“I feel very happy about it; it’s going to save a lot of money.” This is what Grace Straight, 78 years old, says of the Commonwealth of Massachusetts’ new Prescription Advantage drug insurance plan. She and her husband, Donald Straight, are longtime residents of the town of Templeton, living in the same house since 1948.
Donald, who has just applied, agrees with Grace: “It’s a good program, by the looks of it.” He has been retired for twelve years and needs to take several medications daily to keep himself in good health, medications that he could not afford if left to his own resources.
The Straights stand among the early enrollers in the new plan which officially began on April 1st. At least one television station in Boston has reported that Prescription Advantage is running far behind expected enrollments, but Secretary of Elder Affairs Lillian Glickman assures me that this information is incorrect. Already more than fifteen thousand elders and people with certain specific disabilities have signed up for the program.
Secretary Glickman says, “We are ahead of where we want to be.” And this achievement comes before a mass media campaign scheduled to begin in May. Her hope is that all eligible elder citizens will seize the opportunity to sign up.
She expresses excitement about the program. “Finally, every elder will have access to coverage that is affordable,” Glickman says. And she takes satisfaction in Massachusetts being the first state to adopt such comprehensive coverage. “The eyes of the nation will be upon us,” she boasts; “We hope it will inform the national debate.”
Massachusetts has already had programs in place to provide drug coverage for its elder citizens. But these Pharmacy and Pharmacy Plus programs will now be replaced by a new and more sweeping plan.
To get information about Prescription Advantage you can simply call 1-800-AGE-INFO, where you can also find out how to enroll. In addition, you can contact the Council on Aging in your city or town or one of the 27 regional ASAPS (Aging Service Access Points).
In its newsletter, the Executive office of Elder Affairs summarizes how the new program works: “Prescription Advantage enrollees will pay premiums, deductibles and co-payments. Unlike other insurance plans, payments will be graduated and are based on gross annual income.
“The state will contribute to the premiums and deductibles for certain low-income enrollees. Members whose income falls below 200% of the Federal Poverty Level (FPL) pay lower co-payments.
“The maximum monthly premium will be $82, and the state will pay the full cost of premiums for individuals at or below 188% of the FPL.
“There is also an unlimited coverage benefit, and the maximum out-of-pocket expense for co-payments and deductibles for any enrollee will be the lesser of $2,000 or 10% of gross annual household income.”
For a sharp appraisal of Prescription Advantage, I turned to two well-informed advocates for older people. John O'Neill, Executive Director of Somerville Cambridge Elder Services and current president of the Massachusetts Home Care Association, feels mixed about the program. “It’s good that it’s a public plan,” he says, and it should prove helpful for low-income people. But it has too many deductibles and co-payments for his taste.
“The premiums are a shot in the dark,” he adds, because no one knows how much the whole program will cost. “They are afraid of adverse selection, “ he says of the planners, because so many people who are big users of prescription drugs may sign up. And the plan depends on state funding from year to year.
Another highly knowledgeable advocate for older people, Art Mazer of Cambridge, feels concern about some public policy issues connected with Prescription Advantage. A veteran health care analyst with many years’ service with the federal part of the Medicaid program, Mazer also welcomes Prescription Advantage because he sees its promise for so many low-income people.
At the same time he feels critical of arrangements behind the new program for at least three reasons. First, he says, “I am opposed to insuring one item of health care, namely drugs, without insuring other services.”
Secondly, Prescription Advantage will be funded entirely out of funds that Massachusetts received from the settlement with tobacco companies. Currently, some thirty percent of these funds are being used for other needed health services but all that money and more will be soaked up to pay for the new drug program. He fears that the total costs to the state will go far beyond projections.
Thirdly, Mazer regrets that Prescription Advantage will not lower the costs of drugs. The companies that produce them will still be free to spend twice as much money on advertising as they do for research. This advertising of prescription drugs is a practice, he says, that allows patients to pressure their doctors to prescribe more of these drugs, even when not advisable.
Richard Griffin