Proposed Medicare reforms will be good for seniors

The Department of Health and Human Services recently proposed major reforms to Medicare's prescription drug benefit for seniors, known as "Part D." The Department hopes the plan will slash enrollee out-of-pocket spending on prescription drugs and improve access to a variety of crucial medications. It will do just that - and Illinois seniors should welcome HHS' changes.

Part D helps more than 1.1 million Illinois residents - and 43 million Americans in total - afford lifesaving medications.

Under the program, private insurers offer a range of prescription drug plans and the government helps foot the bill. Each plan differs in price and drug coverage. Prairie State residents had two dozen plans to choose from this year, the cheapest costing just $16.70 per month.

Though more than eight in 10 beneficiaries are already satisfied with their Part D coverage, HHS hopes to make the program even stronger. One of the HHS reforms would ensure that beneficiaries receive greater discounts at the pharmacy counter.

Right now, private insurers hire "pharmacy benefit managers" to negotiate with drug manufacturers. As the middlemen, PBMs have the power to influence which drugs are included on Part D plans and how much beneficiaries should pay at the pharmacy counter.

On average, PBMs secure discounts of up to 35 percent for brand name drugs in Part D. Unfortunately, these bargains aren't always passed down to Part D enrollees through lower copays or coinsurance. The HHS plan would ensure that patients see a portion of these negotiated savings at the pharmacy counter. To see the impact this could have, consider that if 80 percent of rebates were passed on to patients taking diabetes medications, each beneficiary with the disease could save $350 per year.

The Department of Health and Human Services has also called for an annual limit on out-of-pocket drug spending. Currently, beneficiaries who shell out at least $5,000 out-of-pocket for prescription drugs enter Part D's "catastrophic phase." Here, seniors are responsible for up to 5 percent of any remaining drug costs for the year. Catastrophic coverage is typically reserved for seniors battling multiple chronic conditions. In Illinois, more than 7.5 million people battle at least one chronic disease. Many of these folks rely on Part D drugs to stay healthy.

But even 5 percent can be burdensome for these vulnerable seniors. That's why HHS wants to cap the amount of money enrollees can spend on prescription drugs each year. In effect, beneficiaries would shoulder no further drug costs once they hit the catastrophic phase. That would save seniors money - and ensure they can afford the medicines that keep them healthy.

Illinois residents should welcome the Department of Health and Human Services' Part D reforms. More patient savings and access to medications is a winning scenario anyone can get behind.

Michelle Orive, of Lombard, is president of the Rush to Live Organization, a not-for-profit agency dedicated to providing pre- and post-transplant patient education.