I knew there would be problems when I tried to help my parents figure out which plan to go with, but I never thought it would be this bad. ___________ From the LATimes: (Sub Required) http://www.latimes.com/news/local/l...ll=la-headlines-california&ctrack=1&cset=true State Orders Help for Elderly as Medicare Glitches Spread California joins other states in giving seniors emergency assistance. Bush's signature program draws sharp criticism nationwide. By Ricardo Alonso-Zaldivar and Peter Nicholas, Times Staff Writers SACRAMENTO — California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program. The action by Gov. Arnold Schwarzenegger's administration capped a day in which the Medicare prescription drug program — one of President Bush's signature domestic policy initiatives — came under sharp criticism from members of Congress and governors of both major political parties. Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one-fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program. In Illinois, Gov. Rod Blagojevich, a Democrat, took action similar to Schwarzenegger's, ordering state funds to be used to provide emergency drug coverage for the elderly. Arkansas Gov. Mike Huckabee, a leading figure among Republican governors on health policy issues, took a similar step Wednesday. Nine states, including California, have stepped in to fill the gaps in the federal program. Bush has staked considerable political capital on the Medicare program, and Democrats were quick to seize on its problems. Sen. Hillary Rodham Clinton (D-N.Y.) criticized the program at a news conference as "a bad policy poorly implemented." "It's a double whammy," Clinton said. Medicare officials in Washington said they were dismayed by the problems and were working around the clock to resolve them. The program is working for most people, said Medicare spokesman Gary Karr, adding that up to 40,000 prescriptions an hour are being successfully dispensed during peak times. "Many states are reporting they really don't have any problems," Karr said. "Most of the pharmacies seem to be reporting to us that things were easier this week than last week." The problems with the Medicare drug benefit do not yet seem serious enough to lead to an immediate repeal effort. But the spectacle of governors bailing out Washington, poor people unable to get their medications and pharmacists angry over not getting paid could damage the Bush administration's credibility on healthcare — an important election-year issue that the White House wants to showcase in President Bush's State of the Union speech, which is scheduled for Jan. 31. James Firman, president of the National Council on the Aging and a supporter of the program, said that continued problems could cause deep trouble for the entire program. "Right now the pressure isn't to repeal it, but to get it right," he said. "I think everybody underestimated the complexity involved. If these problems don't get fixed in four to six weeks, it's going to be very serious." The root of the current problems is a provision of the Medicare prescription drug law that automatically switched about 6 million elderly, low-income and disabled people into the new program Jan. 1. Those people had previously been covered by Medicaid — Medi-Cal in California — the joint state-federal healthcare program for the poor. Moving that many people into the new program, all at one time, appears to have overwhelmed the complicated Medicare drug benefit system. In designing the program, the Bush administration did not want the Medicare drug benefit to be administered directly by the federal government. Instead, it devised a public program run by hundreds of competing private drug plans, each with its own prices and coverage policies. In many cases, pharmacists and patient-advocates say, elderly people are being denied benefits because of inaccurate or outdated information in computer databases used by the government and the individual health plans to interact with pharmacies. In some cases, there is no information on a beneficiary, or the computer says the beneficiary is ineligible for coverage. In other cases, cost-sharing information is wrong, and pharmacists are being told to charge beneficiaries hundreds of dollars when in fact they have co-payments of only $1 to $5. "We've been inundated with calls about this, so we're thrilled" by the state's action, said Sandy Risdon, program manager of the Center for Health Care Rights in Los Angeles, an advocacy organization for Medicare beneficiaries. Staff attorney Deepti Sethi said the center had received as many as 40 emergency calls a day from patients who were told that they could not get their prescription drugs or were asked to pay unaffordable amounts. "People are walking out without their medicine across the board — high-blood-pressure medicine, insulin, pain medication," she said, adding that the problems were putting people at risk for stroke and other health problems. "This is the most vulnerable population." Kim Belshé, secretary of California's Health and Human Services Agency, said at a news conference announcing the state's plan that the Bush administration's implementation of the Medicare plan has been "troubling." "These individuals are some of the most vulnerable Californians," Belshé said. "Because of the problems our residents are having accessing their prescription coverage, Gov. Schwarzenegger has decided to step up and provide temporary coverage." Under the plan, the state will use its own money to essentially continue the