Co-Pay Problems

Some of Arizona's poorest are now paying more for their meds thanks to Medicare Plan D

With the May 15 sign-up deadline for the Medicare Plan D prescription drug plan looming, Bush administration officials and the nation's drug companies are already congratulating themselves on the cost savings for many enrolled senior citizens.

Meanwhile, some elderly or disabled Tucsonans living on incomes below the federal poverty level are actually paying more for medications now--and they don't have any choice in the matter.

"I was paying nothing before and had no warning this was coming," reports one disabled man who requested anonymity, "but now I'm paying more than $30 per month for prescriptions. I got hit with it the first time I went to the pharmacy in January."

Remembering the state of Arizona picked up the unexpected co-pays that month on an emergency basis, but hasn't since, the man continues: "I went 14 days in March without medications for severe back pain, because I didn't have the money for co-pays. In my case, it's a constipation and bowel issue. It's that gross."

Living financially day to day, this man believes he is like many other poor people in not being able to afford the newly required co-pays.

While many older Americans report their prescription drug costs fell considerably since Plan D went into effect at the first of the year, this man also symbolizes what happened to some poor Arizonans at the same time.

Under Plan D, senior citizens and the disabled who qualify for both Medicare and the Arizona Health Care Cost Containment System (AHCCCS) program for the poor were legally obligated by the federal program to be enrolled in Plan D. As a result, an estimated 10,000 poor Arizonans who are "dual eligible" lost their zero co-pay privileges previously provided by AHCCCS.

Even with the required co-pays only ranging from $1 to $5 per medication, they can add up if a poor person takes several drugs. Plus, as Catalina Laborin, patient advocate for the El Rio Health Center, adds, all of the other changes coming about because of Plan D have created additional problems.

"There's a lot of confusion," Laborin says.

Millions of Americans older than 65 have been discombobulated by Plan D (See "Prescription Perplexity," Jan. 5) and have refused to sign up. If they don't by next week, it may cost them a financial penalty they'll only escape when they die.

As for the local poor people who now must make required co-pays under Plan D, which they had no choice to join, Laborin adds: "They're having a hard time. They may have to go without some other things."

Ann Sierra, of the Tucson AHCCCS office, agrees. "While others are doing fine, this population is suffering under it. This is affecting them negatively; $30 a month is a lot of money for someone who's poor."

Laborin explains the El Rio pharmacy works with people to cover their new co-pays, but private pharmacies generally don't do that. Despite that, Walgreens District Pharmacy Supervisor Eric Scherf says because the mandatory co-pays are so low, he hasn't heard about a whole lot of problems, but concedes it could be an issue.

"Even though people can pay, they're not happy, and the co-pays do add up," he says.

To provide future state coverage for the required co-pays by the poor, Tucson state Rep. Phil Lopes, a Democrat, says Gov. Janet Napolitano requested $4.5 million in funding in her proposed budget for the next fiscal year. On the other hand, a similar appropriation wasn't suggested in the alternative budget prepared by the Legislature's majority Republicans, Lopes says.

Lopes indicates approving the funding is a high priority for the House Democratic caucus, but admits that in the budgetary process, "Things get traded all the time."

Calling the idea of charging the poor more for their prescription drugs "shitty," but typical of Republicans, Lopes is harsh in his criticism of those responsible for Plan D.

"While Democrats have a better handle on what the common guy is dealing with, the Republicans in Washington did what was good for the drug companies. But it's wrong to make poor people pay more for their prescriptions."

Offering a completely different perspective, in an e-mail message, Republican Congressman Jim Kolbe comments: "The Medicare drug benefit is offering prescription coverage for the first time in Medicare's history. Already, over 30 million Medicare beneficiaries are now receiving help to pay for their drug costs."

Continuing, Kolbe says: "Moreover, millions of low-income individuals are eligible for coverage without paying a dime in premiums or annual deductibles. I am proud that nearly 80 percent of Southern Arizona's Medicare recipients now have prescription coverage."

The disabled man now forking out more than $30 a month for his pain medications had other problems with the switch to Plan D as well. He was originally told by his insurance company that it would cover all of his drugs, but they it unilaterally rescinded that agreement.

"They lied to me about covering everything," the man says. "I don't know from month to month if they'll cover my medications. I've been put through hell."

Acknowledging he didn't know about El Rio's approach to solving the co-pay problem, the man has definite opinions about the Plan D prescription drug plan.

"The system created a benefit for those who can pay for their medications, while those poor bastards who have nothing pay more. Everybody's putting a gun to the head of the poor right now."

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