| Part
C: Medicare Advantage plans
With the passage of the Balanced
Budget Act of 1997, Medicare beneficiaries
got the option to take their Medicare benefits through
private health insurance plans, instead of through
the original Medicare plan (Parts A and B). These
programs were known as "Medicare+Choice"
or "Part C" plans, and patients paid any
acost over tradoitional Medicare (Parts A and B) on
their own. The Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 which
established Part D, includign prescrition coverage,
also "Medicare+Choice" plans more attractive
to Medicare beneficiaries by the addition of prescription
drug coverage and became known as "Medicare Advantage"
(MA) plans. Medicare Advantage companies said they
could provide benefits without additional funding,
but over great objections from advocacy groups including
OWL, Congress funded these plans by an additional
12-14%.
There has been a strong desire on the
parts of most of the senior advocacy groups, including
OWL, Gray Panthers, CARA and AARP, to eliminate this
12-14% "overpayment." This has been included
as part of the recently passed Health Care Reform
Act. However, it will be difficult to convince many
people that this is not "taking away" or
attacking Medicare.
More from Wikipedia:
Traditional or "fee-for-service" Medicare
has a standard benefit package that covers medically
necessary care members can receive from nearly any
hospital or doctor in the country. For people who
choose to enroll in a Medicare Advantage health plan,
Medicare pays the private health plan a capitated
rate, or a set amount, every month for each member.
Members typically also pay a monthly premium in addition
to the Medicare Part B premium to cover items not
covered by traditional Medicare (Parts A & B),
such as prescription drugs, dental care, vision care
and gym or health club memberships. In exchange for
these extra benefits, enrollees may be limited in
the providers they can receive services from without
paying extra. Typically, the plans have a "network"
of providers that patients can use. Going outside
that network may require permission or extra fees.
Medicare Advantage plans are required to offer coverage
that meets or exceeds the standards set by the original
Medicare program, but they do not have to cover every
benefit in the same way. If a plan chooses to pay
less than Medicare for some benefits, like skilled
nursing facility care, the savings may be passed along
to consumers by offering lower copayments for doctor
visits. Medicare Advantage plans use a portion of
the payments they receive from the government for
each enrollee to offer supplemental benefits. Some
plans limit their members’ annual out-of-pocket
spending on medical care, providing insurance against
catastrophic costs over $5,000, for example. Many
plans offer dental coverage, vision coverage and other
services not covered by Medicare Parts A or B, which
makes them a good value for the health care dollar,
if you want to use the provider included in the plan's
network or "panel" of providers.
Because the 2003 payment formulas overpay plans by
12 percent or more compared to traditional Medicare,
in 2006 enrollees in Medicare Advantage Private Fee-for-Service
plans were offered a net extra benefit value (the
value of the additional benefits minus any additional
premium) of $55.92 a month more than the traditional
Medicare benefit package; enrollees in other Medicare
Advantage plans were offered a net extra benefit value
of $71.22 a month more. However, Medicare Advantage
members receive additional coverage and medical benefits
not enjoyed by traditional Medicare members, and savings
generated by Medicare Advantage plans may be passed
on to beneficiaries to lower their overall health
care costs.
Medicare Advantage Plans that also include Part D
prescription drug benefits are known as a Medicare
Advantage Prescription Drug plans or MA-PDs.
More from Wikipedia:
Enrollment in Medicare Advantage plans grew from
5.4 million in 2005 to 8.2 million in 2007. Enrollment
grew by an additional 800,000 during the first four
months of 2008. This represents 19% of Medicare beneficiaries.
A third of beneficiaries with Part D coverage are
enrolled in a Medicare Advantage plan. Medicare Advantage
enrollment is higher in urban areas; the enrollment
rate in urban counties is twice that in rural counties
(22% vs. 10%). Almost all Medicare beneficiaries have
access to at least two Medicare Advantage plans; most
have access to three or more. Because of the 2003
law's overpayments, the number of organizations offering
Fee-for-Service plans has increased dramatically,
from 11 in 2006 to almost 50 in 2008. Eight out of
ten beneficiaries (82%) now have access to six or
more Private Fee-for-Service plans.
Each year many individuals disenroll from MA plans.