coverage that patients had under Medi-Cal before Jan. 1. Providing the coverage will cost the state as much as $70 million over the next two weeks. State officials here and elsewhere said they would ask Congress and the Bush administration for reimbursement. In a statement, Schwarzenegger said he would use emergency powers to cover the costs for five days and seek immediate legislation to ensure coverage for a total of 15 days. Californians would be reimbursed for any out-of-pocket expenses that have exceeded their $1 to $5 co-payment, officials said. They encouraged those who had been denied medications to return to their pharmacies to try again and see whether the Medicare system can now accommodate their requests. If not, the state, as the "payer of last resort," would cover the cost, officials said. According to the Health and Human Services Agency, pharmacies should provide prescription drugs to anyone who was covered by Medi-Cal before Jan. 1. If reimbursement is denied by the new Medicare system, the pharmacy should seek reimbursement from the state. Schwarzenegger, in a prepared statement, said: "While I am confident the federal government will resolve the problems with this transition, these people need our help now, and we're going to be there for them." The Democratic leaders of the Assembly and Senate said Thursday that they would cooperate in the effort but expressed skepticism that the Bush administration would resolve the program's problems as quickly as Schwarzenegger hoped. "I don't have a lot of faith in the Bush administration's promises that this will be fixed anytime soon," said Assembly Speaker Fabian Nuñez (D-Los Angeles). "It says a lot when there's such bipartisan outrage at the feds' inability to implement a program that's so vital to so many." Administration officials said they would examine the situation at month's end. If the federal government has not improved service, the state would consider whether it should stop providing emergency help, said a spokeswoman for the state Health and Human Services Agency. Healthcare advocates in California praised Schwarzenegger for stepping in to provide assistance, but questioned why it took nearly two weeks for the governor to act. "We knew this train wreck was going to happen," said Angela Gilliard, a lobbyist for the Western Center on Law and Poverty in Sacramento. "We've been saying there was no way when they flipped the switch on Jan. 1, people wouldn't be harmed. No way. We're glad the state acted now." Dr. Jack Lewin, chief executive of the California Medical Assn., said Schwarzenegger had "saved thousands of lives." "This may be the single most important healthcare action he has taken as governor for the nearly 1 million of the neediest patients in California," Lewin said. With Congress still away on its holiday recess, reaction in Washington to the program's problems has been muted. But Sen. Max Baucus (D-Mont.) wrote Health and Human Services Secretary Michael Leavitt on Friday to express disappointment with the transition for low-income seniors. "Switching drug benefits from 50 state-based Medicaid programs to dozens of Medicare prescription drug plans would be complicated under any circumstance," wrote Baucus, who voted in favor of creating the benefit in 2003. "But this task is particularly challenging since these individuals are among the sickest and most vulnerable of all Medicare beneficiaries. Yet despite the awareness of potential problems, [Medicare] has failed to adequately protect these beneficiaries."
Anyone who isn't deaf dumb and blind knows the Medicare Prescription Drug Program is nothing more than a government-blessed cash windfall for the pharmaceutical industry, at the expense of the consumer.
This bill was passed with great haste to try to make Bush look like he had done something beside create war and massive budget deficits during his first term. It was deliberately set up to be a shell that would frustrate people while paying the drug companies. Don't forget the arm twisting, including probable illegal threats against GOP congressmen to get them to vote for the bill. Also don't forget that Bush's Head of Medicare prohibitted the Medicare actuaries from telling Congress their cost projections. Shortly afterward Bush's Medicare guy quit and went to work for the drug companies. My sister, a nurse, has thrown her hands up in frustration trying to help my mother with this stupid law. Government haters should not be put in charge of government. They just appoint cronies and don't take the job seriously unless they can line their pockets off of government, as we see now that the GOP is in complete control of all branches of the Federal Government. I know. Clinton lied about a blow job 10 years ago. Come on ,Bush lovers, let's have your defense or an apology. I guess they will just have a picture of Ms. Alba.
If we can deficit spend for Iraq then we ought to do it for our elderly, our sick, our poor, and our students.
Arizona joined California and the other states in declaring a medical emergency to patch up this travesty. Admin guy was on TV today talking about how "we've filled a million prescriptions a day." First, the administration didn't fill any prescriptions... it's pharmacists who fill prescriptions. Second, that was way too reminiscent of how many bottles of water have been shipped to the Katrina regions. It doesn't how many prescriptions are filled or how many bottles of water you've sent, what matters is how many people are without drugs or water. Incompetence.
