Craig Burridge was recently intervied by local news Channel 6 reporter Steve Flamisch who was doing a report exposing a loophole in the Medicare Part D program for seniors. This was run as a two part video series - below is the report and two links to the video interviews.
CBS 6 exposes Medicare Part D loophole - Some seniors forced to choose between money and medication
Steve Flamisch
April 28, 2008 - 11:28PM
Video - Part 1
Video - Part 2
A Medicare loophole may be causing some senior citizens to lose their prescription drug coverage, while allowing multi-million dollar pharmacy benefit managers to rake-in record profits.
Under Medicare Part D, beneficiaries meet a yearly deductible then pay 25% of their prescription costs up to $2,500. At that point, they fall into a "coverage gap" in which they pay 100%. Unless cumulated costs exceed $5,700 - "catastrophic coverage" - those seniors will spend the rest of the year paying for each prescription out-of-pocket.
"We've had seniors walk away from our counters," said Craig Burridge, President of the Pharmacists Society of the State of New York. "They're in sticker shock."
The loophole in the regulation allows certain Medicare Part D plans to base the cumulated cost on what the plan pays to the pharmacy benefit manager (PBM) for processing the claim, instead of what the PBM pays to the pharmacist for filling the prescription. Since the PBM often gets more money, that pushes the senior into the coverage gap much more quickly.
CBS 6 discovered one example in which a Part D plan - Healthfirst - paid $45.89 to the PBM for the cholesterol drug Simvastatin, but the PBM - ExpressScripts - paid only $16.86 to the pharmacist.
Healthfirst called that "an unrepresentative snapshot," but it certainly adds-up. Last year, ExpressScripts boasted record income of $567 million. Other pharmacy benefit managers fared even better. MedCo earned $912 million, while CVS Caremark netted $2.6 billion.
Back at the pharmacy counter, some senior citizens are forced to decide which medications they can afford to live without.
"We just feel that that's unfair, and we're investigating it now in several states," Burridge said.
WEDNESDAY AT 6:30PM: CBS 6 reveals why some Part D plans are allowed to use such a pricing system, and what's being done to stop it.
