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Wilson Rejects Detrimental Change to Medicare Drug Benefit

Location: Washington, DC

Wilson Rejects Detrimental Change to Medicare Drug Benefit

Today Congresswoman Heather Wilson voted against H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 2007. The legislation passed by a vote of 255-170.

"The legislation considered today would require the government to interfere with the popular new Medicare prescription drug benefit, which is already working to reduce drug costs for seniors beyond what was expected. It would limit access to medications for seniors and I could not support that," said Wilson.

Private companies that administer the drug benefit negotiate with drug companies for lower prices and seniors realize savings through the bulk purchasing of pharmaceuticals by their prescription drug plans.

Competition in the marketplace is working to reduce costs for seniors. Nationwide premiums average $24 per month, down from $37 a month projected when we passed the legislation creating the new benefit in 2003. The total estimated cost of the Medicare prescription drug benefit is 30 percent lower than projected. As a result of strong competition in the marketplace, costs are lower than expected.

The Congressional Budget Office estimated H.R. 4 would not reduce drug prices because the Secretary of the Department of Health and Human Services would be unable to negotiate prices that are more favorable than those obtained by the private drug plans.

"Government doesn't do a very good job of getting the best price. Competition in the marketplace is much better and responds more quickly than government does," said Wilson.

While Wilson did not support H.R. 4, she re-introduced legislation today that would make changes to the new Medicare prescription drug benefit to improve access to affordable medicine for seniors. Wilson's legislation provides access to a class of mental health drugs prohibited in the new drug benefit, broadens the authority of the Health and Human Services Secretary to grant exceptions when a doctor says a prescription is needed, and removes bureaucratic barriers to ensure that these Americans receive the same prescription drugs under the new Medicare prescription plan that they received previously through Medicaid.

H.R. 4 did not go through the normal Congressional Committee process and amendments to the bill, like Wilson's legislation, were not allowed by the Democrat majority.

"The way this bill was handled - coming directly to the floor of the House with no amendments and no Committee consideration - missed opportunities to make a good program better," Wilson said.

Summary of Wilson's Medicare legislation

· Allows full benefit dual eligibles to have access to the same drugs in Medicare Part D they had in Medicaid without bureaucratic barriers.

· Authorizes the Secretary to grant an exception for coverage of a Part D covered drug if all other appeals processes have been exhausted and the patient's physician certifies it is medically necessary.

· Changes the definition of Part D covered drug to include drugs prescribed for off-label and off-compendia use.

· Adds Benzodiazepines as a class of drugs covered in Medicare Part D.

· Allows state Medicaid programs to pay co-payments for full-benefit dual eligibles at state option.

Dual Eligibles: Under the new Medicare prescription drug benefit, the drug coverage for seniors and the disabled with both Medicare and Medicaid was transferred from Medicaid to Medicare. This was the highest priority for all 50 state governors. Dual eligible seniors are automatically enrolled in a plan that in some cases may not cover all the drugs they had previously, or the coverage is subject to new quantity and dosage limitations. Medicaid patients can change plans at any time. In some cases, Medicaid patients have been going through appeals processes and medication changes to keep prescription drugs that already work for them. This legislation would ensure that low-income seniors and the disabled have access to the same drugs, at the same strength and quantity, as they did with Medicaid drug coverage.

Exceptions: Wilson's bill would clarify that the Secretary of Health and Human Services has the authority to grant coverage of any prescription drug if the patient's doctor certifies it is medically necessary.

Benzodiazepines: These are a class of drugs currently excluded in the new Medicare prescription drug benefit. These drugs are used to relieve anxiety, treat insomnia and seizure disorders like epilepsy, and are prescribed for some other mental health conditions.

State Medicaid Programs: The new Medicare prescription drug benefit will pay almost all of the medicine cost for low-income seniors on Medicaid who also receive Medicare, but requires them to pay a $1 or $3 co-payments for their prescription drugs. They paid nothing for these medications in Medicaid. One-dollar and $3 co-payments add up for people taking many prescription drugs. This legislation will give states the option to use Medicaid funds to cover these co-payments. States received savings as drug coverage was shifted from Medicaid to Medicare, and should be allowed to use some of this savings to pay co-payments in circumstances where the co-payments would result in financial hardship.

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