I spoke about it with my folks over the weekend. They're lucky...the prescription coverage they have with retiree insurance via my Dad's old company beats the crap out of any of the plans within the "Medicare Prescription Drug Benefit".
Here we go, down the hole, chasing a Part D drug plan Saul Friedman Family & Relationships January 14, 2006 Welcome to 2006, when millions of older Americans will be falling down the doughnut hole, searching for new adventures in Medicareland, where things are "curiouser and curiouser." Despite the pleas of 43 million Medicare beneficiaries for a prescription drug benefit, the federal Centers for Medicare and Medicaid Services says less than 5 percent (1 million) of the 21 million eligible Medicare beneficiaries with little or no drug coverage had enrolled in a Part D prescription drug plan as of Jan. 1. In a misleading announcement that was close to a lie, CMS said that 21 million Medicare beneficiaries now have drug coverage. But 20 million already had coverage from former employers, the VA, their HMOs and other sources. That means 95 percent of Medicare beneficiaries who need coverage have yet to decide whether and how to enroll. During the first 11 months after passage of original Medicare in 1965, 93 percent of those eligible had enrolled. No one knows yet how many of the 6.4 million "dual eligibles," poor or disabled Medicaid beneficiaries also eligible for Medicare, were automatically switched from Medicaid to Part D on New Year's Day, as the law required, without missing their vital medicines. My guess is that thousands of the sickest and most vulnerable people were not successfully switched and will be desperate for their medications. But CMS, at the Department of Health and Human Services, has not figured out what to do to tide over such people. After the dual eligibles are switched, they can choose their own drug coverage. Although Part D is supposed to be voluntary, if a dual eligible does not enroll in Part D, he or she would lose Medicaid coverage for other health services. If you have health insurance from a former employer and you signed up for Part D drug coverage, be careful; you and your dependents could lose all your health coverage. Companies and unions that took subsidies to continue retiree coverage will not receive the subsidies for retirees who join Part D. Therefore, they will end all retiree health benefits for beneficiaries and their covered spouses and dependents if the retiree signs up for Part D - and they might not tell you. So check with your former employer and, if necessary, disenroll from Part D. To make matters worse, a dual eligible's family could lose all their retiree coverage without knowing it if he or she is automatically signed up for Part D. Many of those beneficiaries are in nursing homes. Again, if your family is getting retiree health coverage, check with your former employer and, if necessary, quit Part D. Vicki Gottlich, a Washington attorney for the Center for Medicare Advocacy, along with the National Senior Citizens Law Center and the Medicare Rights Center, has asked Congress and CMS to delay the May 15 deadline for enrolling through the end of 2006, and to delay or abandon penalties for signing up after the deadline, to give the program time to work out the worst kinks. They told Medicare: "This situation has a particularly severe impact on dual eligibles who are auto enrolled in Part D and whose spouses count on their retiree benefits for all health coverage.... Employers have no obligation to inform their retirees and current employees about the loss of health benefits." Gottlich said there may be an effort when Congress reconvenes to relax restrictions on getting extra help for about 2 million poor, non-Medicaid beneficiaries whose income is below the limits ($12,920 for a single person and $17,321 for a couple) needed to qualify for low-cost benefits but whose savings are too high. The savings limits are $11,500 for an individual and $23,000 for a couple. But Gottlich doubts this Congress or President George W. Bush will deal with the fundamental reason for these problems. As correspondent Margaret Warner said recently on PBS' "NewsHour," "There's no standard government-designed plan" administered by Medicare. "Instead, enrollees have to choose from dozens of plans offered by private insurance, with different deductibles, co-pays and lists of authorized drugs." Some Democrats want to modify the privatization aspects of the law by having at least one standard plan run by Medicare. But that would mean competition for private companies from the more efficient Medicare system, which could use its purchasing power to drive prices down. The Republicans and the drug companies who bought them won't hear of it. So, as reader Edwin Berlin, formerly of Huntington, writes from San Diego, Part D is filled with "Alice in Wonderland" absurdities: "It aims to help seniors lower their medical costs, but it's run by private insurers whose primary goal is profit.... Some insurers advertise low