A recent study noted that about 20 percent of enrollees
report that "their most important reason for
leaving was due to problems getting care." There
is some evidence that disabled beneficiaries "are
more likely to experience multiple problems in managed
care." Some studies have reported that the older,
poorer, and sicker persons have been less satisfied
with the care they have received in MA plans. On the
other hand, an analysis of the Agency for Healthcare
Research and Quality data published by America’s
Health Insurance Plans found that Medicare Advantage
enrollees spent fewer days in the hospital than Fee-for-Service
enrollees, were less likely to have "potentially
avoidable" admissions, and had fewer re-admissions.
These comparisons adjusted for age, sex and health
status using the risk score used in the Medicare Advantage
risk adjustment mechanism.
In December 2009 the Kaiser Family Foundation published
a report that rated Medicare Advantage organizations
on a five star scale. The ratings were based on data
from CMS, the Consumer Assessment of Healthcare Providers
and Systems (CAHPS), Healthcare Effectiveness Data
and Information Set (HEDIS) data, and the Health Outcomes
Survey (HOS). New plans did not receive ratings, because
data were not available. Almost six out of ten (59%)
of MA plans did receive ratings, and these plans represented
85% of the enrollment for 2009. The average rating
was 3.29 stars. Twenty-three percent of enrollees
were in a plan with four or more stars; 20% were in
a plan with fewer than three stars.
Twenty percent of African-American and 32 percent
of Hispanic Medicare Beneficiaries were enrolled in
Medicare Advantage plans in 2006. Almost half (48%)
of Medicare Advantage enrollees had incomes below
$20,000, including 71% of minority enrollees. Others
have reported that minority enrollment is not particularly
above average.Another study has raised questions about
the quality of care received by minorities in MA plans.
The Government Accountability Office reported that
in 2006, the plans earned profits of 6.6 percent,
had overhead (sales, etc.) of 10.1 percent, and provided
83.3 percent of the revenue dollar in medical benefits.
These administrative costs are far higher than traditional
fee-for-service Medicare.
Back to top
Pharmacy
Labeling Bill
Margie Metzler
Background of the activity on the Pharmacy
Labeling Bill, SB 472:
A group of senior advocates and limited English proficiency
consumers has worked for three years to get legislation,
SB 472 (Corbett) passed, and then implemented by the
Pharmacy Board. We have attended numerous hearings
and presented reams of evidence indicating that labels
unreadable by senior citizens or limited-English speakers
pose a very real hazard to their health. According
to the Institute of Medicine of the National Academies,
medication errors are among the most common medical
errors, harming at least 1.5 million people every
year. Sen. Corbett carried the Bill and many of us
testified on its behalf. It passed; here are the major
provisions:
(1) Medical literacy research that points to increased
understandability of labels.
(2) Improved directions for use.
(3) Improved font types and sizes.
(4) Placement of information that is patient-centered.
(5) The needs of patients with limited English proficiency.
(6) The needs of senior citizens.
(7) Technology requirements necessary to implement
the standards.
(d) (1) On or before January 1, 2010, the board
shall report to the Legislature on its progress
under this section as of the time of the report.
(2) On or before January 1, 2013, the board shall
report to the Legislature the status of implementation
of the prescription drug label requirements adopted
pursuant to this section.
Note that the legislation left it up o the Board
to consider all the studies and medical literature,
as well as considering testimony from the public before
implementing details.
Alas, the majority of the members of the Board refused
to mandate our two most important requests: that medication
labels be written in at least 12-point font, and that
they be translated into the most commonly spoken languages
in California.
People at the February Meeting of the Pharmacy Board
included CARA, OWL, and Gray Panthers, as well as
a representative of Sen. Corbett’s office. We
actually weren’t allowed to testify, but we
took a small opening as the opportunity to have a
Die-in and speak on behalf of our issues.
We are outraged that the California Board of Pharmacy
has failed egregiously in its mission “to protect
the health and safety of Californians.”
We have observed that the Board of Pharmacy has changed
over the years. It used to be consumer oriented, back
in the days when it still had a majority of Davis
appointees. Now it has mostly Schwarzenegger appointees,
lawyers and executives of the large chain pharmacies.
