Medicare Prescription Part D Drug Plan

Date: Nov. 15, 2005
Location: Washington, DC
Issues: Drugs

MEDICARE PRESCRIPTION PART D DRUG PLAN -- (House of Representatives - November 15, 2005)


Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding to me, and I thank him for once again bringing this subject to the floor of the House.

It is a timely subject. Here we are celebrating Medicare's 40th birthday; and, Mr. Speaker, as the Members will recall, 2 years and 1 week ago we actually passed this legislation, on November 22 of 2003, which now has become the Medicare Modernization Act and with it the prescription drug plan.

Mr. Speaker, I have been doing town hall events and informational groupings throughout my district, and my district is pretty diverse. I have been very fortunate. I have had someone there from CMS with me, and together I think we have been able to answer a lot of the questions that come up. I do not want to get ahead of the program that Dr. GINGREY has proposed for this evening, but the concept of the worksheet, the concept of prearranging some of the information in an organized fashion, is a critical one. It is so important because we are coming up on a time of year of celebration of holidays, Thanksgiving and Christmas holiday, when families are going to be together. It is a great opportunity for them to talk, after they have had all the football and turkey that they can handle, to sit down and talk about what are the changes that are coming up in this Medicare program.

The gentleman alluded to calling 1-800-Medicare. I must admit I have not had the courage to do that myself, but I do go on the Internet, and we can go into the plan selector part on They do ask for their Medicare number, but if they scroll down that page just a little bit, they can actually fill out the plan finder information without giving up any information, if they just want to check and see what is available.

I have done this for Texas. We have got in excess of 40 plans available to seniors in the Lone Star State, and they are good plans. Some of them come in with less of a premium and less of a deductible than what Medicare proposes. In fact, I have seen premiums as low as $10 and $20, and I have seen some programs with a zero dollar deductible.

A lot has been made about the so-called gap in coverage that occurs at some levels. And do remember, Mr. Speaker, we passed this legislation 2 years ago, and what were we trying to do? We knew we could not cover every last single person in this country, so we wanted to provide the greatest amount of coverage to those who were the poorest and those who were the sickest, and I think we did a good job in accomplishing that. But it does leave a gap in coverage, or at least the Medicare proposal, the proposal for the Medicare prescription drug plan, was to leave a gap. But, actually, there are some plans in Texas where, if they are willing to accept generics, there is, in fact, no gap in coverage. So there is complete coverage from the first dollar spent up and to the so-called catastrophic ranges.

I have had some people complain about the time frame that is available to sign up for this program. It starts today, and for the next 6 months people can sign up for any of the Medicare-eligible programs. Those who have not signed up by May 15, right now Medicare is proposing a 1 percent penalty per month. That will be 32 cents penalty the first month of June of 2006, and it will continue at a 1 percent per month increase thereafter.

But realistically, this should be thought of as insurance and not an entitlement. That is what I have tried to explain to my constituents when they say they do not like the idea that you are forcing me to sign up. It is a voluntary program. If you decide it is not for you, you are absolutely free not to sign up.

But when I was a physician and I offered health insurance to my employees, they would be expected to pay a small part of it. If they chose not to pay that part, they could opt not to take the insurance. But they could not just wait until they got sick and then say, I would like to sign up for the insurance. Otherwise, it would not be fair to the rest of the people who have been paying their premiums all along. The program is structured to look like commercial insurance. It is on purpose not scheduled to look like an entitlement, because it is not. It is insurance coverage for seniors who need help with paying for their prescription drugs.

Mr. Speaker, I would just stress as a last point that when people evaluate these plans for their families or for themselves, that they look at cost, coverage, and they look at convenience. Many of the plans cost less than what Medicare has proposed.

