American Medical News
LISTINGS
'01 By region Map
'01 By health plan
'01 By section
'01 News briefs
'01 Columns
'01 Editorials
'01 Letters
Topics & series
Reader opinion
Other years
Search
SERVICES
E-mail alert
Print subscriptions
Staff directory
Author bios
Advertising
Permissions
AMNews FAQ
Contact info
Send feedback
 |
GOVERNMENT & MEDICINE
Medicare Rx card plan faces legal hurdle
Pharmacists, chain pharmacies challenge Bush's discount drug program in court; meanwhile, Tommy Thompson tries to drum up congressional support.
By Tanya Albert, AMNews staff. Aug. 6, 2001. Additional information
President Bush's prescription drug discount card program must overcome a legal battle before seniors could receive "Medicare Rx" cards this fall.
The National Assn. of Chain Drug Stores and the National Community Pharmacists Assn. sued the Dept. of Health and Human Services and the Centers for Medicare & Medicaid Services in July, seeking an injunction to stop the program's implementation.
HHS and CMS don't have the legislative authority to create the program, and the government violated federal law by secretly meeting with private companies to create it, the groups charge in the lawsuit filed in U.S. District Court for the District of Columbia.
"Medicare can't do this," said John M. Rector, NCPA general counsel. "They have to go through Congress. Anytime they want to involve the private sector, there has to be debate."
NACDS and NCPA said that didn't happen before Bush announced the prescription drug card proposal.
The plan -- part of an outline of broad principles Bush wants to see in Medicare reform legislation -- calls for seniors to get some immediate breaks on prescription drug prices while Congress works on comprehensive reform.
Pharmacy benefit management firms would issue government-approved "Medicare Rx" cards that seniors could begin using in January 2002. The managers would use the combined purchasing power to negotiate discounts with manufacturers and pharmacies to generate savings. Five of the nation's largest PBMs already have agreed to participate.
The plan's supporters, including the AMA, say it would be a tangible benefit for seniors that could be put in place quickly.
Worries about drug choices
But others, including the consumer group Families USA and the NACDS and NCPA, say the plan would do more harm than good.
"It's another way of switching from doctors to others the power of making medical decisions," Rector said.
For example, he said, participating PBMs might discount only one brand of drug in each class. There's a fear that Medicare beneficiaries might end up taking a drug that may not be the best one for them because it's discounted, he added.
"The standards will actually limit the ability of beneficiaries to receive discounts by restricting their ability to choose more than one discount card in the marketplace," NACDS and NCPA said in their lawsuit.
Rep. Pete Stark (D, Calif.) said he was seeking to become a plaintiff in the NACDS and NCPA lawsuit as a private citizen. He called the program a "placebo" for Medicare problems and said it had been created illegally.
"It was created in secret," he said. "Congress was not consulted."
HHS is not commenting on the lawsuit, said an agency spokesman. But HHS Secretary Tommy Thompson promoted the program at a House Ways and Means Committee hearing in late July.
Nearly 90% of Medicare recipients use at least one prescription drug per year, but 27% pay for drugs out of their own pockets or go without needed medications because they don't have a prescription drug benefit, Thompson testified.
"While the administration believes that the addition of a ... drug benefit should be included within an integrated modernization of the Medicare program, we intend to act now to provide immediate assistance to Medicare beneficiaries currently without prescription drug coverage," he said.
Thompson said the administration thought the program also would have side benefits, including greater competition that would lower prices and innovations that would improve quality and patient safety.
ADDITIONAL INFORMATION:
Weblink
HHS Medicare Rx discount card fact sheet (http://www.hhs.gov/news/press/2001pres/20010712a.html)
Joint statement of National Assn. of Chain Drug Stores and National Community Pharmacists Assn. on Medicare Rx discount card plan, at NCPAnet. (http://www.ncpanet.org/NEWSMEDIA/010718cards.html) Also available at the NACDS site (http://www.nacds.org/).
Copyright 2001 American Medical Association. All rights reserved.