FOR IMMEDIATE RELEASE: February 8, 2006
SCHUMER: NEW DISCLOSURES IN MEDICARE DRUG PROGRAM REVEAL
UPSTATE NY EPIC ENROLLEES NOT PROTECTED, REQUIRED DRUGS MAY BE UNAVAILABLE
ON NEW PLANS
360,000 New Yorkers on EPIC, and 574,000 Dual Medicare/Medicaid
Enrollees May Lose Benefits, Receive Inferior Drugs, Or Lose Coverage
At Local Pharmacy
As New Reports Reveal Pharmaceutical Industry Making
Out Like Bandits from Plan, Schumer To Grill CMS Administrator McClellan
at Finance Hearing on Today, Advance Legislation To Address Gaping
Holes Leaving New York’s Seniors Stranded
Schumer to Detail How Many New Yorkers Vulnerable In
Each Region: 22,000 in the Capital Region; 25,000 in Central NY;
43,000 in Hudson Valley; 17,000 in North Country; 30,000 in Rochester/Finger
Lakes; 23,000 in Southern Tier; 52,000 in Western NY
Across New York, 367,000 seniors enrolled in New York’s Elderly
Pharmaceutical Insurance Coverage (EPIC), may lose protection from
loopholes in the new Medicare prescription drug plan, U.S. Senator
Charles E. Schumer revealed today. Schumer grilled the Center for
Medicaid and Medicaid Services’ Administrator Mark McClellan
and urged him to offer the same safeguards to EPIC that are currently
given to other private plans. Schumer today also spotlighted how
drug plans can change the lists of drugs they cover even after a
patient has enrolled in a plan and has committed them to that plan
for a year.
“The Federal government has not been straight with the American
people, especially seniors,” Schumer said. “Seniors
who thought they were getting a Cadillac of a prescription drug
program are now finding out their insurance plan is a jalopy. We
all have a special duty to protect New York’s seniors and
turn this lemon of a program into lemonade.”
Schumer today released regional
data detailing how many EPIC and dual-eligible seniors in each
county are eligible for the Medicare benefit:
• There are 22,484 Capital Region seniors enrolled in New
York’s well regarded EPIC program, 6,148 of whom will be transitioned
to Medicare Part D. 22,646 Capital Region seniors eligible for both
Medicare and Medicaid may lose access to certain drugs if emergency
coverage is not extended.
• There are 24,813 Central New York seniors enrolled in New
York’s well regarded EPIC program, 6,203 of whom will be transitioned
to Medicare Part D. 21,044 Central New York seniors eligible for
both Medicare and Medicaid may lose access to certain drugs if emergency
coverage is not extended.
• There are 43,070 Hudson Valley seniors enrolled in New
York’s well regarded EPIC program, 10,768 of whom will be
transitioned to Medicare Part D. 45,424 Hudson Valley seniors eligible
for both Medicare and Medicaid may lose access to certain drugs
if emergency coverage is not extended.
• There are 17,391 North Country seniors enrolled in New
York’s well regarded EPIC program, 4,348 of whom will be transitioned
to Medicare Part D. 15,303 North Country seniors eligible for both
Medicare and Medicaid may lose access to certain drugs if emergency
coverage is not extended.
• There are 30,006 Rochester/Finger Lakes seniors enrolled
in New York’s well regarded EPIC program, 7,502 of whom will
be transitioned to Medicare Part D. 22,558 Rochester/Finger Lakes
seniors eligible for both Medicare and Medicaid may lose access
to certain drugs if emergency coverage is not extended.
• There are 22,832 Southern Tier seniors enrolled in New
York’s well regarded EPIC program, 7,502 of whom will be transitioned
to Medicare Part D. 17,507 Southern Tier seniors eligible for both
Medicare and Medicaid may lose access to certain drugs if emergency
coverage is not extended.
• There are 52,305 Western New York seniors enrolled in New
York’s well regarded EPIC program, 7,502 of whom will be transitioned
to Medicare Part D. 35,799 Western New York seniors eligible for
both Medicare and Medicaid may lose access to certain drugs if emergency
coverage is not extended.
Transitioning From EPIC to Medicare:
Some of the 367,000 New York seniors enrolled in EPIC will be forced
to enroll in Medicare drug plans by July 1st. Governor Pataki’s
2006 budget proposal, released January 17th, would push about 91,000
low-income New York seniors from the EPIC program onto the Medicare
drug program. EPIC provides prescription coverage for seniors who
have too high of an income to qualify for Medicaid, but need help
paying for costly prescription drugs. These 91,000 people are the
members of EPIC who are eligible for a federal low-income subsidy
if they enroll in a Medicare drug plan, which will make their drugs
cheaper, but will also give them coverage that is inferior to EPIC.
