I have been in Pharmacies all over North Carolina, Tennessee, and South Carolina.  I have discovered that in some cases (not all) the charges for the Prescriptions are indeed more than was previously paid under another plan of the patient's.  Some were upgraded to Medicare D when they were still under the State's "welfare" plan.  Instead of perhaps a $3.00 copay, now they can pay anywhere's from that $3.00 upwards towards much more money, depending on the exact drug, the plan, and the formulary of that plan.  Private enterprise was definitely NOT the way to go here, as it involved the greedy Drug Companies. 

 

Plan D's dirty little secret: the fleecing of America
Saturday, April 01, 2006 - Bangor Daily News

   
By Tom Allen
By now, people know that Medicare Part D - the new prescription drug plan
for seniors and disabled people - is a bureaucratic nightmare. While some
beneficiaries have received significant benefits, many have been wrongly
denied coverage and millions more have been baffled by an absurdly complex
system.

But there is another dirty little secret about the program. A study I
commissioned has just confirmed that seniors and taxpayers are paying much
higher prices than if the federal government had been allowed to negotiate
prices with drug companies. As the cost of Part D mounts, and beneficiaries
plunge into its notorious "doughnut hole," this flaw will soon overshadow
the program's other problems.

When Part D was debated in Congress, I argued unsuccessfully that the
simplest approach was the best: expand Medicare itself to include
out-patient drug coverage. Medicare has a proven track record of low
administrative costs and reliable, uniform benefits. The federal government,
moreover, could harness the enormous purchasing power that flows from buying
drugs for more than 43 million Americans to negotiate steep discounts with
drug manufacturers. Instead, President Bush and the Republican congressional
leadership pushed through a program that relies on hundreds of private
insurance companies to offer competing, stand-alone drug plans and to
negotiate individually with drug companies. The administration promised that
this private competitive market would yield lower prices.

They were wrong. According to a study conducted by the Democratic staff of
the House Government Reform Committee, the prices charged by the 10 leading
Medicare Part D insurance plans in southern Maine for the 10 best-selling
drugs used by seniors is almost 80 percent higher than the prices the
Department of Veterans Affairs negotiates for its purchases; almost 60
percent higher than the prices available to consumers in Canada; and more
than 5 percent higher than the prices available on

Drugstore.com, a popular Internet supplier of prescription drugs. For
specific drugs, the price differences can exceed or approach 100 percent.

Since the drugs in question are expensive, the price differences are very
significant. In Part D plans, the average price for a one-month supply of
each of the 10 drugs is $1,187.

If you are a patient at a VA clinic, the federal government would have paid
just $665 for those drugs. With respect to specific drugs, the difference
can be even more dramatic. On average, the Part D drug plans offer Protonix,
a medication to treat heartburn and acid reflux, for $111 for a one-month
supply, compared to the $21 the VA pays. Similarly, in Canada the ulcer
medicine Prevacid would cost $63 for a month's supply, compared to the $135
under Part D plans.

Seniors and disabled people are shouldering much of the extra cost. The
convoluted Medicare Part D design provides that the first $250 in eligible
drug costs is the responsibility of the beneficiary. Thereafter, each
covered individual pays a 25 percent co-pay until his or her total drug
spending reaches $2,250. Then the entire price of each drug is again an
out-of-pocket expense until spending totals $5,100, when the co-pay drops to
5 percent.

This is the so-called doughnut hole, a benefit-free zone that makes no sense
except as a way to limit the cost of the program. As drug purchases under
the plan accumulate (Part D has been operating for only three months), more
and more seniors will fall into the doughnut hole. High prices will rapidly
deplete their limited financial resources.

High prices are very bad news for taxpayers, too, for they expand both the
number of seniors who exhaust their deductible and the number who spend
through the doughnut hole, thereby increasing the total cost of Medicare
Part D without increasing its value. With the drug program projected to cost
between $500 billion and $1 trillion over 10 years, the fiscal stakes are
high.

There are other major flaws in Part D that threaten its usefulness. For
example, the most critical factor for seniors to consider in choosing a plan
is whether it covers the specific drugs they use. This is not an easy
investigation, and if the available facts are incomplete, the choice will be
wrong.

Yet, another recent report prepared by the Democratic staff of the House
Government Reform Committee concluded that the vast majority of Medicare
Part D plans restrict access to popular drugs. These barriers are not
disclosed to consumers unless and until they encounter the restrictions,
which include pre-authorization, step therapy (which requires the senior to
use other drugs-and have these therapies fail-before being allowed the drug
of choice) and volume (dosage and quantity) limits.

These problems - overwhelming confusion and complexity, inflated prices and
poor coverage - reflect a fundamentally flawed design. Until it is replaced
by a more sensible system, drug manufacturers and insurers, not seniors and
the disabled, will be the major beneficiaries.

Tom Allen is Maine's 1st District congressman.