Prescription conferees won’t meet deadline

Published 6:46 pm Thursday, October 16, 2003

By By JOHN EBY / Niles Daily Star
CASSOPOLIS -- Conferees trying to hammer out a compromise on the Medicare prescription drug benefit are not expected to meet their deadline Friday, Rebecca Henley of U.S. Rep. Fred Upton's office told the Cass County Republican Women's Club Wednesday night in the Kincheloe room of the 1899 courthouse annex.
Upton is a senior member of the House Subcommittee on Energy and Commerce, which has jurisdiction over Medicare.
He's been involved in developing this issue for three years.
Upton wants to provide every senior citizen with an option of Medicare prescription drug coverage.
Prescription drugs were a very small part of medical care when the program was created in 1965.
America leads the world in developing new drugs that enable the effective treatment of countless medical conditions and diseases.
The House, where Upton represents southwest Michigan, and the Senate each passed its own version of a prescription drug plan June 27. These incompatible versions go to a conference committee to work out differences between these two bills, although they are less likely to achieve the loftier goal of settling on one bill that makes everybody happy.
The House bill, passed by one vote, 216-215, was called Medicare Modernization 2003. The Senate version was named the Prescription Drug and Medicare Improvement Act of 2003 and prevailed 76-21. Both bills would add, effective Jan. 1, 2006, the new prescription drug benefit for Medicare beneficiaries under a new Part D. Both would rely on private plans to provide the benefit and assume some of the financial risk. Both measures would be designed to insure access to plans in all areas. Increased federal assistance would be authorized, where necessary, to encourage participation. The Senate bill -- but not the House bill -- would include a fallback mechanism in areas where private plans were not available. Under the fallback mechanism, Medicare would contract with private plans to provide benefits.
The plan would not be at financial risk, except for a small portion of management fees tied to performance.
Both the Senate and House versions would require plans to provide standard coverage. The definition of "standard coverage" is quite different between the two proposals, however.
That's where the conference committee comes in -- to get the two on the same level through compromise.
Both measures would provide additional assistance to low incomes.
In addition, bills would establish a temporary drug discount card endorsement program under which the secretary would endorse card programs offered by prescription card sponsors which met certain requirements until 2006, when the actual Part D would go into effect.
Both bills attempt to close drug cost loopholes manufacturers are using to block or delay the entry of generics into the market, which would create competition and hold down drug costs. The Senate bill contains a 20-percent co-payment for lab services which the House bill lacks. But the House bill does include a co-pay for home health services.
As the House bill stands now, there would be a voluntary prescription drug benefit available to all Medicare beneficiaries. "It's voluntary," she stressed. "If you choose to be a part, you can. But those who want to stay with their current coverage may do so. They're not going to be forced into it."
The House bill would have a $250 deductible. After that, 80 percent of coverage would be accomplished through the plan. An individual would have to cover 20 percent, up to $2,000 a year. Then, catastrophic coverage would kick in and $3,500 and up.
The premium of $35 a month equates to about a dollar a day, she said.
Median spending for seniors presently is $1,285. The majority would be covered with 80 percent being provided by the government.
The bill would target those who need assistance. "Low-income beneficiaries would pay $2 per generic and $5 per brand-name drug per prescription. High-income beneficiaries, including individuals with incomes of $60,000 and couples with incomes of $120,000, would have a higher catastrophic benefit, so when I said after $3,500 it would all be covered by the government, that number would be higher for those in that income range. The more you make, the higher that level is going to be. They're guaranteeing that you'll have a choice of at least two different plans. That, of course, is another way to keep costs down."
Quality improvements offered by the House bill include protecting against adverse drug interaction, electronic prescribing to minimize medical errors, pharmacy therapy and chronic care management for beneficiaries of chronic conditions.
The conference committee is also working on drug reimportation, average wholesale price and cancer drug payments.
Henley, of Kalamazoo, has assisted John Proos in providing constituent service for the past year after completing an internship with Upton's office in Washington, D.C.
She grew up in Mattawan in Van Buren County and majored in international affairs and political science at Marquette University.
Henley drew Mary Henkel's name as winner of an afghan.
The Republican Women's next meeting will be at noon Wednesday, Nov. 12, at the Edward Lowe Center for the Council on Aging to plan next year's programs.
At noon on Monday, Dec. 1, at Lindy's, the club will have its holiday party.