monthly fees and no deductibles. But their co-pay drug charges are excessive. Some insurers increase their profit margin by placing normally preferred brand drugs in a nonpreferred category with higher co-pays." The most popular plan is AARP's MedicareRx Plan, offered here by United HealthCare Insurance Co. of New York. It carries no deductible and charges a relatively low monthly premium ($28.61). But a 30-day supply of most brand-name maintenance drugs (such as Celebrex, Paxil, Lipitor, Cardizem and Pravachol) for which there are no generics, carries co-pays of $28 to $55. A 90-day supply, which costs three times as much, is no bargain, even through the mail. Generics cost $5, but for some special and expensive drugs, beneficiaries must pay 25 percent of the cost. And AARP's formulary lists more than 100 drugs the insurance will cover only in limited amounts. Reader Chet G. e-mails that Part D "has a hidden feature that permits insurance plans to restrict drug coverage called 'step therapy.'" That means the insurance company may arbitrarily substitute for a doctor's prescription a drug that costs the insurance company less. If it doesn't work or if the doctor or beneficiary protests, the insurer is supposed to cancel the change. In AARP's plan, several popular drugs are subject to step therapy. "This could be dangerous to one's health," said Berlin. "The physician prescribed the original drug for a medical reason, not a profit-based one." Finally, a Long Island physician friend suggests a way to enroll in Part D to escape the late-enrollment penalty, and find bargain drugs. Enroll in a cheap drugs-only Part D plan (PDP) like one in New York (Humana) with a $4.10 premium, then look for an inexpensive source, like Canada, for mail-order drugs. Patricia Barry, writing in the January AARP Bulletin, says many drugs from these PDPs are cheaper than in Canada. But Canada could be useful in filling the doughnut hole. http://www.newsday.com/news/columni...,6856294,print.column?coll=ny-news-columnists
Ahhh. If your plan is a failure, revise the numbers downward until they appear to be a success. It's also funny in a tragic sort of way that the big part of the plan to fix the problem is a PR offensive. Nothing wrong here that a few speeches and extra staffing in the call center can't handle. _________ http://www.washingtonpost.com/wp-dyn/content/article/2006/01/17/AR2006011701376_pf.html HHS Works to Fix Drug Plan Woes Widespread Difficulties With New Medicare Benefit Reported By Ceci Connolly Washington Post Staff Writer Wednesday, January 18, 2006; A03 President Bush's top health advisers will fan out across the country this week to quell rising discontent with a new Medicare prescription drug benefit that has tens of thousands of elderly and disabled Americans, their pharmacists, and governors struggling to resolve myriad start-up problems. Health and Human Services Secretary Mike Leavitt, who will visit Oregon and California, said yesterday that 24 million Medicare beneficiaries now have prescription coverage, compared with the 20.4 million who had been receiving drug benefits last year through state- or employer-sponsored plans. That means the new program, expected to cost $700 billion in the first 10 years, is providing drug coverage to 3.6 million new retirees. In a call with reporters, Leavitt said enrollment in the program, called Medicare Part D, exceeded expectations and put the administration "well on track to meet our goal of enrolling 28 to 30 million in the first year." Last year, officials predicted 39 million seniors and disabled people would participate, according to documents published in the Federal Register on Jan. 28, 2005. In the past month, 2.6 million people have signed up for a drug plan. Seniors have until May 15 to enroll. Even as federal leaders touted the enrollment figures, state officials and health care experts continued to report widespread difficulties, especially for the poorest and sickest seniors who were forced to switch from state Medicaid programs to the new Medicare plans on Jan. 1. Nearly two dozen states have intervened, saying they will pay for medications for any low-income senior who is mistakenly rejected. The District, Maryland and Virginia have not intervened. Saying "it is time for us to take care of our own," Republican Gov. Arnold Schwarzenegger said California will spend as much as $150 million to provide medications to as many as 1 million low-income seniors who have been turned away by pharmacists or overcharged co-payments because of glitches in computer databases. "Right now, the new Medicare Part D prescription drug program is not working as intended," the governor said in a release. In a letter to Bush, 14 Democratic governors wrote that, "while well-intended, the new Medicare drug benefit has caused confusion, mismanagement, and a bureaucratic nightmare." Leavitt conceded that HHS caseworkers have responded to tens of thousands of complaints by seniors, pharmacists and others who could not get the correct medications