Health care “reform” profiteers

WELL, HERE we go again. Opportunist drug and insurance companies are raising their prices and premiums for 2010 in anticipation of possible health insurance "reform."

The Medicare Part D program, which provides prescription drug coverage to recipients in the government's Medicare health care program for the elderly, has seen significant price increases for its plans during the annual open enrollment period that began November 15.

According to the Kaiser Family Foundation, premiums for stand-alone Medicare prescription drug plans will rise 11 percent, to an average of $38.94 a month. The average premium for Medicare Advantage plans (plans that provide both health care and prescription drug coverage) will increase by an average of 32 percent. In Rhode Island, Medicare Advantage plans offered by the main provider will increase between 40 and 173 percent for its three plans.

As reported in the New York Times, drug companies are also raising wholesale prices for medications by an average of 9 percent. This completely offsets one of the main elements of President Barack Obama's plan for controlling Medicare costs--an $80 billion reduction over 10 years in the nation's drug bill. By raising prices of medications and premiums, the pharmaceutical and insurance industries will more than make up this $80 billion--while they stand to gain access to around 30 million new customers under the health care plans.

One major selling point of the planned "$80 billion cost reduction" is a 50 percent discount for Medicare Part D members paying for brand-name medications, when these individuals reach the so-called "donut hole" in out-of-pocket drug expenses, and need to pay the entire cost of medications until the higher threshold, when Part D kicks in again and covers 95 percent of costs. But there is a danger in promoting a discount only for brand-name medications. Brand-name medications are more expensive and push people into the donut hole much quicker.

This selective subsidy could lead individuals or doctors to choose and/or prescribe more expensive brand-name medications when a generic medication would be suitable. It would be better for recipients if there was a decrease or elimination of the actual donut hole--or a push to subsidize less-expensive generics and allow generics to reach the market more easily and quicker.

THE IMPLICATIONS of a possible move to a brand-name medication subsidy can be seen in the increased prevalence of biotech or biologic drugs. Biotech medications are manufactured in a living system, such as a microorganism, a plant or an animal cell. Many biologics are essentially the same drug, except for a small difference in the way the molecules are built. The $60 billion biotech field is the future of the pharmaceutical (pharma) industry.

The biotech industry is expanding much more rapidly than standard pharma. Biotech grew by 20 percent to a total of $40 billion in sales in 2006, compared with regular pharma, which increased by 8 percent, with sales of $275 billion. According to Reuters, the top six biggest-selling drugs in 2014 are going to be biotech: Avastin, Humira, Rituxin, Wyeth, Lantus and Herceptin. Fifty of the top 100 will be biotech.

Why the interest in biotech medications? An analyst for Deutsche Bank North America states it plainly: "The profit life-cycle of biologics is much longer than it is with small molecules because there's no clear path for biogenerics." Currently, there is a 12-year "exclusivity" on these drugs, meaning that no generic can be made for that time.

As a social worker who assists individuals with Medicare Part D, I see how expensive the program is on a daily basis--and how brand-name medications, including biotechs, are forcing senior citizens and disabled adults to make the choice of paying for their medications, or paying for food or the rent. Many rely on samples from doctors, and they are forced to take less of their medication than prescribed in order to cut costs.

The donut hole is increasing again this year and will continue to increase in future years. If an individual had prescriptions for only three of the most common brand-name medications on the market--Lipitor, Plavix and Nexium--that person would reach the donut hole in August if not earlier. They would have to completely pay out of pocket for their medications from August until December, until they pass $4,000 in out-of-pocket costs and reach "catastrophic coverage."

Another major issue with the Medicare Part D program that has led to increased profits for companies is that more and more medications are being dropped from plan formularies--that is, the list of drugs that prescription drug plans will cover. In 2009, only three of the top 10 drugs taken by people were on the formularies of all 44 Medicare Part D plans nationally.

Simply because you have a Medicare Part D plan doesn't mean your medications are covered! A majority of brand-name medications, even if they're covered by a plan, are on a high-cost-sharing tier--meaning high copays at the pharmacy. Also, drug companies can place restrictions such as "prior authorization" and "step therapy" that hinder a member's access to medications.

Besides these premium and price increases, Social Security recipients will not see an increase in their Social Security checks in 2010, for the first time in 25 years. Plus new enrollees to Medicare are being asked to pay even more for their Medicare Part B coverage.

The only people (besides the founder of the "blue-dog" Democrats and current Pharmaceutical Research and Manufacturers of America swindler Billy Tauzin) who seem to believe in the dreamland of "success" for the Medicare Part D program are former Senate Majority Leader Bill Frist, and John Breaux, a former Democratic senator from Louisiana who recently wrote an article with that very title: "Medicare Part D: A health care success."

Breaux stated, "Six years ago, members of both parties came together to pass a plan that offered affordable access to the best private-sector medicine. Seniors, taxpayers and private industry all found a way to make the program work. These are the successes we need to celebrate--and replicate."

How wrong a statement this is. The one thing that Medicare Part D has shown is that the privatization of health care leads to people not being able to access medical services and medications they need and deserve.