[Congressional Record Volume 145, Number 54 (Tuesday, April 20, 1999)]
[Extensions of Remarks]
[Page E711]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




MEDICARE PRESCRIPTION BENEFIT FOR ALL SENIORS IS URGENTLY NEEDED; GOOD 
        HEALTH CARE REQUIRES ACCESS TO PHARMACEUTICAL TREATMENT

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Tuesday, April 20, 1999

  Mr. STARK. Mr. Speaker, today, Representatives Henry Waxman, John 
Dingell, myself and others are introducing the Access to Rx Medications 
in Medicare Act of 1999. Senators Edward Kennedy (D-Mass.) and Jay 
Rockefeller (D-W. Va.) are introducing the bill in the Senate. It 
provides a basic, affordable Part B benefit of $1,700 per year that 
will cover 80% of pharmaceutical costs for all seniors and eligible 
disabled individuals with more than $200 in annual drug costs. The bill 
also helps all Medicare beneficiaries by covering 100% of their costs 
above $3,000 in annual out-of-pocket prescription drug expenditures.
  The benefit is to be administered by private-sector entities such as 
pharmacy benefit managers (PBMs), insurers, or networks or wholesale 
and retail pharmacies, which would competitively bid for Medicare's 
business. Entities contracting with HHS to provide the drug benefit 
would be required to meet certain standards, including establishing an 
adequate formulary and an exceptions process to the formulary, as well 
as a 24-hour counseling program for enrollees, an education program for 
medical providers on appropriate prescribing and dispensation of 
covered drugs, and drug utilization review.
  To stabilize employer-sponsored retiree health coverage, we're 
proposing to subsidize employer's coverage by paying companies a 
capitated amount that would otherwise be paid to a private entity--but 
only if that coverage is at least as good as what Medicare is offering. 
In return, employers would have to agree to pay the cost of their 
retirees' Medicare Part B prescription drug premium for at least a 
year.
  Clearly, adding a prescription drug benefit to Medicare is not an 
inexpensive proposition. But the price of leaving pharmaceutical 
medications out of the programs' benefits package and instead paying 
for unnecessary hospitalizations for those who just `try to do without' 
is also high. The Food and Drug Administration estimated that the cost 
of hospitalizations caused by inappropriate use of prescription 
medicines was $20 billion annually higher in 1995.
  There are several financing options that I hope will be considered as 
the Medicare prescription drug debate advances. One is to assess 
tobacco companies for what they cost the program to treat smoke-related 
illnesses. A second is to support a strategy of recouping Medicare 
expenditures on tobacco-related diseases through suits against Big 
Tobacco. A third is to consider dedicating a portion of projected 
budgetary surpluses to paying for Medicare drug coverage.
  Debate about the financing options for a Medicare drug benefit will 
inevitably be contentious. But there is no better time to join this 
debate than today--when the program's solvency has been extended until 
2015 even without an infusion of money from budgetary surpluses. With 
an infusion, the solvency timeline stretches far into the future--until 
2027.
  It is time to turn our attention to meeting the needs of the growing 
number of senior citizens who are being rapidly priced out of drug 
coverage. Adding a prescription drug benefit is an investment--one of 
the most important we can make--in the health of tens of millions of 
our citizens.
  I recently sent out a survey to seniors in my district to assess the 
prices they pay for a range of specific prescription medications. Their 
responses were both revealing and sad. Asked what percentage of her 
monthly $547 income is dedicated to prescription drugs, one elderly 
women suffering from osteoporosis replied very simply: ``I cannot 
afford them.'' Queried about how this makes her feel, she said: ``I 
just try to cope.''
  Another of my constituents, who has asthma, wrote: ``During the 
winter and spring my asthma is particularly bad and I have to use my 
inhaler quite often; and I sometimes am not able to purchase another, 
and I limit my use.'' Asked whether she has ever had to choose between 
paying for items like food or electricity because of the high cost of 
prescription drugs, she said: ``Yes, and I felt frightened.''
  People who are sick need pharmaceutical treatment. Many who aren't 
take pharmaceuticals to stave off illness. In my case, taking Zocor 
lowers my blood cholesterol and helps reduce my risk of winding up in 
the hospital for costly bypass surgery.
  There are millions more elderly Americans with similar stories in 
congressional districts across the country. There are people who suffer 
from lack of medically appropriate access to pharmaceutical treatment.
  I submit that for a health plan in the year 2000 not to offer 
pharmaceutical care is preposterous.
  In today's era of unprecedented prosperity, who would say ``No'' to 
legislation providing prescription drug coverage to the one group that 
would benefit most--our nation's seniors?
  In the 105th Congress, we invested in children's health when we 
enacted the State Childrens' Health Insurance Program. Now we must fix 
the huge hole in Medicare's benefit package. If we don't a bolder 
future Congress will.

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