[Congressional Record (Bound Edition), Volume 145 (1999), Part 15]
[Extensions of Remarks]
[Pages 21754-21755]
[From the U.S. Government Publishing Office, www.gpo.gov]



INTERNATIONAL COMPARISON OF PRESCRIPTION DRUG COVERAGE FOR THE ELDERLY 
    SHOWS UNITED STATES LAGS FAR BEHIND MAJOR INDUSTRIALIZED NATIONS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                     Wednesday, September 15, 1999

  Mr. STARK. Mr. Speaker, my staff recently conducted an analysis of 
eight industrialized nations and found that the United States is the 
only country lacking government-sponsored prescription drug coverage 
for its senior citizens.
  The chart I am submitting today clearly illustrates our Government's 
failure to provide pharmaceutical coverage for seniors who need it 
most.
  Canada, the United Kingdom, Germany, Japan, France, Sweden, and the 
Netherlands all provide universal prescription drug coverage for the 
elderly. The UK and France fully exempt the elderly from copayments for 
certain prescription drugs. Sweden provides a similar exception, but in 
no case charges seniors more than a $10 copayment for prescription 
drugs or more than $200 in annual out-of-pocket expenses. The findings 
clearly show that elderly Americans are being denied a fair system of 
drug coverage.
  Further, recent analyses show that drug prices in the United States 
are surging by 18 percent per year, with the result that more seniors 
will be unable to purchase needed medications. Yet the elderly have a 
particular need for prescription drug coverage, as seniors purchase 
one-third of all prescription drugs while they only comprise 12 percent 
of our population.

[[Page 21755]]

  As employer-sponsored retiree health coverage in the United States 
rapidly erodes and Medicare HMO's pull out of many markets and lower 
existing drug benefits, it is time to recognize that the private sector 
will never be able to guarantee drug coverage for all seniors. In 
contrast, adding an outpatient drug benefit to Medicare would do 
exactly that.
  If so many other industrialized nations can provide prescription drug 
coverage for their senior citizens, why can't we?
  I urge you to support legislation to add a prescription drug benefit 
to Medicare. If we do not, we will do great harm to millions of seniors 
who lack any drug insurance to pay for medications their doctors 
prescribe.
  Contrary to what the pharmaceutical industry would have you believe, 
the debate is not about price controls. The debate is about coverage.

                                                               GOVERNMENT SPONSORED PRESCRIPTION DRUG COVERAGE FOR SENIOR CITIZENS
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                                                                                                             Country--
                                 ---------------------------------------------------------------------------------------------------------------------------------------------------------------
                                     United States          Canada          United Kingdom          Germany              Japan            Netherlands           France              Sweden
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National Policy.................  No outpatient       All provinces       Prescription drug   Copayments range    Free medical care   Patient cost        ``Essential         No charge for
                                   prescription drug   provide             coverage with co-   from $5 to $7,      for all             sharing of 20       drugs'' (e.g.,      pharmaceuticals
                                   coverage for        prescription drug   payments;           depending on the    individuals over    percent, up to a    cancer treatment)   for treatment of
                                   seniors under       plans for senior    exemptions from     prescription.       age 70 (over 65,    maximum level. In   require no cost     chronic diseases.
                                   Medicare.           citizens, with      some copayments     Patients also pay   if bedridden),      addition,           sharing; ``Normal   $10 co-payment
                                   Medicaid provides   copayments that     for people over     the difference      with nominal co-    patients pay        prescriptions''     for all other
                                   prescription drug   vary by province.   age 60.             between             payments. Free      difference          (e.g.,              prescription
                                   coverage for some                                           government          care includes       between maximum     antibiotics)        drugs. Annual
                                   low-income                                                  reimbursed price    ``supply of         reimbursed price    require 30% cost    copayments capped
                                   seniors; policies                                           and the market      medications''       and the market      sharing;            at $200, for
                                   vary by state.                                              price (typically    Additional          price, similar to   ``comfort'' drugs   combination of
                                                                                               the difference      nominal co-         Germany.            (e.g.,              prescription
                                                                                               between generic     payment for                             tranquilizers)      drugs, physician
                                                                                               and name brand.     individuals                             require 60% cost    consultations,
                                                                                                                   taking more than                        sharing. Elderly    physical therapy,
                                                                                                                   one, two to                             individuals with    and hospital
                                                                                                                   three, or six or                        a need for          inpatient care
                                                                                                                   more prescription                       multiple drugs
                                                                                                                   drugs per day.                          are reimbursed
                                                                                                                                                           for all costs.
Does this coverage exist for non- No. Low-income      No. Extent of       Yes. However,       Yes...............  Yes. However,       Yes...............  Yes. However,       Yes
 elderly?.                         individuals may     coverage varies     coverage for                            coverage for                            coverage for
                                   be covered under    by province.        elderly is more                         elderly is more                         elderly needing
                                   Medicaid. Varies                        generous.                               generous.                               multiple drugs is
                                   by state.                                                                                                               more generous.
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Source: The Boston Consulting Group, Inc. ``Ensuring Cost-Effective Access to Innovative Pharmaceuticals: Do market Interventions Work?'', April 1999. Graig, Laurene A., Health of Nations: An
  International Perspective of U.S. Health Care Reform. (Congressional Quarterly Inc. Washington, DC: 1999). Lassey, Marie L., Lassey, William, R., and Martin J. Jinks. Health Care Systems
  Around the World: Characteristics, Issues, Reforms. (Prentice Hall, New Jersey: 1997).

  

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