – because now, there will be no going back to a time when a quarter of our nation’s seniors struggled without any assistance whatsoever to pay for the prescription drugs that can be the difference between a decent quality of life, and life itself.

This law is the new baseline, and benchmark from which future progress will be measured … and attained. As we look ahead, I plan to introduce legislation this spring with Sen. Ron Wyden, D-Ore., to tackle the ongoing crisis of spiraling drug costs by tracking the prescription drug prices to protect against unjustified price spikes.

To paraphrase a well-known quotation, this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning – of the struggle to provide a meaningful prescription drug benefit for America’s seniors.

Olympia Snowe is a senior member of the Senate Finance Committee, which has jurisdiction over Medicare, and a co-sponsor of S. 1, the Senate version of the Medicare prescription drug bill.


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