Portland, Oregon

Portland, Oregon

Thursday, February 18, 2016

Medicare vs VA Drug Formularies

Well rats, the Republicans are having another tantrum, this one involving the president's proposed budget. I'd like to call your attention to a few things that affect senior citizens that they're refusing to consider.

The Center for Medicare Advocacy laid out the impact the president's proposed budget, if passed, would have on Medicare drug policies.  I'm using the short version posted on Time Goes by.

~ Restore drug rebates for brand name and generic drugs to beneficiaries who do not receive the Part D Low -income subsidy (LIS)

~ Greater transparency in drug pricing

~ Negotiate prices with drug manufacturers for biologics and high-cost prescription drugs covered under Part D.

~ Close the Part D doughnut hole in 2018 - two years earlier than under current law.

This NYT article, titled "The Reason Medicare is a Lousy Drug Negotiator" is worth reading.

"The real problem is that Medicare can very rarely say "No way" to a drug company.  Medicare beneficiaries wanted the program to cover most drugs that older people would want to use.  So Congress put in place rules that strengthen the hand of the drug companies in negotiations."

"The government does have one program that can say "no" to drug companies, and it gets much better deals than Medicare.  The Department of Veterans Affairs negotiates hard with drugmakers. But it is also bound by fewer rules than Medicare, and one result is that it covers far fewer drugs."

From personal experience we have found the drug formulary for the military to be very different from the formularies of Medicare and private insurance companies.

Last year when Bob's twin was dying he needed a drug that was prohibitively expensive, more than $5,000 a month.  It was not covered by Medicare or his insurance company.  Fortunately he had served in the Navy and qualified to go to a veterans hospital.  He got the drug there for free. What if it had been his wife that needed that drug, where would she have turned for help?

I find all this troubling.  How about you?


  1. I have no idea about this - I do not qualify for medicare.

  2. Absolutely. Drug companies seem to really enjoy playing God.

  3. I agree that it's shameful that drug companies in the U.S. hold everyone hostage.