The current market leaders could run into some challengers.
Feb. 09--Nancy Underwood figures it takes about $400 in prescription drugs each month to keep her transplanted liver working.
Five years after the transplant, she still counts on Medicare to contain that expense. But like hundreds of transplant recipients and supporters across the country, Underwood, 59. of Charleroi worries that an Obama administration proposal could erode federal cost controls for many poor and elderly patients on high-priced pharmaceuticals. Two dozen senators agree and are urging the administration to reverse course.
"A lot of us are disabled, so we have fixed incomes," said Underwood, who does not work and as a Medicare recipient pays for none of her transplant drugs out of pocket. "Sometimes it comes down to whether you're going to eat, pay your rent or get your medication. In our case, if you want to live, you have to take your medication."
Federal rules since 2006 have mandated that private insurance plans providing prescription benefits for seniors and disabled beneficiaries on Medicare must cover "all or substantially all" medications in three categories. Those are widely used antidepressants, antipsychotics and prescriptions that suppress the immune system and prevent rejection of transplanted organs.
Medicare officials argue the prescription protections no longer are necessary to guarantee access to the drugs. They say taxpayers and beneficiaries could save millions of dollars by dropping special protections for the targeted patients, whose out-of-pocket expense often hovers around $50 a month. The improved availability of generic drugs could allow some standards to be relaxed safely, according to the administration, which introduced the idea in January.
Sen. Bob Casey Jr., D-Scranton, said he worries the change could diminish access for vulnerable patients. He and Sen. Pat Toomey, R-Lehigh Valley, are among the Senate finance committee members asking the Obama administration to reconsider.
"It's important that patients dealing with challenges like a transplant have access to the medications that their doctor feels will best improve their health," Casey said. His office reported receiving 80 letters from constituents concerned about the proposal. None supported it.
In a Feb. 5 letter to Medicare administrator Marilyn Tavenner, Senate committee members cautioned the change could limit the number and types of medications easily available to affected patients. That could force some to rely temporarily on medication that is ineffective or leads to side effects, they wrote.
Medicare officials released a written statement in response to Tribune-Review questions but did not indicate whether they had composed a response for the senators. They argued again that the proposal would strengthen quality of care, reduce costs for beneficiaries and enable new tools to fight fraud.
"This is a proposed rule and we welcome comments from the public on the proposal," the statement reads. The government is accepting public comment through March 7.
Groups including the Transplant Recipients International Organization, or TRIO, and the National Alliance on Mental Illness sounded alarms about the plan. So did Rep. Tim Murphy, R-Upper St. Clair, a clinical psychologist who called the proposal a "grave concern."
TRIO encouraged its 1,600 supporters to contact lawmakers, said group president Jim Gleason, 70, of Edgewater Park, N.J.
"You can't just take one type of medication and say this applies to everybody," he said.
Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or [email protected].
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