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Francine Hardaway

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Is Medicare Part D A Bait And Switch?

Posted: 02/19/10 11:16 AM ET

An Intelligent friend of mine, who is now on Medicare, just found out inadvertently about yet another deal between Congress and the drug companies. In this deal, Medicare Part D (prescription drug benefit) was passed with a right of the pharmaceutical companies to raise drug prices during the open enrollment period. For the person choosing a plan during the Open Enrollment that occurs every year from November to the end of the year, this means it's a bait and switch.

He wrote a letter to his Congressman about it, the text of which can be found here.

Like me, he was under the impression for the last five years that during Part D open enrollment the plans were not allowed to change prices. He was shocked during this last open enrollment to discover that two of the plans he was reviewing changed the full price of some of their drugs AFTER November 15. When he reported this to Medicare he was told that because my complaint was against CMS he had to complain to his Congressman.

Congressman Ed Pastor (D-AZ) confirmed that Congress did write into the MMA law of 2003 that CMS could not interfere with the pricing of drugs and companies could update their prices as often as every 14 days, including during open enrollment and thus Congress either deliberately or unwittingly stacked the deck in favor of the plans and drug companies. My friend, who was saving search results on his computer, discovered this by accident.

He says this is a bait and switch tactic that was resolved by an act of Congress as far back as 1946. How can a consumer properly evaluate and compare plans if the prices unbeknownst to him or her are changing during the process and they have no awareness that prices are changing?

This is either an outrageous hoax that Congress played on the American people who are on Medicare, or a frank admission that no members of Congress read the legislation they pass.

It makes no difference if you have a standalone Part D plan or you are a member of a Medicare Advantage plan. For the last five (5) years the insurance companies and the drug companies have been getting away with robbing the pocketbooks of senior.

Only Congress can correct this. You might want to write a letter to your Congressperson, reminding them that it's an election year and that seniors vote. And that this isn't much different than what the banks and credit card companies do with the small print in their mailers.

 
 
 

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HUFFPOST SUPER USER
jakitchen
09:01 PM on 02/21/2010
Bait and Switch my @ass. It is a total rip-off.
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mcmutter
A Groover has to expect a few setbacks .....
10:43 PM on 02/20/2010
Its a GOP give-away to the pharma industry, big business never losses under republicans ....
06:21 PM on 02/20/2010
Hello

Sign this petition where you can demand congress and the President fix the Medicare Prescription drug benefit

http://bit.ly/drug_benefit

also the original url

http://healthcare.change.org/actions/view/congress_and_the_president_must_enact_a_new_prescription_drug_benefit_in_medicare_part_b

Please get as many people as you can to sign this petition. Everyday I seek new people to sign this petition.

Thank you.
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HUFFPOST BLOGGER
Francine Hardaway
Serial entrepreneur, angel, and HuffPo
09:17 AM on 02/22/2010
I'm hoping something like a change to Medicare D will be part of the eventual reform bill that gets passed. I signed this petition, although as the daughter of an attorney who grew up during the McCarthy era,, I have been taught to be careful which petitions I sign.
This user has chosen to opt out of the Badges program
03:38 PM on 02/20/2010
Medicare Part D has so many problems it needs to be scrapped. The biggest mystery to me is how you can choose an insurance plan for the upcoming year based upon the drugs you will need. Doesn't this require some sort of supernatural ability to see into the future?
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HUFFPOST BLOGGER
Francine Hardaway
Serial entrepreneur, angel, and HuffPo
09:18 AM on 02/22/2010
That, too! It occurred to me, but I never really thought of it until a friend of mine got CML, a form of cancer treatable by Gleevec, a drug that costs $4500 a month.
09:40 AM on 02/26/2010
Thanks for pointing out the problems with medicare part D. Some points could be worked upon while some need improvement or be scrapped for sure. What do the others have to say on this?

http://www.facebook.com/pages/Kolkata-India/Sun-Knowledge/347219307008
02:33 PM on 02/20/2010
The Part D insurance companies for Medicare are padding their pockets in more ways than one.

For instance, I can buy one prescription medicine for $325 without insurance, but the part D insurance says they have to pay $525 total cost for the drug.

They are doing this so you will hit the doughnut hole faster. The total cost of a drug counts toward the doughnut hole, not just what you pay. If you had to buy this same medicine, you would hit the doughnut hole in 4 months. Then, if you buy from the prescription D plan during the doughnut hole period, they will make huge profits off their drugs by charging $525 for a drug they probably pay $200 or less for.

Then when you have spent your way out of the doughnut hole at the cost of $4300, then you only pay 5 percent of the cost of the medicine. That will run about $150 a month when you include your premium. It averages out to cost more by having prescription D.

This is just on one drug. It is no savings for the elderly. The doughnut hole is silly and prescription D is a piece of junk insurance created to help ruin Medicare. Many plans are subsidized by the government at Medicare's expense. This is blatant theivery.
scipio2009
Alan Wolfe's "The Future of Liberalism"
09:00 AM on 02/20/2010
Like, the Senate healthcare bill calls for, Medicare Part D needs to be scrapped, and the drug cost benefits, that Part D was supposed to generate, need to be reincorporated into the direct Medicare system.