In fact, one member who is a CVS Pharmacy executive
was appointed the night before the fateful action
took place. (See LA Times article below.) The voice
of the small pharmacies is muted, and we have only
Ramón Castellblanch truly representing us.
Jodi Reid of CARA, who organized our visit, wrote
the following:
We suffered a bad blow on February 17th at the Board
of Pharmacy – when the board voted for proposed
regulations that send us backwards to a 10 point
font standard and no requirement for translations
on the labels. It was a complete travesty, and I
know many of us were ready to explode by the end
of the hearing. But I was so proud of all of you
who stood up and spoke your mind, told the truth,
and “died” before the Board to make
our point. Below are some you tube videos that CARA
has posted on our website which were taken by Chuck
Walker at the hearing. The Mary Magill video is
the “die in” and the Bill Powers video
sums it all up (Bill was the past president of the
BOP and served as a consumer rep for 7 ½
years).
The Board will leave the file open for a 15 day
comment period on these regulations, so I urge everyone
to send in your comments about their awful proposal.
We are doing an Alert to our CARA members this weekend
urging them to write or email the Board and will
send these videos too. You can do the same. Then
we need to consider our long term strategy (law
suits, another bill that specifically requires translation
and a minimum 12 point font that is not left to
interpretation, etc). Our work is not over . We
have been talking with a reporter from the LA Times,
who we hope is writing an article about this fiasco
at the BOP. Keep an eye out for that.
I want to thank all of you for your diligence on
this issue. I look forward to our continued efforts
to enact a true patient centered standardized label
in California.
Onward,
Jodi Reid, CARA
415-550-0828
The contact information for the Board of Pharmacy
is 916-574-7913 and their email is Carolyn_Klein@dca.ca.gov.
Michael Lyon video
http://www.youtube.com/watch?v=06VUgI0YR8M
Mary Magill video
http://www.youtube.com/watch?v=919-woor2Ns
Bill Powers video
http://www.youtube.com/watch?v=NAcdSvcXPNE
Diana Madoshi video
http://www.youtube.com/watch?v=E28ywylSenM
Carol Bailey video
http://www.youtube.com/watch?v=33yJVWkuy8E
Margie Metzler's letter to the editor, sent
Sat. Feb. 20
I was interested to read that a California Legislator
believes that the California Board of Pharmacy is
“getting too cozy with those it regulates,”
since I absolutely concur. A group of senior advocates
and limited English proficiency consumers has worked
for three years to get legislation, SB 472 (Corbett)
passed, and then implemented by the Pharmacy Board.
We have attended numerous hearings and presented reams
of evidence indicating that labels unreadable by senior
citizens or limited-English speakers pose a very real
hazard to their health. According to the Institute
of Medicine of the National Academies, medication
errors are among the most common medical errors, harming
at least 1.5 million people every year.
Alas, while Sen. Corbett and the Legislature saw the
value of our ideas, the Board refused our two most
important requests: that medication labels be written
in at least 12-point font, and that they be translated
into the most commonly spoken languages in California.
We are outraged that the California Board of Pharmacy
has failed egregiously in its mission “to protect
the health and safety of Californians.”
Margie Metzler
Member of Gray Panthers, the Older Women’s League
(OWL), and the California Alliance for Retired Americans
(CARA)
Article in the LA Times:
The L.A. Times did a nice story on Feb. 20th about
the Board of Pharmacy vote. You can read it by clicking
on to the link below.
http://www.latimes.com/news/local/la-me-drug-labeling20-2010feb20,0,7709163.story
Drug executive cast key vote to
kill labeling law
Pharmacy board was poised to OK measure opposed by
one of the governor's major donors until he named
a CVS/Pharmacy official to the panel.
By Shane Goldmacher
February 20, 2010
Reporting from Sacramento - After months of public
input and consultation with experts, the state's pharmacy
board appeared to be poised to adopt strict new requirements
for prescription drug labels last month.
But that changed when Gov. Arnold Schwarzenegger placed
a drugstore industry executive on the board a day
before the vote.
CVS/Pharmacy official Deborah Veale provided the vote
that killed a plan to require large type on drug labels
and instructions and to make oral translation of them
available for all non-English speakers.
