Dec. 04, 2013

Access to Prescription Drugs is a Must

by Kim Cantor, Senior Director of Public Policy and Government Relations

Access to prescription drugs is vital for managing and treating lupus. Many people with lupus receive their health insurance through Medicare, whether they aged into Medicare or qualified through Social Security Disability. Before 2003, Medicare did not cover outpatient prescription drugs, making access to essential prescription drugs very challenging.

On December 8, 2003, the situation changed when President George W. Bush signed the Medicare Modernization Act into law. The law established the Medicare Part D Prescription Drug Program, providing a way to access necessary prescription drugs for seniors and for people with chronic diseases and disabilities.  For nearly 10 years, Medicare Part D has been a lifesaver and a lifeline for thousands of people with lupus.

In response to the creation of Medicare Part D, the Lupus Foundation of America founded the Medicare Access for Patients RX (MAPRx) Coalition.  MAPRx brings together more than 45 national beneficiaries, patient, family, caregiver and health professional organizations committed to protecting the health of people with chronic diseases and disabilities through Medicare Part D.  MAPRx advocates for policies that ensure access to affordable prescription drugs while helping people with chronic diseases and disabilities maintain their health, well-being and financial security.

More than half of all Medicare beneficiaries, about 32 million Americans, rely on Medicare Part D to access prescription medications.  Medications that were previously beyond the financial reach of many..  Medicare Part D has been a successful program because it provides beneficiaries with access to insurance plans  offer a wide variety of prescription drugs, a range of affordable premiums, guaranteed coverage of six-protected classes of medications (anti-depressants, antipsychotics, anticonvulsants, antiretrovirals, antineoplastics, and immunosuppressants), and strong programmatic oversight and transparency. 

Since the program’s start, ample research, reports, surveys and polls support the notion that the program is working well.  A September 2013 survey showed that 90 percent of Medicare Part D enrollees were satisfied with their coverage and said it worked well for them.  In addition, multiple studies linked access to prescription drugs through Medicare Part D to improved health outcomes and decreased spending in other areas of the Medicare program.  Furthermore, applying Medicare Part D cost 30 percent less than originally budgeted.

All the successes aside, Medicare Part D is not perfect. Weaknesses in the program prevent people from taking full advantage of the benefits of prescription drugs. For example, specialty tiers (where highly specialized drugs are placed in a plan’s formulary) and co-insurance, (when people pay a percentage of the total cost of a drug) create significant access problems.  In addition, restrictive medication usage tools, such as prior authorization (an insurance company requires pre-approval or authorization for filling a prescription written by a doctor), medication substitution (automatic switching from one medication to another with or without physician notification), or quantity limits (restrictions on how much of a drug can be prescribed at a single time), place unfair burdens on patients and needless barriers to access to the use of medications as suggested by physicians.

During the week of December 2, MAPRx and its Coalition members are engaging in a number of activities to celebrate the 10th anniversary of Medicare Part D.  Lupus activists can support MAPRx and Medicare Part D by sending your Senators and Representative an email thanking them for delivering on the promise of a prescription drug program and encouraging them to build an even stronger program for the future.  As more Americans become eligible for Medicare, Part D will play an essential role in maintaining health and reducing overall health care costs not only for people with lupus, but for all Americans.


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