we do share drugs because I can't get the samples or it's just too
costly, but my husband Val has gone as long as a month without medication”
a retired truck driver, has diabetes. His wife Dottie has high
blood pressure. They can’t afford their medications and often take
less than the full dose or just go without. They don’t want charity
but do feel there should be some sort of subsidy for people like
themselves in the middle-class.
cost of prescription drugs most frequently used by seniors rose
more than four times the 1998 rate of inflation, and yet one third
of America’s Medicare beneficiaries lack prescription drug coverage.
security of prescription drug coverage significantly affects whether
or not the elderly or anyone -- take their medication as prescribed.
For the past several years, out-of-pocket spending on prescription
drugs has been rising. New research and development in the pharmaceutical
industry has led to advances in drugs that treat conditions commonly
afflicting the elderly, and direct-to-consumer marketing has driven
up prescription drug demand.
1999, Medicare beneficiaries spent approximately $400 out-of-pocket
on drugs, and many expect this number to rise. But those seniors
who can't afford to pay for their medications often don't fill necessary
prescriptions, or they take their medicine irregularly. The consequences
can be dangerous, or even deadly. “Original” Medicare does not
cover the cost of prescription drugs outside the hospital, which
means that more than a third of Medicare beneficiaries lack coverage
for outpatient prescription drugs. That number is expected to grow
as private sources of coverage get more expensive. This coverage
gap becomes more of a hardship as drugs grow more expensive and
more important in treating the ills of old age. But some seniors
have some drug coverage under other plans, including Medicare HMOs.
HMOs and other forms of managed care are often able to negotiate
lower prices for drugs from the manufacturers, but people paying
for their medications as individuals cannot take advantage of these
discounted rates. Logically, people who do not have drug coverage
are less likely to fill the prescriptions their doctors give them,
and less likely to take medication that could improve their health
and prevent more serious effects of chronic diseases.
still account for only 7 percent of all U.S. medical spending, a
figure that is expected to reach 8 percent in 2003. Though the amount
spent on drugs may seem small, it is expected to increase dramatically
in the coming years. America is the only industrialized nation with
a free market for pharmaceuticals, or without government restraints
on drug prices. In 1998, there was a record number of new drug launches,
and the industry spent $1.3 billion on direct-to-consumer advertising
four times the 1994 amount.
Medicare was enacted in 1965 as the healthcare linchpin of President
Lyndon Johnson's Great Society, its proponents saw this insurance
plan for the elderly as a step towards the goal of universal coverage.
That goal has yet to be achieved, but Medicare now insures 39 million
Americans and is the nation's single largest source of payment for
medical care. Since Congress established Medicare, its benefits
have remained largely unchanged, with the exception of a few additional
preventative services. Some 151 million employees make mandatory
contributions to Medicare's Part A Hospital Insurance Trust Fund,
which finances inpatient hospital services, continued treatment
or rehabilitation in a skilled nursing facility, and hospice care
for the terminally ill. All eligible beneficiaries are automatically
enrolled in Part A. Medicare Part B is supplemental medical insurance,
modeled after traditional indemnity coverage. Enrollment in Part
B is voluntary and pays for physicians' services and outpatient
services, including ambulatory surgery and diagnostic tests. Under
Part B, Medicare pays 80 percent of the approved amount (according
to a fee schedule) in excess of a $100 annual deductible.
of all, we absolutely have to improve the Medicare benefit package.
We have to add a prescription drug benefit. We have to do something
about catastrophic out-of-pocket expenses.”
Bruce Vladeck, PhD, Director, Institute for Medicare Practice, Mount
Sinai School of Medicine
comments about prescription drug benefits and related topics by
In order to maintain Medicare for future generations, we will need
to increase the funds available, while at the same time reduce the
growth in Medicare spending, possibly by increasing cost-sharing.
Private options for affordable drug coverage include requiring insurers
to cover drugs or allowing pharmacies to buy drugs at the same low
price paid by federal agencies. Public options include expanding
Medicare to include drug coverage, or targeting benefits for those
with catastrophic drug expenses.