The Medicare Prescription Drug Program: Working for Seniors

By Larry Lucas, Deputy Vice President
Pharmaceutical Research and Manufacturers of America

The Medicare Prescription Drug Program, known as Part D, is helping seniors and disabled Americans get the prescription medications they need to live healthier, longer lives.

While Part D has been in effect for just over one year, already 90 percent of America’s seniors are benefiting from comprehensive prescription drug coverage, according to government reports. This is nearly twice as many Americans as were covered just a few short years ago.

Beneficiaries also have experienced significant savings on their prescription medicines. On average, seniors are saving $1,200 a year, according to the Centers for Medicare and Medicaid Services (CMS). Last year, the average monthly premium was $23 – and it is expected to be $22 in 2007 – about one third less than the $37 that was originally projected, CMS reports.

What’s more, seniors enrolled in a Medicare drug plan can decide – in consultation with their doctors – which medicines are best for them. Medicare does not prescribe a one-size-fits-all plan, but instead allows beneficiaries to pick the plan that best meets their individual needs and health conditions.

Part D has brought comprehensive prescription drug coverage and peace of mind to millions of America’s seniors and disabled. However, there are millions more who can benefit from the program – and many are eligible for “extra help” from the government.

Low-income subsidies are available to those who cannot afford a Medicare
Part D plan, making it possible for all seniors to receive the medicines they need. Beneficiaries who meet the income and assets requirements can receive additional help from the government to pay monthly premiums and annual deductibles as well as little to no co-payments. In addition, these “extra help” recipients do not face a coverage gap (or “doughnut hole”) in their prescription drug plan, meaning their medication will be covered all year without interruption.

While the general open-enrollment period for 2007 coverage ended on December 31, seniors who meet the low-income subsidy requirements can sign up at any time this year with no penalty.

Last year, government health officials estimated that just over three million Americans were eligible for the low-income subsidy, but had yet to apply. If you have not signed up for a Medicare drug plan because of financial concerns, I urge you to look into possible help through the subsidy program. Seniors and disabled Americans can learn more by visiting their local Social Security office or calling 1-800-772-1213.

Medicare Part D also has brought the Medicare program into the 21st Century by focusing on prevention. With prescription medications now covered under Medicare, the emphasis has shifted from treating patients once they are sick to helping patients keep healthy. This preventive model is part of modern medicine’s comprehensive approach to health care, which often includes prescription medications, particularly for seniors.

This is especially important for those with chronic conditions like diabetes and hypertension – which, if managed with medication and appropriate lifestyle modifications, can be controlled. Without treatment, such illnesses can lead to heart disease, stroke, even death.

In addition to comprehensive prescription drug coverage, Medicare Part D provides an array of screening services aimed at disease prevention. Seniors enrolled in a Part D plan are eligible to receive a “Welcome to Medicare” physical exam, as well as periodic screening tests for cardiovascular conditions, colorectal cancer, prostate cancer, diabetes, pap tests, mammograms and more. Part D also covers bone mass measurements for people at risk for osteoporosis, glaucoma tests and flu shots.

What’s more, Medicare drug plans also are required to provide beneficiaries with chronic conditions additional assistance in managing their prescription drugs. Medication therapy management programs differ by plan, but can include counseling to discuss complex treatment regimens, help with medication compliance and other patient education services.

I can’t emphasize enough the importance of Medicare Part D for all seniors, especially those in the African-American community, who suffer disproportionately from certain chronic conditions like hypertension and diabetes.

For help, contact a Medicare counselor at 1-800-MEDICARE, or visit www.medicare.gov. They can help find the best plan for you and determine whether you qualify for a low-income subsidy.