at the correct price. But he promised to "fix every problem as quickly as possible." To do that, HHS has hired thousands of customer service representatives and set up special phone lines for pharmacists. It also has notified insurers that if a drug is not going to be covered, the plans must provide a 30-day "transitional" supply until the patient's physician can recommend a comparable medicine that is covered. "Since this is a new program, some people may experience a problem the first time they go to get their medicines, but we're confident that after you use it once, things are going to go more smoothly," he said. "If you are one of those seniors experiencing problems, our message is don't leave the pharmacy without your drugs." Starting an enormous insurance program for 42 million people is bound to entail bumps, Leavitt said. "For the majority of people who are enrolled in the drug benefit, the system's working," he added. "Pharmacists across the country are filling more than 1 million prescriptions a day successfully. Seniors are continuing to enroll in large numbers." Precise figures are not available, but government officials and researchers at health care think tanks said pharmacists were filling hundreds of thousands of prescriptions for previously eligible Medicare recipients before the Jan. 1 start of the new program. "Many of the people already had coverage in 2005," said Tricia Neuman, who studies Medicare policy issues at the nonpartisan Kaiser Family Foundation. "The numbers show there's been some progress since December, but we clearly have a ways to go to reach everyone the program was designed to help." Medicare's actuaries reported that 8 million seniors would be eligible for subsidized drug coverage, based on income levels, and they projected 4.6 million would enroll in 2006. So far, 1.1 million are signed up, she said.
Want to see good policy implemented by competent people? Don't look here... _________ Medicare won't be reimbursing states http://www.dfw.com/mld/dfw/news/nation/13652098.htm?template=contentModules/printstory.jsp By TONY PUGH Knight Ridder Newspapers WASHINGTON - The federal government won't repay states that are making emergency purchases for hundreds of thousands of poor, sick people whose new Medicare drug coverage isn't yet working, Medicare officials say. Instead, those states must recoup the money from the private plans that began providing drug coverage Jan. 1 on behalf of Medicare. Medicare administrator Mark McClellan said the new Medicare legislation was clear: "Under this program, we don't have the authority to pay states directly. People are in Medicare drug plans, and it's the Medicare plans that are supposed to pay for the medications." That could create an administrative nightmare for the states that stepped up to safeguard the health of low-income elderly and disabled people whose Medicare coverage hasn't materialized because of administrative problems and poor planning by Medicare officials. Now, those states will bear the cost of filing hundreds of thousands of claims with the dozens of private drug plans that provide Medicare coverage within their borders. "That's going to be very complicated," said Arkansas Gov. Mike Huckabee, chairman of the National Governors Association, who was disappointed by the news. "We're doing the federal government a favor. We're in essence loaning them money while they get their problems worked out. ... Now we're going to not only become the bank, but the collection agency? Next, we'll be manufacturing the drugs and selling them," he said Tuesday. In New Hampshire, which has paid 814 claims so far, Pamela Wash, a spokeswoman for Gov. John Lynch, said state officials were examining the administrative costs and possible legal issues that could arise from a state seeking reimbursement on behalf of a federal program. If states have trouble with the plans, Huckabee said, congressional action might be needed to get direct payment from Medicare. "I think they should accept responsibility to fix it rather than asking us to bail them out. And then when we do, to say, 'Gee thanks. As far as paying for it, good luck, you're on your own'? That kind of defies the old good-neighbor rule. They borrowed our lawn mower and they gave us back a pair of scissors," Huckabee said. Medicare's new prescription-drug benefit has been hobbled nationwide by a series of computer, phone, data and human errors that have left an estimated 1.28 million of Medicare's most frail beneficiaries unable to get the life-sustaining medications they need. The problems stem from incomplete enrollment data, jammed phone lines, uninformed pharmacists, people being placed in drug plans that don't cover their medicines and others being charged incorrectly with exorbitant out-of-pocket fees. Realizing that the affected patients have higher rates of disability, chronic disease, cognitive impairment and other problems, about 20 states have passed emergency legislation to purchase medications until the problems are resolved.
