SACRAMENTO – Ensuring that elderly and disabled persons receive medically necessary prescription drugs is the objective of state Sen. Patricia Wiggins' SB 623, which passed the Senate Health Committee today on a bipartisan 7-3 vote Wednesday.
The Medicare Modernization Act of 2003, which went into effect in January 2006, resulted in the biggest change to the Medicare program since its inception roughly 40 years ago. A new component, Part D, gives beneficiaries the option to sign up for a drug plan to help cover a portion of their prescriptions.
Prior to 2006, there were over a million low-income elderly and disabled Californians who received drug coverage from both Medi-Cal and Medicare. These people were automatically shifted into the Medicare Part D program and were required to begin making co-payments for their drugs for the first time.
As a result of the change, dual eligibles are now required to do something that no other Medi-Cal beneficiaries are required to do – make co-payments to receive medically necessary drugs ranging from $1 to $5 for each prescription filled.
While the co-payments may seem small, they can add up to a significant monthly cost for people on limited incomes (the 100,000 dual eligible beneficiaries in California nursing homes are not required to make co-pays, thus creating a financial incentive for institutionalization).
“By definition,” Wiggins says, “dual eligibles are low-income seniors and individuals with disabilities who are among the most vulnerable populations in the state and have the least amount of disposable income. In spite of this, these individuals must now pay a substantial amount of their fixed income for live-saving medications.
“Even minimal co-payments are unaffordable for most of these beneficiaries and therefore serve as a barrier to obtaining medically necessary mediations,” she adds. “This group is very low income, sick and frail. They are all elderly or significantly disabled and are among the highest users of prescription drugs because many suffer from chronic illnesses.”
The average number of medications for this population frequently ranges to 10 to 12 per month, but may be many more to treat certain conditions.
“These individuals are being forced to choose between rent, utilities, food and medicines,” Wiggins says. Many are on Supplemental Security Income (SSI) and have a total monthly income of $901 or less. Tens of thousands live in Residential Care Facilities for the Elderly (RCFE) and assign their entire monthly SSI check to the RCFE for room and board.
“This leaves them with virtually no cash income to pay drug co-pays,” she adds. “One result is that this frail, vulnerable population may choose to not take medicine putting them at risk for hospitalization or long-term institutionalization.”
Until May 16, 2006, California’s emergency Medicare Part D backup program covered co-payments for dual eligible beneficiaries. DHS estimates that the annual cost of covering co-pays to be $75 million, while the Health Insurance Counseling and Advocacy Program, a group of state and federally funded agencies advising seniors on Medicare issues, believes that the cost would be lower.
The HICAP estimate is based on the fact that the state’s obligation to cover co-pays will be capped at $5,100 annually for total prescription costs, even though many seniors would easily exceed the limit.
SB 623 is backed by numerous individuals and organizations, including the Congress of California Seniors (sponsor), Health Access, AIDS Healthcare Foundation, Western Center on Law and Poverty, Alliance for Retired Americans, Gray Panthers, National Health Law Program, Older Women’s League of California, and the Western Center on Law and Poverty.
Wiggins' district includes Lake County. For more about her, including legislation and other issues, visit her Web site at http://dist02.casen.govoffice.com/.
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