Saturday, January 22, 2011

Part D — for duplicity

The following story is a small tale among volumes regarding the insanity of health care in this country.

Mine happens to be about Medicare, which is supposed to be one of our brighter lights.

I am having trouble seeing the light. The problem isn’t my vision, which happens to be my “presenting” medical problem.

You see I take two pressure-lowering eye drops to ward off glaucoma and possible blindness.

I’m 68 years old, a month away from 69, and I’ve been covered by a Medicare Med Advantage policy (through Oregon Regence Blue Cross/Blue Shield) for four years. It’s worked pretty well up until now.

Still in good health with no need for drugs, I had not enlisted in the Part D “drug coverage.” Then, a couple of years ago, the eye specialist said I needed the eye drops, and I paid out-of-pocket for the small vials. Xalantan vials cost me $86.96 and Istalol cost $129.06.

The total came to $216.02 out of pocket — every five or six weeks.

But late last year, understanding “drug coverage” to mean, well, “drug coverage,” I added Part D to my plan and saw my monthly premium rise. I figured I’d more than make up the modest difference when it came time to refill my eye drop prescriptions.

Earlier this month, I put Part D to the test. I renewed my prescriptions fully expecting to see most of my out-of-pocket costs vanish, save for modest deductibles.

The result: With “drug coverage,” the Xalantan cost me $75.00, the co-pay. The insurance, paid a staggering $11.96.

But the real surprise was the Istalol. It actually cost me more, $144.94. MedAdvantage’s Part D paid zip.

I’m still not entirely sure why, even after talking to the predictably pleasant Regence Med Advantage customer service representative. The price apparently had gone up or, because I had Part D “drug coverage,” I no longer qualified for a small discount through the state’s senior drug discount program.

So to review, without “drug coverage” I paid $216.02 for drugs; with “drug coverage” I paid $219.94. I can manage it, but it is evidence of a system gone mad.

I have since discovered there are bureaucratic explanations about generic and non-generic, and “tiers” of drugs and “formularies,” etc. My vial of Istalol lasts 40 days, which exceeds some 30-day limit.

You need to be a student of fine print to figure it all out. And, as I say, my eyes aren’t all that great to begin with.

Let’s face it, this country needs plain-and-simple, universal healthcare. Not “insurance” but healthcare.

Get rid of the flim-flam, the drug company’s wheeling and dealing with doctors, the formularies, the Big Pharma lobbyists, the donut holes, the tiers and the deductions.

The good news for me is that I’m among the fortunate who can afford these scams, at least for now. I worry about those who can’t, and I worry about a government whose patch-work, contrived program deceives and rips off its people.

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