Facts about the Medicare Prescription Drug Improvement Act (MEND)
The Medicare Mend Bill takes significant steps to strengthen
the recently adopted Medicare prescription drug benefit by lowering drug prices,
stabilizing benefits, and improving access for Americas seniors.
In addition to improving the new Medicare drug benefit, Senator Conrads
Medicare Mend Bill will eliminate wasteful overpayments to private Medicare
plans, which will save billions of dollars in spending over the next ten years.
These critical cost savings will be used to reduce the federal budget deficit.
Senator Conrads Medicare Mend Bill would help restore financial
integrity to Medicare by containing costs, while still giving seniors in North
Dakota — and across the nation — the stability, access and lower
drug prices they need.
Key provisions are outlined below:
Lower Drug Prices
More Choices
A More Stable Benefit
More Insurance for Seniors
Improving Pharmacy Access
Providing Better Information for Seniors about the Medicare Drug
Benefit
Cost-Savings to Protect Medicare's Future
Lower Drug Prices
The new Medicare law prohibits the Secretary of Health and Human Services
from working with pharmaceutical companies to lower prescription costs. Senator
Conrads legislation would reverse this measure by allowing the Secretary
to negotiate directly with drug companies to provide seniors fairer and lower
prices for their medications. This provision would also allow pharmacists
and drug wholesalers to immediately begin re-importing safe drugs from Canada.
These measures will reduce drug costs for consumers across the nation.
More Choices
In certain parts of the country, seniors may have only one private drug plan
in their community, with the only other option being to enroll in an HMO to
get drug coverage. To reduce the likelihood that seniors will have to leave
traditional Medicare, this provision would require that beneficiaries have
at least two private drug plans in their community. If there are not two private
plans available, then seniors would be able to remain in traditional Medicare
through a government “fallback” option that would provide their
drug coverage.
A More Stable Benefit
Under the current Medicare law, if two or more private plans are available,
seniors cannot remain in a government drug plan – even if they prefer
the government plan over what the private plans offer. Senator Conrads
bill would improve the stability of the new drug benefit by allowing seniors
enrolled in a government plan to remain in that plan for up to two years,
even if additional private plans enter the area.
More Insurance For Seniors
Senator Conrads bill would strip a current provision that bars seniors
from using supplemental insurance plans to help cover out-of-pocket drug expenses.
Under Senator Conrads legislation, seniors would be able to use supplemental
insurance plans to fill in the gaps in the Medicare drug benefit.
Improving Pharmacy Access
Senator Conrads legislation includes various measures to protect seniors
access to pharmacy care under the new drug benefit. Specifically, it strengthens
the requirements that seniors have access to a traditional, community pharmacy
as part of the new drug benefit. It also provides federal resources to pharmacists
so they can provide face-to-face educational services to seniors.
Providing Better Information to Seniors about the Medicare
Drug Benefit
Under the new Medicare bill, it is unclear whether seniors will receive adequate
information to decide which drug plan to enroll in. Senator Conrads
legislation will address this problem by requiring drug plans to provide seniors
full information about whether their drugs will be covered and any changes
to this coverage throughout the year. It also requires this information be
made available by telephone, the mail and on the Internet.
Cost-Savings to Protect Medicares Future
Senator Conrads legislation offers several common-sense measures that
will save the federal government billions of dollars over the next ten years.
Senator Conrad believes these cost savings can be used to strengthen the financial
longevity of Medicare. They can also used to reduce the federal budget deficit
in the coming years.
- Requiring More Appropriate Payments to Private Plans. Under
current practice, private health plans receive up to 9% higher payments
than traditional Medicare for providing similar services to the exact same
patient. Senator Conrads legislation would reduce this inequity by
bringing private plans payments more in-line with traditional Medicare reimbursement.
- Managing Chronic Care. The Medicare bill includes a chronic
care demonstration project that seeks to reduce costs by coordinating services
and medications. Senator Conrads bill would expand the availability
of chronic care services, particularly in rural areas. Further, it mandates
that one of the 10 demonstration sites be in North Dakota and provides $1
billion to fund the project.
- Repealing Premium Support. This Conrad provision would
repeal a demonstration project in the current Medicare prescription drug
benefit that many fear would increase the premiums that seniors would pay
to remain in Medicare. Senator Conrads bill strikes the “premium
support” demonstration project entirely.
- Protecting Coverage for the Sick and Low-Income. The
existing Medicare bill would allow for the creation of so-called “health
savings accounts,” that people could use to pay for their medical
care. However, these accounts would serve to drive up premiums for those
who remain in the employer-based market, making health care unaffordable
for the very sick and some low-income beneficiaries.