The EPIC program is a simple, cost-sharing prescription drug plan
that covers almost all medications for enrollees. Most pharmacies
in New York accept EPIC, and EPIC seniors pay at most $20 for a
medication. The Medicare drug plan, on the other hand, is extremely
complex and difficult to navigate. With over 40 drug plan options
in New York and each plan covering different drugs, many seniors
have found choosing a Medicare drug plan unbearable. Additionally,
the Medicare drug plan drastically differs from EPIC in that not
all pharmacies accept the wide variety of Medicare drug plans, and
co-pays vary from plan to plan.
The grave nature of the impending transition of EPIC seniors onto
the Medicare drug plans by July 1st is amplified because of the
Medicare drug plan’s remaining glitches. Many seniors still
aren’t receiving the drugs they need, are trapped in inappropriate
plans, or are paying far too much for their medications. Since the
implementation of the Medicare drug plan, New York seniors “covered”
by Medicare drug plans have faced dangerous gaps in drug coverage.
Knowing the abundance of problems with the Medicare drug plan, EPIC
seniors shouldn’t be forced from a simple plan that provides
secure coverage to a complex plan that still has many glitches.
Today, Schumer announced he will:
• Introduce legislation to prevent the remaining 276,000 EPIC
enrollees from being transitioned onto Medicare in the future. The
Medicare program currently pays 28% federal subsidies to employers
to ensure that companies will not push their retirees from employer-sponsored
plans onto Medicare. EPIC should benefit from the same federal subsidies
to give the State the incentive it needs to retain EPIC coverage
for New York seniors.
• Call on New York State to put explicit protections in place
for EPIC enrollees in any plan that will shift members of EPIC onto
the Medicare drug plan. These protections should include the assurance
that all EPIC enrollees can continue to stay on the same drugs they
currently take, can continue to use the same pharmacies they use
now, and should have a smooth transition that is not put into effect
until the kinks in the Medicare program have been resolved.
Formularies
Under current law, Medicare prescription drug plans can change the
drugs that they cover, through their formularies, at any time. The
only stipulation to this provision is that the drug plans must give
their enrollees a notice two months in advance of the change. However,
most seniors enrolled in a Medicare drug plan are prohibited from
changing plans except during an annual open enrollment period. This
provision traps seniors in drug plans without a guarantee that the
drugs that they need will be covered all year long. Even a senior
who has conscientiously decided on a drug plan that covers all needed
medications could lose coverage of drugs if the drug plan changes
its formulary.
Today, Schumer, along with Senators Dianne Feinstein (D-CA), Susan
Collins (R-ME), and others, introduced the Medicare Drug Formulary
Protection Act of 2006, which prohibits Medicare prescription drug
plans from making their formularies more restrictive unless beneficiaries
have the option to change plans.
Medicare-Medicaid Dual Eligibles
The 570,000 New Yorkers eligible for both Medicare and Medicaid-eligible
continue to struggle to obtain the medications they need through
Medicare drug plans. Although Governor Pataki took emergency action
to provide medication to New York’s vulnerable dual-eligibles
through the state’s Medicaid program, this temporary coverage
of duals will end March 8th. Dual-eligibles have been unable to
consistently obtain drugs that they need, for a variety of reasons,
and continue to leave pharmacies empty-handed. Duals have to jump
through many hoops, such as appeals processes, to obtain both formulary
and non-formulary drugs; have been charged inappropriate amounts
for co-pays and deductibles; cannot find a plan that covers all
of their drugs; and have been auto-enrolled in inappropriate plans.
Schumer, along with others, introduced the Requiring Emergency
Pharmaceutical Access for Individual Relief Act (S.2183) which would
immediately provide relief to low-income and disabled individuals
that are experiencing gaps in drug coverage, through provisions
including a requirement for plans to provide at least a 30 day supply
of any needed drugs until an individual can switch to a plan that
covers the drug.
While seniors continue to face countless problems attaining and
paying for their prescription drugs, new reports reveal record profits
in the pharmaceutical industry. Economist Dr. Stephen Schondelmayer
at the University of Minnesota estimates that Medicare could pay
drug prices 20-30% higher than Medicaid drug prices. This means
the windfall for the drug industry – just from the nation’s
6.4 million dual eligibles-- could be $30 billion over the next
ten years. According to pharmaceutical industry journal RPM Report,
pharmaceutical manufacturers will earn an additional $2 billion
in 2006 profits from supplying the same patients with the same drugs.
Click here to view
report.
# # #
|