Will Big Brother continue to allow a successful state program or will the pillmaker lobby win out?

Isn't it amazing what a state-level Rx program can achieve when allowed to "negotiate" for Rx prices (unlike the federal government pressured by Big Pharma lobbyists)? Will Big Brother wipe out a successful and cost-savings program -or- will the pillmaker industry once again win out? Wisconsin... the only state "without a donut hole!" As far as CMS applying pressure to eliminate the Wisconsin program...with the new Congress in place, it might not be a "done deal." Those Wisconsinites... they're so anti-establishment (tongue in cheek)! They just want to save money and serve their citizens... how un-American!

John [Curry]

Thursday, March 29, 2007
kaisernetwork.org
Kaiser Daily Health Policy Report
Medicare

CMS Likely Will Not Issue New Waiver for Wisconsin Rx Program

Acting CMS Administrator Leslie Norwalk on Wednesday at a hearing of the Senate Special Committee on Aging said that the Wisconsin SeniorCare prescription drug program likely will not receive a new Medicaid waiver after June 30, CQ HealthBeat reports (Reichard, CQ HealthBeat, 3/28). According to the Milwaukee Journal Sentinel, SeniorCare, which began in 2002 and has enrolled about 105,000 Wisconsin residents ages 65 and older, "is now the only remaining state-based alternative to Medicare Part D in the country" (Gilbert, Milwaukee Journal Sentinel, 3/28). In 2005, before the implementation of the Medicare prescription drug benefit, HHS issued a waiver to allow Wisconsin to continue to operate SeniorCare until at least June 30. SeniorCare has no monthly premiums, lower copayments than the Medicare prescription drug benefit and no gaps in coverage (Kaiser Daily Health Policy Report, 10/13/05). In addition, SeniorCare, unlike the Medicare prescription drug benefit, does not measure the assets of beneficiaries. Under SeniorCare, beneficiaries pay a $30 annual fee and make small copayments for prescription drugs after they reach an annual deductible based on income. Wisconsin Gov. Jim Doyle (D) has requested a new waiver to allow the state to continue to operate SeniorCare for three additional years (Milwaukee Journal Sentinel, 3/28).

Doyle Testimony

At the hearing, Doyle said that SeniorCare, unlike the Medicare prescription drug benefit, negotiates "big discounts" for the most commonly used medications. SeniorCare in 2006 reduced prescription drug costs for beneficiaries by almost $200 million, Doyle said. According to Doyle, most SeniorCare beneficiaries "love their coverage and don't know what they'll do if it's taken away." He added, "Most of them will be forced into the Medicare Part D program, where they'll face higher payments, more complicated bureaucracy" (Mantell, Dow Jones, 3/28). Doyle also said that the Wisconsin congressional delegation supports a new waiver to allow the state to continue to operate SeniorCare.

Additional Testimony

Norwalk said that SeniorCare has not met "budget neutrality" requirements in the current waiver. In addition, she said that private plans under the Medicare prescription drug benefit can negotiate more comprehensive and affordable options for beneficiaries than SeniorCare (CQ HealthBeat,, 3/28). Norwalk said, "I don't want seniors to be scared about this. What I'd like to do is work with the state so that (seniors) see as little change as possible." Norwalk added that "we believe the transition to Medicare Part D must be made as quickly as possible," although CMS might allow Wisconsin to continue to operate SeniorCare until the end of the year to make the transition "as seamless as possible." Committee Chair Herb Kohl (D-Wis.) said, "We believe it would be a huge mistake for the administration to pull the plug on SeniorCare," adding, "It costs less, it covers more and seniors are happier" with the program than they are with the Medicare prescription drug benefit. Rep. Jim Sensenbrenner (R-Wis.) said, "One Republican principle ought to be to allow the states to be incubators of new and effective programs" (Milwaukee Journal Sentinel, 3/28). Kohl estimated that SeniorCare saves the federal government almost $500 more per beneficiary than the Medicare prescription drug benefit (Dow Jones, 3/28).