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January 17, 2006

Sorry, We Don't Like That Drug

We've talked a lot about the screwball incentives and laughable implementation of Medicare Part D, but Kriston takes another approach: if you're an epileptic, the benefit simply doesn't cover a necessary class of drugs. This, as various elderly folks with uncommon conditions are finding out, is proving a fairly common problem across the benefit, and it's replicated on a micro scale across various drug plans. While few drugs are simply banned across the program, many are excluded from individual plans. That means a wrong choice now results in paying out-of-pocket for essential drugs later, which is why so many seniors are so scared to sign up.

January 17, 2006 | Permalink


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It should also be noted that the insurers can change the drugs they support at any time, without notice, but the retiree can only change plans once a year, creating real opportunities for bait and switch situations. Lure enrollees by saying they support high cost drugs, and then remove them one month into the program.

This provision is completely intolerable. If the retiree is stuck for a year, so should be the insurance company.

But really, the whole thing sucks. What advantage to society is gained by having 10-20 companies offering competing plans - each remarkably complex in different ways - over a price range that is remarkably small - but differing in ways that are hard to comprehend?

And none of these companies can achieve the market weight to effectively bargain with the drug companies because their share is too small to matter. Note also that the government is prohibited by this law from bargaining with drug companies.

A total disaster, this is.

Posted by: JimPortandOR | Jan 17, 2006 2:01:44 PM

Kevin's been on this too, and I'm not entirely convinced; I mean, it's lousy policy, but to say there's no cause for concern over sleeping pill and Valium use in the elderly seems a bit cavaier as well. Ideally a drug plan would be able to balance out risks and benefits and temper caution with efficacy; to expect that in Medicare Part D seems a bit much.

Which brings me to my point on Kevin's - as much as I sympathize with adding a drug plan to Medicare - especially because it was great politics, the devil is in the details, and one of those details is that, like it or not, this is what the pharmaceutcal industry craved - ever increasing reliance on their products as the first, or sole, means of treatment. There are other options. Even Kriston acknowledges that she's had better quality of life off meds than on. I have no doubt that there's probably ultimately a nexus of Psychiatric groups and pharma that will lobby to add benzodiazepenes and barbituates, and succeed. If what we wanted was plugging old folks with uppers and downers, bravo. I think there's more that's problematic than good in succeeding at this, though.

Posted by: weboy | Jan 17, 2006 6:06:03 PM

We already have eldercare abuse, drugging them so they can't be inventive enough to require thoughtful care from staff. Global Citizen might have a different take, but I have a problem with supplying uppers/downers like candy.

Posted by: op | Jan 17, 2006 7:23:46 PM

It's really time for someone to call this for what it is: A travesty brought to you by the same people who brought you the Iraq war. This is an unimplementable piece of legislation that many people of good faith will try to work with. They shouldn't. It should be boycotted and allowed to die.

Posted by: miriz | Jan 17, 2006 10:02:32 PM

weboy, that's horseshit. My quality of life has been much improved since I was able to successfully wean myself off the drugs that prevented my epileptic seizures, which, let me assure you, even more drastically improved my quality of life over the period in which I was regularly having epileptic seizures. I do not in any way disparage the value of those drugs. I was only able to wean because my type of epilepsy is somewhat conditional. Had I not had those prescriptions—had I not had a health plan that allowed me to arrive at the specific prescription that provided the best prevention with the most minimal side effects portfolio—my quality of life would have been (and would surely have continued to be) far, far worse.

Posted by: Kriston | Jan 18, 2006 2:10:36 AM

Weboy, you may not know that for someone who's already on a regular regimen of benzos, abruptly stopping them is physically dangerous. It's nice that you want a philosophical discussion of the proper role of pharmaceuticals, but sudden loss of access to these drugs can kill people.

Posted by: Hob | Jan 18, 2006 3:03:03 PM

weboy: as other people have said, that's a complete crock. I'm epileptic too; I don't know whether you bothered to think at all about what going off epilepsy drugs means, for someone who is still prone to seizures, so let me fill you in:

It means that you will almost certainly have seizures. Personally, I quite predictably last 4 days without medication and then have one. (I have not tried this often.)

Seizures are not painful (except for the time I bit part of my tongue off, ha ha ha), but they are dangerous, if you happen to have them in the wrong circumstances. If you have seizures, you really can't do any of the things that it would be problematic to lose all muscular control and start jerking around randomly while doing. Crossing busy streets, for instance, or hang-gliding, or many sports (imagine having a seizure while skiing or scuba diving, ha ha ha), or, notably, driving.

In fact, epileptics can only drive if they've been seizure-free for a considerable time (it varies from state to state.) Have a seizure, lose your license. (Rightly: who wants to drive on the same highway as someone who might at any moment have a grand mal seizure?)

So my quality of life off medications would be harmed not just be the seizures themselves and their sequelae, but also by having to stop doing a number of things that I love, and also losing my license.

By contrast, I have no side effects from medication, and my seizures are perfectly controlled. (The last one was in 1985.)

So tell me again why my quality of life would be better off meds? Or why, my doctor's views to the contrary, there are non-pharmaceutical alternative treatments for my version of epilepsy? Or why I should be OK with the fact that the drug I'm on, though not a barbiturate, is not covered by almost any Medicare Part D plan? (I could switch to another, but some people respond to some anti-convulsants and not others, and no one seems to know which ones, if any, a given person will respond to. I am now on one that works perfectly; on Medicare Plan D, I would have to switch around until I found another one that worked. This would probably mean having seizures, and thus losing my license, unless I was lucky enough to hit on the right one on the first try.

If I were on Medicare, I'd be furious. Actually, I'm furious as it is, since I know that there are people on Medicare who are in my exact situation, and who have no recourse.

Posted by: hilzoy | Jan 18, 2006 10:46:14 PM

but to say there's no cause for concern over sleeping pill and Valium use in the elderly seems a bit cavaier as well.

that isn't a case for excluding them (and treating epileptics brutally as well), it's a case for careful prescribing. Barbiturates are now rarely prescribed here in the UK (and our doctors are even more benzophobic than yours), but when they are prescribed under the NHS, they cost as little (which can be zero) as any other drug; and quite rightly.

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