The proposals had been championed by consumer advocacy
groups and senior citizens and minority organizations.
They had been fought aggressively by one of Schwarzenegger's
biggest donors, the California Retailers Assn., which
has contributed $400,000 to his political committees.
"It seems that, in the end, a very few interests
with a whole lot of money get their way," said
Ramón Castellblanch, a health educator and
pharmacy board member who supported the stricter labeling
requirements.
Under new draft rules, translations must be provided
only if such services are readily available. And the
print on medicine labels can be small enough to be
a problem for people who are visually impaired, senior
citizens' groups say.
"We can't clearly read little tiny type,"
said Nan Brasmer, 71, president of the California
Alliance of Retired Americans.
The latest rules are a reversal from last October,
when the pharmacy board voted 6 to 0, with one abstention,
to publicize a plan that included a larger-type requirement.
It met a standard that the board staff and the National
Assn. of Boards of Pharmacy have recommended.
When it came up for final approval last month, the
plan was set aside on a 5-4 vote in favor of a smaller
type size and the less stringent translation requirement,
according to the board's executive officer, Virginia
Herold. Veale, whose vote was the deciding factor,
could not be reached for comment.
Sen. Ellen Corbett (D-San Leandro) wrote the state
law that empowered the pharmacy board to create label
guidelines. She said she was "extremely disappointed
in the outcome."
The retail and drugstore industries objected to the
larger text requirement, their representatives said,
because it would have made labels and bottles bigger
and thus more costly to produce, as well as cumbersome
for consumers.
Bill Dombrowski, president of the retailers association,
said he has "discussions with the governor's
office about the board of pharmacy all the time"
and took issue with any suggestion that Schwarzenegger
stacked the board for the Jan. 20 meeting. He noted
that Veale filled the one slot reserved in state law
for a pharmacist representing chain pharmacies; her
predecessor's term ended in December.
The governor left vacant three other spots on what
can be a 13-member board. It is composed of pharmacists
and others, including a union official, a health educator
and a former congressional aide.
Schwarzenegger made two appointments the day before
the January meeting, though only Veale attended on
the day of the vote. The other appointee is South
Pasadena attorney Tappan Zee.
"We have input on our one appointment,"
Dombrowski said. "The governor asks people for
recommendations. That's how it works. . . . That's
what we do and we're not ashamed of it."
The California Retailers Assn. has contributed $400,000
to the governor's political campaigns and causes since
2005. Other Schwarzenegger donors also lobbied the
pharmacy panel against the label requirements. Among
them were Walgreens, which has given $22,300, Rite-Aid
($10,000) and the National Assn. of Chain Drug Stores
($2,500).
Aaron McLear, a Schwarzenegger spokesman, said the
governor does not have a position on labeling and
was not trying to influence the vote. As for contributions,
McLear said, "people donate to the governor and
his causes because they believe in his vision for
the future of the state."
The new labeling rules are not yet final. The board
is set to accept public comments on them for 15 days,
probably starting next week, Herold said. She encouraged
public feedback before the panel takes final action
at its April 21 meeting.
We truly want comments," Herold said. "We
will consider them."
shane.goldmacher@latimes.com
Copyright © 2010, The Los Angeles Times
Please send your own comments to carolyn_klein@dca.ca.gov
Margie's comments to the
Board of Pharmacy, Feb. 22:
This was a disastrous decision which will kill and
injure scores of seniors. It also brings into question
the possibility that the Board is under undue pressure
from CVS and Rite-Aid. No one in Gray Panthers, CARA
and OWL believes that this decision was made fairly
and in the spirit of the law. You have stirred up
a real hornet's nest.
From another Gray Panther:
The board's callous disregard for the thousands of
people who are unable to read the excessively small
font on prescription labels is shocking! While magnifying
devices can help, they are often impractical at the
site of the prescription container.
The decision is so obviously wrong decision. Does
this decision suggest that members of the board have
been paid off by the pharmaceutical industry? As an
observer, that would be my opinion.
The only justice in this decision is that everyone
on the board, including staff, will experience sight
limitation of some kind, which will make it impossible
for them to read that small print too--hopefully sooner
rather than later.
Back to top
|
