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Medicare Part D Stories

Eleanor Clifton

For the past ten years, I’ve enjoyed working with friends of Public Health and CCHC as a volunteer. Seeing Champaign County Board of Health established and getting off the ground was one great accomplishment.

ECAs a retired medical professional, I can honestly say our National Health Care System is in a sad state of affairs, which I am tremendously concerned about. Currently, we are diligently working on two important Medicare Task Forces. The first one is to obtain various improvements to the Medicare Part D program for seniors. The second is for better access to health care for all citizens of Champaign County.

There are many examples of dire circumstances the elderly are encountering with the Medicare Part D program’s “gap” or “donut hole” period and excessive drug prices, medical insurance rates, etc. Many county residents are being refused health care due to inadequate insurance coverage, no medical insurance, medical debt, or some due to being Medicaid recipients.
I myself was told if I signed up for Medicare Part A program outside my insurance plan that all my medical coverage could be dropped. These examples are shameful for our county!

Volunteers are always welcome and appreciated to write letters to our state representatives and help accomplish our goals.

S. Stewart

SSThis is just to let you know that the Part D plan needs to be fixed immediately. It does not do the job it was supposed to do in helping seniors with their prescription drugs. It seems to favor the drug companies instead of helping the seniors get necessary prescriptions they need to survive. How can they deny you a prescription the doctor has written for you with the excuse it isn’t medically necessary?! How in the world do they know what you need and don’t need? They haven’t seen you, or examined you, or are they calling your doctor a liar? They don’t know you from a hole in the ground.

A very good example is this Spring I had developed this cough and couldn’t get rid of it on my own, so finally I went to the doctor and he gave me two prescriptions to fill. Much to my surprise, they wouldn’t fill the one and I was told I would have to buy this outright; it wasn’t medically necessary. Since this was going toward the end of the month, (and you never have money left at that time) I asked the pharmacist how much it was and he said $75.00. I told him I didn’t have that much left so I would have to do without it. He asked me if I had $35.00 and he would fill enough for five days. I told him I could do that and hoped that this would pretty well knock out the cough. He said that this prescription isn’t given just for kicks, and it was a very strong one that the doctor felt I needed. When the five days was up I still had a week to wait for my Social Security check, so I couldn’t get the rest of the prescription. The moral of this problem is that I wound up in the hospital with pneumonia for six days. My question is this- What right does a Prescription D plan have to tell you that it is not medically necessary?

This isn’t the first time I have had problems. Any number of times the doctor’s office had to call in to verify I did need a certain prescription even though my prescriptions haven’t changed in three years. The doctor’s office is getting upset on having to call in and verify things. It isn’t one call they have to make, it winds up being two or three times for the same thing. This takes away from the staff doing their jobs and they are reluctant to do this when it is not a new drug. The Prescription Part D plan is really a big joke. When are you people going to fix it, or do a bunch of us have to die while we wait for it to be done

Shirbie L. Faulkner 

SFI have not fallen into the “Doughnut Hole”, but after listening to all of the horror stories of others who have, it’s really frightening. There is a fellow by the name of James who is in our Task Force to Fix Part D that told us about the medication needs of his wife that literally kept me blinking to fight back tears. He didn’t have the money to pay the higher prices for her medication so he had to cut back on something else in order to pay for his wife’s much needed medications.

I have heard and read about similar situations all over the United States. I knew a lady whose husband told someone I know that she was taking one pill, for cancer, that cost $1,700 daily. Now that is really ridiculous! My sister and her husband and myself included would be DEAD if we had to pay this kind of money for medicine. My sister used to work for Mobil Oil, but her insurance does not cover all the medications her doctor wants her to take. She is diabetic along with having degenerative arthritis, and is allergic to anything that has aspirin in it, so she is leery of all drugs for fear of having some sort of reaction that may be fatal. Just thinking of these three families really makes me live in fear every day. I keep thinking, “There, but for the Grace of God, go I”.

So I prayerfully beg all of you to please FIX MEDICARE PART D before all of the elderly that are not rich end up dead because they can’t afford their needed medications. Thanking You In Advance.

Bea Stratton   

I personally feel very strongly about the need to fix Part D because I am struggling in the Donut Hole right now.  I fell into the Donut Hole during June of last year and I fell in even sooner during May of this year. Once my prescription drugs costs reached $2,510 (which includes both what Health Alliance paid and what I paid in co-pays) they dropped my coverage and I now have to pay 100% of my prescription drug costs. Health Alliance will not pick me back up until I pay $4,050 more out of my own pocket. Keep in mind that I still have to pay them a monthly premium even for the months that they are not helping with my drug costs at all.

BSEven though I am spending $300-$600 out of pocket every month for my prescription drugs, I have never been able pay myself out of the Donut Hole. I just have to wait until next year when coverage starts over in January, knowing that I only have a few months before I fall into the Donut Hole again. So, for 7 months this year, Health Alliance is getting paid by me and the federal government, using tax payer dollars, for literally doing nothing. Talk about a deal for them! In the meantime, I on the other hand, am trying to work with my doctor to find other ways to control my diabetes because I cannot afford the drugs that I need.
My story is just one of millions of seniors suffering from the problems with Part D all over the country. We have seen what the private insurance companies have to offer. It’s time to try something new, by creating a Medicare-administered drug plan that negotiates for lower drug prices, increases consumer protections, and eliminates the Donut Hole.

Medicare has been providing access to health care that is universal, uniform, simple, and dependable to all seniors and people with disabilities regardless of their income, health status, or where they live for over 40 years now.  Congress should use this history of success as an example of how to create a REAL prescription drug benefit that, like Medicare, is easy-to-use, provides guaranteed coverage, and is cost-effective.

Because Congress created Medicare Part D, they are the only ones who can pass the legislation necessary to fix it. That is why it is so important for us to elect legislators who understand where Part D is failing and be willing to fight for seniors’ health by introducing and co-sponsoring legislation that will fix those problems.
 

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