Add a Drug Coverage Option to the Original Medicare Program

imagePeople with Medicare need a drug benefit that covers the drugs they need at prices they can afford. The Medicare Part D program does neither.

The Part D program relies on insurance companies to hold down costs by barring or restricting coverage for certain drugs in the plans they offer. Prices are higher than those the Veterans Administration is able to negotiate. In fact, although Medicare pays 75 per cent of the cost of coverage through Part D plans, the expense to the consumer is comparable to, and often higher than, what they would pay if they were to buy drugs from Canada, without any government subsidy at all.

Lowering drug costs is one of the Medicare Rights Center’s main priorities. We’re working hard to allow Medicare to negotiate lower drug prices and administer prescription coverage directly instead of through private insurance companies.

“It takes us time to go to Canada, but it’s worth the trip,” say Mr. and Mrs. Q of Maine.
For over three years, the couple has been regularly crossing the border to buy prescription drugs. Both have diabetes and high blood pressure, and Mrs. Q has high cholesterol. Buying Canadian-priced drugs for their conditions saves the couple $2,655 a year!

If Medicare were to administer the drug benefit and negotiate better prices as other industrialized countries like Canada do, there would be enough savings to close the “doughnut hole” or gap in Part D coverage, when people continue paying premiums but pay the entire cost of their drugs.

Many people with Medicare have also experienced problems obtaining coverage for drugs that treat mental illnesses. Medicare Part D plans impose a range of restrictions on mental health drugs that result in the denial of coverage.

Requirements to obtain prior authorization and excessive cost-sharing often block access to antipsychotics and antidepressants—medications that treat serious mental illnesses. The benzodiazepines, medicines used to treat anxiety and panic disorders, insomnia and related conditions, are completely excluded from Part D coverage.

Ms. Z is 64 years old and has suffered from schizophrenia for over thirty years. She takes Abilify and Zyprexa to control her symptoms. Before January 1, 2006, these drugs were covered by Medicaid.

For five years, Ms. Z’s medications helped stablize her condition. But in January 2006, Medicare Part D went into effect. People like Ms. Z, who had both Medicare and Medicaid, were transferred to a Medicare private drug plan for coverage of their medications. Ms. Z. was automatically enrolled in a randomly assigned plan.

When she attempted to fill her prescriptions using her new drug plan, the pharmacist told her that her medications required prior authorization.

Ms. Z left the pharmacy empty-handed and confused. The pharmacist had not explained what prior authorization was, nor did he use her plan’s transition policy to fill her prescriptions.

Ms. Z. then turned to a caseworker at the medical clinic where she receives her regular care. She was told that only the doctor could give prior authorization, and because he only came to the clinic twice a week, and saw over 50 patients a day, it would be virtually impossible for him to find the time to secure the necessary authorization.

People with Medicare are feeling the impact of the decision by Congress to hand the drug benefit to private insurance companies instead of administering it through the Medicare program. Older adults and people with disabilities are finding that their medications are not covered and they’re facing obstacles when they appeal for coverage. Many people are experiencing more restrictions and paying higher co-payments than they did with the coverage they had prior to the implementation of Part D.

The Part D program is a bad deal for people with Medicare and for all taxpayers!

The Medicare Rights Center supports a number of legislative and regulatory changes that will help people with Medicare get the drugs they need. We’re working to:

As a concerned citizen, you can act for change in Congress. Take action now!

The Medicare Rights Center publishes many talking points about and reports on the Drug Benefit:

Resources for Understanding and Talking About Fixing the Medicare Drug Benefit

Letter of Support for the Medicare Prescription Drug Savings and Choice Act of 2009

Campaign Synopsis

Talking Points

The Best Medicine: A Drug Coverage Option Under Original Medicare (October 2007)

Truth Is the Best Medicine

Sign-on Letter for Organizations

Letter to Congress

Letter to the Editor


Off-Base: The Exclusion of Off-label Prescriptions from Medicare Part D Coverage, August 2007

Norvir: Gouging Medicare on AIDS Drugs, January 2007

Clearing Hurdles and Hitting Walls: Restrictions Undermine Part D Coverage of Mental Health Drugs, September 2006

Making Medicare Therapy Management a Cornerstone of Community-Based Care for People with Alzheimer's Disease and Other Forms of Dementia, September 2006

People Must Be Allowed to Change Their Drug Plan, May 2006

Medicare Part D Appeals System Breaks Down, March 2006

The Knowledge Gap: Drug Plans Fail to Provide Critical Information to People with Medicare, February 2006


July 24, 2020 Testimony of Paul Precht before the House of Representatives Committee on Oversight and Government Reform: "Medicare Part D Drug Benefit"

June 21, 2007 Testimony of Paul Precht before the House of Representatives Committee on Ways and Means Subcommittee on Health: "Beneficiary Protections in Medicare Part D"

May 2, 2007 Statement for the Record, Robert M. Hayes, Esq. for the Senate Finance Committee: The Medicare Prescription Drug Benefit: Monitoring Early Experiences

July 18, 2006 Testimony of Robert M. Hayes, Esq. before the United States House of Representatives Committee on Government Reform, Subcommittee on Regulatory Affairs, "Another Year Another Billion Hours: Evaluating Paperwork Reduction Efforts in the Federal Government."

July 17, 2006 Testimony of Robert M. Hayes, Esq. before the Senate Democratic Policy Committee: An Oversight Hearing on Providing Relief to People with Medicare Who Have Fallen into the Prescription Drug 'Doughnut Hole'

June 14, 2006 Statement for the Record, Robert M. Hayes, Esq. for the House of Representatives Committee on Ways and Means: Implementation of Medicare Part D Prescription Drug Benefit

May 3, 2006 Testimony of Robert M. Hayes, Esq. for the House of Representatives Committee on Ways and Means Subcommittee on Health: Implementation of Medicare Part D Prescription Drug Benefit

February 27, 2006 Statement for the Record, Robert M. Hayes, Esq.for the Democratic Policy Committee