People with Medicare need a drug benefit that covers the drugs they need at prices they can afford. The Medicare Part D program does neither.

The Part D program relies on insurance companies to hold down costs by barring or restricting coverage for certain drugs in the plans they offer. Prices are higher than those the Veterans Administration is able to negotiate. In fact, although Medicare pays 75 per cent of the cost of coverage through Part D plans, the expense to the consumer is comparable to, and often higher than, what they would pay if they were to buy drugs from Canada, without any government subsidy at all.

Lowering drug costs is one of the Medicare Rights Center’s main priorities. We’re working hard to allow Medicare to negotiate lower drug prices and administer prescription coverage directly instead of through private insurance companies.

If Medicare were to administer the drug benefit and negotiate better prices as other industrialized countries like Canada do, there would be enough savings to close the “doughnut hole” or gap in Part D coverage, when people continue paying premiums but pay the entire cost of their drugs.

Many people with Medicare have also experienced problems obtaining coverage for drugs that treat mental illnesses. Medicare Part D plans impose a range of restrictions on mental health drugs that result in the denial of coverage.

Requirements to obtain prior authorization and excessive cost-sharing often block access to antipsychotics and antidepressants—medications that treat serious mental illnesses. The benzodiazepines, medicines used to treat anxiety and panic disorders, insomnia and related conditions, are completely excluded from Part D coverage.

People with Medicare are feeling the impact of the decision by Congress to hand the drug benefit to private insurance companies instead of administering it through the Medicare program. Older adults and people with disabilities are finding that their medications are not covered and they’re facing obstacles when they appeal for coverage. Many people are experiencing more restrictions and paying higher co-payments than they did with the coverage they had prior to the implementation of Part D.

The Part D program is a bad deal for people with Medicare and for all taxpayers!

The Medicare Rights Center supports a number of legislative and regulatory changes that will help people with Medicare get the drugs they need. We’re working to:

• Make it easier for low-income people with Medicare to receive Extra Help under the Part D benefit, including elimination of the asset test for the Extra Help program.
• Protect people with Medicare from deceptive marketing by Part D and Medicare private health plans and ensuring that no one is “locked in” a plan that does not meet their needs;
• Make the Part D appeals system work fairly and efficiently;
• Ensure unrestricted access to all medically necessary mental health drugs and other critical medicines.

As a concerned citizen, you can act for change in Congress. Take action now!

For more information regarding your medicare rights, visit www.medicarerights.org.