Return ‘Dual-Eligibles’ To Medicare

There has been a health care crisis occurring in New York City for two weeks. Many of our most needy and frail citizens cannot afford their life-saving medications or are being left stranded without any drug coverage.
The culprit causing chaos among our needy senior population is the new Medicare Part D Program. This program began on January 1st 2006. It is the federal program meant to provide prescription benefits for those individuals who previously had little or no coverage for prescription drugs.
There are now about 7 million seniors nationally in Part D and of these, the biggest group, 6.2 million are “dual-eligible.” In New York City the “dual-eligible” patients number over 300,000. These are the patients at or slightly above the poverty level suffering from life-threatening illnesses, who previously had their drugs covered by Medicaid.
Under Part D they were randomly assigned to one of many prescription drug plans by CMS (Center for Medicare and Medicaid Services). The plans often require a patient to change from a drug they have achieved success with to a different drug. This results in the doctor having to find the correct new drug, which will keep the patient’s condition in check.
Under Part D the “dual-eligibles” are also required to pay co-payments for their drugs, which they had been exempt from under Medicaid. Unfortunately many do not fill their prescriptions because they simply cannot afford to pay the required co-payment which will result in increased hospitalizations and complications that may lead to premature deaths.
Also, approximately 20% or 60,000 New York City “dual eligible” residents have fallen between the cracks and are being denied both Medicaid and Medicare coverage. Pharmacists have seen many patients with this problem in the last fourteen days.
State Assembly Speaker Sheldon Silver and New York Assembly members recognized this crisis and called for state action to cover these “dual eligible” patients under Medicaid.
Finally, on Friday, January 13, 2006, Governor George Pataki acted to allow pharmacists to bill Medicaid for these patients, but only for seven days. This is merely a band-aid solution for the problem.
Medicare Part D is an inferior program forced on the most vulnerable people in New York City. Instead of helping, it has caused confusion and stress not only for the participants, but for pharmacists and doctors as well.
Our senior citizens deserve a better drug program than Medicare Part D. Part D does not seem to provide a true “drug benefit” for the “dual eligible” population. It is simply far less inclusive and more costly coverage than Medicaid. This “benefit” was an ill-conceived and badly implemented program, which has not provided New Yorkers with better healthcare. “Dual eligibles” should be brought back to the Medicaid program. Congress must understand that this plan is flawed and changes must be made to make it work for our senior citizens.
— Bill Scheer R.Ph., President of the Pharmacists Society of the State of New York, Chairman of the New York City Pharmacists Society