Kaiser Daily Health Policy Report

Thursday, June 03, 2004

Medicare

Prescription Drug Prices Higher Through Medicare Discount Cards Than Through VA Health System, Report Says

      The prescription drug discounts that veterans receive through the Department of Veterans Affairs exceed the savings that are available through the new prescription drug discount cards, according to a new study released Wednesday by Families USA, the Hartford Courant reports (MacDonald, Hartford Courant, 6/3). The discount card program, which was created as part of the new Medicare law and debuted Tuesday, is available to Medicare beneficiaries who do not have prescription drug coverage through Medicaid. Beneficiaries have access to a number of discount cards sponsored by private companies and endorsed by Medicare. Card sponsors can charge an annual enrollment fee of as much as $30 and likely will offer savings on at least one medication in each of 209 classes of treatments commonly used by Medicare beneficiaries. Medicare beneficiaries with annual incomes of less than $12,569 for individuals or $16,862 for couples will qualify for a $600 annual subsidy for their prescription drug costs and will not have to pay enrollment fees. Beneficiaries can use the Medicare Web site or call 1-800-MEDICARE to make card-to-card comparisons of prescription drug discounts. According to HHS Secretary Tommy Thompson, the discount cards provide average savings of about 10% to 17% for brand-name medications and 30% to 60% for generic treatments (Kaiser Daily Health Policy Report, 6/2). In a comparison of the 20 prescription drugs most commonly prescribed to Medicare beneficiaries, Families USA found that the lowest prices available through the Medicare cards for 10 of the medications were at least 50% higher than prices negotiated by VA, according to Families USA Executive Director Ron Pollack. The study also found that the lowest drug card price for Lipitor, a cholesterol-lowering medication and the most frequently prescribed drug for seniors, was 59% higher than the price available through VA. According to the study, the Medicare drug card price was 46% higher than the VA price for cholesterol-lowering drug Zocor, 56% higher for acid reflux treatment Prevacid and 65% higher for blood pressure medicine Norvasc. VA discounts also exceeded Medicare drug card prices for the other 10 drugs, although only by 7% in one case (Hartford Courant, 6/3). A price comparison chart from the Families USA study is available online.

Criticism
Pollack criticized Congress for not including in the new Medicare law a provision that would allow the federal government to negotiate prices with pharmaceutical companies, as VA does. He said, "Instead of the drug discount cards, Congress and the president should have provided real price relief for America's seniors by enabling them to bargain for lower prices" (Hartford Courant, 6/3). He added, "Other than political pressure from the drug lobby, there is no sensible reason why Congress and the president refused to take this far more effective step" (Barfield
Berry, Long Island Newsday, 6/3). Sen. Debbie Stabenow (D-Mich.) said, "The phenomenal power of federal bulk-purchasing has been proved by the Veterans Administration, but those crafting the Medicare bill yielded to the influence of the pharmaceutical industry and blocked Medicare from using its large pool of beneficiaries to negotiate good deals." Sen. Edward Kennedy (D-Mass.) said, "A genuine discount program would provide a single discount card for Medicare, and the [HHS] secretary ... would negotiate large savings and fair prices for senior citizens, just as the secretary of Veterans Affairs does for veterans" (Hartford Courant, 6/3). He added, "We need to end this shell game and find honest solutions to the crisis of excessive costs of prescription drugs" (Heldt Powell, Boston Herald, 6/3).

Response
However, Thompson said on Tuesday that the VA model would not be practicable for the Medicare population because VA runs the hospitals where drugs are distributed and Medicare is a far larger program. "It's not an apples-to-apples comparison, he said, adding that allowing the federal government to negotiate drug prices for Medicare would have a distorting effect on the drug market (Heil, CongressDaily, 6/2). Rick Smith, a spokesperson for the Pharmaceutical Research and Manufacturers of America, added, "Medicare would be a price fixer, not a negotiator" (
Long Island Newsday, 6/3). CMS spokesperson Peter Ashkenaz said the comparison between VA and Medicare "isn't ... fair" (Boston Herald, 6/3). In a statement, the Pharmaceutical Care Management Association, said, "The VA national formulary requires access to prescription drugs in 31 classes. By contrast, the new Medicare drug discount card program requires that beneficiaries have access to drugs in 209 therapeutic classes" (Hartford Courant, 6/3). Phil Blando, a spokesperson for the PCMA, added that the Families USA report did not take into account lower-cost mail-order drugs or generic drugs, which account for about half of all prescriptions. He said, "These data wouldn't pass muster in a Statistics 101 course" (Long Island Newsday, 6/3).