The plan is so labyrinthine and complex that I genuinely doubt that anybody could have created it intending it to be a success. It would seem that if you are in favor of scaling back government health benefits, the appropriate way to stop a move to expand them is to create a program that seems to expand them but is so complicated that it is impossible to use.
http://goldenstateblog.latimes.com/goldenstate/2006/01/golden_state_co_3.html Golden State: Medicare Drug Benefit Gap May Prove Costly When a government program is defined in terms of a void at its core, you know it's trouble. In the case of the new Medicare drug benefit, that void has been evocatively named the "doughnut hole." This is a gap in coverage beginning when the full cost of an enrollee's prescriptions for a year reaches $2,250 (including co-pays, a $250 deductible, and the amount the customer's health plan pays for the drugs), and ending when the enrollee's own out-of-pocket expenses reach $3,600. After that point, Medicare will pay 95% of qualified drug costs to the end of the calendar year, a so-called "catastrophic" benefit. The doughnut hole was designed to limit the new program's burden on taxpayers. But its complexity is one reason that fewer than 4 million seniors eligible for the stand-alone drug benefit have enrolled so far, well short of the 23 million who are eligible. Because of the doughnut hole, a plan that appears at first blush to be an inexpensive option - one carrying a low monthly premium, for example - may be the most costly in reality. That's because some plans with high premiums provide discounted drug coverage even within the doughnut hole. Patients who know their prescriptions will cost more than $2,250 a year might save money by choosing an option with a $60 monthly premium and gap coverage, instead of a plan with a $5 premium that consigns the member to doughnut hole hell. Such calculations are intricate and individual. The variations in premiums, coverage terms, and rosters of covered drugs (known as "formularies") make the comparison of plans head-to-head extremely difficult, if not impossible - a gift for the private health insurers that sponsor the plans. They also undermine projections of how many enrollees will gain from the benefit. A 2004 study for the Kaiser Family Foundation projected that the 29 million expected enrollees would save an average of 37% on prescription drugs. But that figure doesn't count monthly premiums, on which there are few constraints. Moreover, the study forecast that these savings would be unevenly distributed: 8.7 million enrollees receiving special low-income benefits would save 83% on average, but 25% of all enrollees - 7.4 million people - would pay more for their prescriptions under the program than without it. Many of the latter are low-income seniors who will lose their access to free medicines thanks to the new program. These are only hints of the flaws in the system. The latitude that health plans have to determine their own premiums and formularies give them the upperhand in dealing with enrollees. Medicare guidelines generally prohibit them from manipulating formularies to discriminate against patients with poor health or certain ailments. But the rules don't define discrimination, and there are few other constraints. Importantly, the health plans are permitted to drop drugs from their formularies at any time with 60 days' notice; patients, however, are only permitted to change plans once, at the end of the year. Therefore, although enrollees will choose plans based on the drugs covered, they may find one or more dropped from the lists as the year wears on. Many patients may end up paying full price for drugs they thought would be covered. Healthcare professionals expect the plans to exploit their power over formularies very aggressively to keep costs controlled. The plans also are permitted to impose stringent prior-authorization rules almost at will. These typically force doctors to jump through hoops - such as filling out paperwork or spending hours on the phone with health plan reps drilled in how to say "no" - before a plan will pay for a prescribed medicine, even if it's on the formulary. Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example. Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked. That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602. The difference is important because the quoted price determines whether and when a patient will exceed the initial coverage limit of $2,250, as well as how many months that patient may spend in the doughnut hole before crossing the catastrophic coverage threshold and receiving the 95% subsidy. A patient covered by the plan that assigns a $470 price to Actonel would transition into the doughnut hole after about 41/2 months, or in mid-May. (This is assuming he or she had no other prescriptions.) The plan charging $602, however, would land the patient in the hole a full month sooner, thus imposing higher out-of-pocket costs for the year. It's worth noting that those prices don't necessarily correspond to what each plan actually pays for the drug; they're merely contrived from a formula. Indeed, any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash - spending slightly more for a year's supply than some plans charge for a month. Not all prescriptions involve such pricing peculiarities, of course. But there are so many that this program's value as a consumer benefit has come properly under question. The wholly unnecessary complexity of the Medicare drug program simply burdens patients while enhancing profits for drug makers and health insurance companies. Congress and the Bush White House were determined to experiment with what happens when a government program is handed over, wholesale, to private industry. In the process they treated the public as lab rats running in big business's maze.
