FRIDAY, July 23, 2004 (HealthDay News) -- It's the ultimate pocketbook issue that many senior citizens are still struggling with: Should I sign up for the Medicare drug discount card?
The federal government in May launched its drug card program, which will be in place until Medicare offers prescription insurance in 2006. The Bush administration says cardholders can save an average of 11 percent to 18 percent on brand-name medications and up to 60 percent on generic drugs.
And, the administration estimated, 7 million low-income elderly U.S. residents can expect even greater savings: between 29 percent and 77 percent on brand-name products and as much as 92 percent on generic drugs.
But sign-up for the cards continues to lag. Medicare's top official told Congress Monday that nearly 4 million seniors have signed up in the six weeks since the program began. Dr. Mark B. McClellan said, of those, 2.5 million were automatically enrolled through Medicare HMO plans.
Critics of the voluntary program say pitfalls and confusion continue to abound. Dozens of cards are available in some markets -- with both national and regional options -- posting a particular challenge for people taking multiple medications or who have trouble using the Internet to register for the program.
Another twist: Drug-card sponsors can change their roster of discounted drugs, and the prices of those products can vary on a weekly basis. So, discount card users must be ever vigilant to ensure that today's savings exists tomorrow. Medicare enrollees will be able to change cards until the end of this year, after which they will be locked into only one.
Advocates for the elderly agree that low-income seniors have the most to gain from the discount cards. Those with annual incomes less than $12,372 and couples earning less than $16,608 a year could qualify for a $600 annual subsidy of their prescription costs. They also get a free card, while wealthier beneficiaries will pay up to $30 to enroll.
"It's money on the table," said Elinor Ginzler, of the retiree group AARP. "We don't want Medicare beneficiaries who have $600 coming to them this year and $600 next year to walk away from that."
Scott Parkin, a spokesman for the Access to Benefits Coalition, a group of non-profit organizations promoting use of the cards for low-income Medicare beneficiaries, said people also should be aware of so-called "wrap around" programs that can pick up where the discount cards end.
Many drug companies, including Merck, Abbott, Astra Zeneca, Eli Lilly, Novartis, Pfizer and Wyeth have said they will provide their products at little or no cost to low-income card holders who run through their $600 annual credit.
The coalition "is trying to get makers and card programs talking together and making sure they make this as automatic and seamless as possible," Parkin said.
Despite the confusion, Parkin said, "The message out of all of this is that it's going to be worthwhile, especially for the low to modest income Medicare beneficiary, to take a little time, be careful, and look at these programs and how they work together and get some help if you don't understand it. You might find this is worth a lot more than you ever thought."
People of more substantial means and those who already have comprehensive drug coverage -- from a health plan or through a drug company, for example -- must decide whether they want to spend the money and take the time to sign up, Ginzler says. On the other hand, if they can spare both, they might want to do so. "This becomes another tool in their arsenal to comparison shop."
Some critics of the discount cards have argued that Medicare beneficiaries could do better buying drugs imported from Canada, or buy shopping for their prescriptions over the Internet. A 1999 survey by Consumer Reports found that people could save nearly 30 percent on certain drugs by buying them online. However, other research has found that some medications may cost more over the Internet than at local pharmacies. And some recent studies have raised questions about the safety of generic drugs purchased outside the United States.
Under the new program, seniors in New York City, for example, can expect to pay about $114 for a 30-day supply of the anti-inflammatory drug Celebrex, while Drugstore.com charges $91 for twice as many pills. The online retailer offers even deeper price cuts when customers pay with their own money for bigger quantities.
Still, many Medicare enrollees aren't computer savvy and may not be able to take advantage of any potential Internet savings. On the other hand, that same problem promises to bedevil the online sign-up arm of the discount card program.
Gail Shearer, director of health policy analysis at Consumers Union, said most people should go ahead and get a discount card, even if they'll see minimal savings. "If you pay $2 per drug, you don't need one, but for most people it's probably worth going through the exercise," Shearer said.
Shearer's group believes the cards fall well short of what seniors need to grapple with the rising costs of prescription drugs, which have been posting double-digit percentage increases in recent years. "There should have been a reform with much deeper discounts. We don't see it as a terrific solution."
The U.S. government's Medicare site takes you through the steps to determine whether you should apply for a card.