Simple as that.
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HUFFPOST SUPER USER
Elle Bach
Mr. Einstein...please call me
12:52 AM on 02/20/2010
The Medicare Modernization act was nothing but more corporate welfare to begin with, a Republican scheme to steal more of the middle class's money. This is a shocking revelation, but no amount of corporate greed nor the blatant lies routinely fed us surprises me anymore.

US citizens are being reduced from participants in a vibrant democracy to victims of ruthless corporate capitalists. It's like we're being held hostage by kidnappers, and to add insult to injury, we're having to pay our own ransom. I'm beginning to feel like an abused wife, or just something dirty. I feel sad and ashamed to be an American. I predict the incidents of planes being flown into buildings will escalate in America in the coming years. We're definitely in a steep decline, the end of which is no where in sight..
10:29 PM on 02/19/2010
Low-income seniors who are eligible for both Medicare and Medicaid were switched from Medicaid drug coverage to Medicare Part D/Medicare Advantage and actually lost a big selection of benefits.

The program signed by Bush in 2004 paid $177 billion in government subsidies to insurance companies. This wasn't Health Insurance Reform this was Corporate Welfare.

Even Bush and the Republicans were for single payer when it lined their pockets.

Example – just drugs- nothing else. Some 25% of out-of-pocket spending by individuals is for prescription drugs

Currently, the U.S.negotiates some drug prices but is forbidden by law from negotiating drug prices for the Medicare program due to a Medicare bill passed by the Republican-controlled 109th Congress and signed into law by President George W. Bush in 2005. This allows the pharmaceutical industry to profiteer off of the Medicare program.

Patented drug prices in Canada average between 35% and 45% lower than in the United States. The price differential for brand-name drugs has led Americans to purchase upward of $1 billion US in drugs per year from Canadian pharmacies. (So because of republicans billions of US dollars goes into Canada’s coffers to help pay for their health care)

Bushes Medicare program is single payer – but in no way paid for. It entirely went on the debt. It also has a donut hole that penalizes the very people it is supposed to benefit but instead benefits the drug companies and insurers.
10:35 PM on 02/19/2010
Also

Back in 1993, all our Veterans Administration hospitals got together and agreed to buy prescription drugs as a group. The next week, the costs of those drugs went down by 50 percent.
08:25 PM on 02/19/2010
As a pharmacist, medicare part d is destroying my profession. I keep begging my reps to "un-privatize" it.

the PBMs (middle men between the plans and the pharmacies) are reimbursing at cost, charging the plans at least 10x more.. and keeping the spread as "profit"-

For example, my dad's atenolol 50mg #30 - I was reimbursed $1.50, when I checked his plan it said they had paid the pharmacy $23- they use the higher number to get you to the donut whole faster- The PBMs rip everyone off and hide their business from any transparency.- I am not allowed to tell anyone what pharmacies are being reimbursed by what plans because they consider that info "proprietary" -

ENOUGH!!! I would pick socialized medicine or ANY other system vs this corporate tyranny.
02:43 PM on 02/20/2010
I asked at a drug store what the cost of a medicine was and they said they could tell me the price to me but not the price to the insurance company.

How about a little transparency?

You know it is obvious that they are having their pharmacy to buy it from the other pharmacy for $200 and paying their pharmacy $500 and making themselves a high profit off of the elderly in this country.
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HUFFPOST BLOGGER
Francine Hardaway
Serial entrepreneur, angel, and HuffPo
09:22 AM on 02/22/2010
Thank you so much. If there is any reason I blog here, it is for you, the readers. No matter how much I read, I always learn more from the comments than I had to know to write my own posts.!
07:50 PM on 02/19/2010
It wouldn't be so bad if we were free to switch to another plan at anytime or at least when the prices change for a current plan, but we are locked in until the next open enrollment period. The system is definitely rigged in favor of the insurance companies. If my car insurance or home insurance prices rise, I can switch to another company immediately. We should be able to do the same with our prescription drug plans. The insurance companies would be less likely to gouge us if they knew they could lose our business as a result.
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FoonTheElder
Always choosing between the lesser of two evils
05:40 PM on 02/19/2010
Medicare Part D was nothing more than corporate welfare for drug companies paid for through taxpayers. It is an example of what happens when you let Republicans in charge of health care issues. They never worry about 'fiscal conservatism' when it comes to Americans paying big money to the big corporations who pay for their campaigns.
schatsie
Wall Street is Worse than Vegas
07:47 PM on 02/19/2010
bingo!
06:34 AM on 02/20/2010
Exactly, Foon.
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Marlyn
If I'm wrong, let me know.
04:01 PM on 02/19/2010
YES. Of course it is.
mamalisa38
I love you Thomas and I miss you like crazy RIP
03:46 PM on 02/19/2010
This legislation also has the insane "donut hole" that gives coverage then takes it away until thousands are spent out of pocket. My neighbor's father has meds that cost $500.00 a month and now must put them on his credit card because he does not have the cash. Now he's getting screwed by the credit card companies as well.

We need single payer in this country with cost controls on drugs. Unfortunately, no one in Washington cares about the American people.