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| Wilson Votes for Landmark Prescription Drug Legislation |
June 28, 2002 |
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| Thousands of New Mexico seniors will receive a prescription drug benefit
Washington, DC-In a late night session, the House of Representatives approved a prescription drug benefit to be added under the Medicare program. Congresswoman Wilson has long been a proponent of implementing this plan and has been active in its creation. Passage of this bill means that approximately 139,000 seniors in New Mexico will pay nothing to receive their prescription medications and thousands more will see significantly reduced out-of-pocket costs for their much-needed medicine.
“No one should be forced to choose between buying food or buying medicine,” said Wilson. “While prescription drugs have helped millions of senior citizens improve their quality of life, the costs of these cutting-edge, life-saving medicines also have skyrocketed - putting a particular pinch on those living on a fixed-income. We can help these seniors get the prescription drugs they need to live a long, happy life.”
The bill passed last night lowers the costs of prescription drugs for the average senior by 44-percent. It guarantees affordable drug coverage under Medicare for any and all seniors who want it. It provides 100-percent coverage for low-income seniors - those folks most in need. It caps out-of-pocket costs at $3,700 so no senior in the future will have to face bankruptcy in case of a long-term, serious illness. And it strengthens Medicare for the future by helping doctors, hospitals, and other health care providers - particularly in rural America.
The best kind of price control is competition. This plan lowers costs now through competition. That competition creates savings off the bottom line of drug manufacturers.
Wilson had also worked to include a geographic adjustment for physician reimbursement rates under Medicare in this bill. This adjustment seeks to level the playing field for physicians nationwide to prevent doctors in rural state like New Mexico from fleeing to higher paying positions in other states. Wilson’s amendment raises the geographic adjuster to .985 for physician work component of the physician fee schedule and will result in approximately 33 localities across the country receiving higher reimbursement rates without harming any other localities.
Summary of H.R. 4954, the “Medicare Modernization and Prescription Drug Act”
Voluntary Rx Drug Benefit Available to ALL Medicare Beneficiaries
· All Medicare beneficiaries covered
· CBO predicts 96% of seniors will voluntarily sign up for the benefit
· Those who want to stay with their current coverage, may do so, and employers encouraged to continue retiree coverage by receiving funding assistance.
Standard Benefit:
· $250 deductible
· $251- $1,000: 80% coverage, 20% cost-sharing
· $1,001-$2,000: 50% coverage, 50% cost-sharing
· Catastrophic protection after $3,700 out-of-pocket (100% of costs covered)
· Premium around $33 per month or about $1 a day
· Front end benefit aids most seniors
Extra Assistance for Low-income
· Fully subsidized premium and cost-sharing up to 150% of poverty
· Premium subsidy phased out between 150% and 175%
· Medicare is primary payor
· State Medicaid obligations phased out over 10 years. State governments receive assistance
· Allow tier cost-sharing up to $5
Beneficiaries Choose Plan that is Best for Them
· Choice of at least 2 plans guaranteed
o Can choose actuarially equivalent benefit package
o Can choose plan that has formulary (list of preferred drugs) and pharmacy network that best suits their needs
· Competition holds down costs
Quality Improvements to Improve Seniors Health
· Protections against adverse drug interactions
· Electronic prescribing to minimize medical errors
· Pharmacy therapy management for chronic conditions
Long Overdue Modernizations
· Reform of irrational physician payments
· Covers an initial physical and once every two year cholesterol screening
· Bipartisan regulatory relief and contractor reform
· Stabilization of Medicare Choice followed by competitive bidding
· Rural relief package for underpaid rural hospitals and home health
· Repeal of 15% of home health cut
Competitive bidding for Durable Medical Equipment
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