The coverage part is important. You want to be certain that you pick a plan that covers the medicines that you are actually taking. Talk it over with your doctor. If your doctor is watching a problem like a mildly elevated blood pressure, be sure that those medications would likely be covered. Every plan lists on the Web site how many of the top 100 prescriptions covered by Medicare that particular plan covers. Most are in the high-90 range. I have not seen one less than 82 or 83 of the top 100 prescriptions covered by Medicare. But check out the coverage.

Finally, convenience. They will provide a pharmacy that is close by. If your neighborhood pharmacy is the one you want to use because they have a delivery boy you like, use that tool to help you decide which one of those pharmacies you want to use. There is also mail order.

There is a lot of flexibility in these plans. Yes, it is complicated. Health care is complicated in the 21st century. These are not easy decisions. Yet at the same time, Tom Brokaw called you the Greatest Generation. You beat the Nazis, solved the problems of the Great Depression, and solved a lot of the problems related to civil rights. Seniors can solve these problems as well.

This program will become streamlined over time. I am happy about things like disease management and physicals that will be offered now. It is good legislation. Mr. Speaker, it is good medicine.


Mr. BURGESS. Mr. Speaker, my understanding is you will be offered the top three plans based on cost to evaluate. Then you can go to the next three plans and the next three plans. So the information is given in those sorts of segment. My understanding is cost, since cost is one of the principal concerns in people's minds, cost is one of the parameters upon which the three plans are picked. Here are the top three plans in your area based on cost, covering some portion of these medications, and whether there would be a stand-alone prescription drug plan or one of the PPO- or HMO-type products that would include a prescription drug plan, those are also included in the choices as they are given.

We have some 47 prescription drug plans in Texas that are recognized by Medicare as being good products. You cannot evaluate all 47. So give me the top three based on cost, and let me figure out the coverage and convenience aspect of those. If you have expanded the search to include a HMO or PPO product, let me make the decision based on can I see any doctor I want or would I have to see a select panel of doctors.

Those are the kinds of decisions, the same kinds of decisions people would make in starting a new job, when they went and met with their employee benefits manager. Just like we did when we started in the House 3 years ago, they asked, do you want a HMO, PPO product, and went through the litany of things that might be available to us.

This would be the type of information that would be given to someone. And again, this may be too much for an individual 85 years of age to deal with three plans that are somewhat different in their construct. That is why it is going to be helpful to have a child, a nephew, a grandchild to be able to help make those decisions. Probably the person who helps arrange for those prescription purchases on a regular basis would be the best person to advocate for that particular senior and help them make those choices.

Mr. MURPHY. Mr. Speaker, when you are comparing plans, my understanding is if you look at the most commonly prescribed drugs for seniors, and not every drug may be covered by every plan, there is 97 to 95 percent overlap.

Mr. BURGESS. That is correct, and that information is listed on the Web site.

Mr. MURPHY. And the reason a person wants to compare different plans is to make sure that not only their drug is covered, but different plans may have different costs for those individual drugs. So the person can actually shop around on the Internet or on the phone.

Mr. BURGESS. That is correct. The Internet would provide some transparency that probably is not available to that senior today.

Mr. MURPHY. Mr. Speaker, I was in the grocery store the other day, and I wanted to buy a loaf of bread. I had not been in this store before. This store must have had 30 or 40 different types of bread. Every roll, shape, flat, cut, everything. I said I just want some whole wheat bread. They helped me find it.

I thought this sort of reminds me with some of the choices with the Medicare plan. If anything, yes, there are many choices, but it is important to keep in mind that by working with somebody on the Web site or on the phone, and many pharmacies and senior centers offer this. Ultimately the issue is this: that a person should not just compare the cost of a drug, what is this drug going to cost, but what is it going to cost me over a year's period of time.

We looked, for this hypothetical person Jane, what does it cost for a year because in some cases people may say if there is coverage up to $2,250, and if my drugs cost $3,000, they may ask, do I have to pay $3,000? And the answer to that is?

Mr. BURGESS. The answer is, if it is over $2,250, it would be $750.