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Doughnut hole discounts help seniors; health exchanges on hold in Missouri

Pills prescription drugs pharmaceuticals
ep_jhu | Flickr

Last year's fight between Walgreens and Express Scripts over prescription drug prices overshadowed the much bigger issue of whether health reforms have eased drug costs for many seniors, as well as whether state lawmakers should set up a health insurance exchange.

Near the end of last year, Walgreens broke off talks with Express Scripts, a pharmacy benefit company, over what Walgreens could charge consumers for prescriptions. Rather than agree to reducing its prices, Walgreens walked away from its business with millions of customers in the Express Scripts network. Walgreens reportedly has tried to sway public opinion by paying people to Tweet that consumers should be able to choose their pharmacy.

Some elderly in the Express Script network have had complaints about not being able to get their medicine through Walgreens. That problem is a contract issue between two businesses, and the government is not stepping in. Another concern of seniors is being addressed under the health-reform: the so-called doughnut hole, the gap between their out-of-pocket cost of medicine and the amount paid through a Medicare prescription drug plan.

In the past, after reaching a limit on the amount a plan would pay for their prescription drugs, seniors would have to pay the entire drug price out of pocket. The health-reform law has brought relief by giving 50 percent discounts on brand name drugs for seniors affected by the doughnut hole.

According to data supplied by U.S. Rep. Russ Carnahan, D-St. Louis, efforts to close the hole has shaved about $32 million off prescription drug bills of approximately 57,000 Medicare recipients in Missouri. He cites this benefit as an example of the value of the health-reform law, adding that the law also has made it possible for more than 540,000 seniors in Missouri to get free screenings to prevent certain health problems.

How much or how long these benefits will continue might depend in part on the U.S. Supreme Court ruling on the validity of the health reform law. It is expected to hand down a decision this summer.

Health exchanges

Uncertainty is stalling some other parts of the law from taking root in Missouri. Last year, for example, the legislature debated the creation of a health insurance exchange system through which consumers could shop for the most affordable health coverage. The Missouri House passed a bill, but the issue stalled in the Senate.

In this new session, two state Senate Republicans, Rob Schaaf of St. Joseph and Scott Rupp of Wentzville, have offered SB464. It forbids the governor or any state agency to take any steps to create an exchange unless it is first authorized by state statute. SB464 also calls for submitting the issue to voters in November.

Last year, Rupp chaired statewide hearings that were supposed to determine public sentiment for setting up an exchange. He issued no report but said senators would have access to a transcript of the hearings. He also said no legislation to set up an exchange should be approved before the Supreme Court ruled on the validity of the Affordable Care Act. The big issue before the court is whether the government can require individuals to buy health insurance even if they do not want it

Sen. Jay Wasson, R-Nixa, doesn't object to the Schaaf-Rupp proposal, but he thinks some type of insurance exchange proposal should be in place. That's why he has filed SB608, an exchange framework, co-sponsored by Sen. Ron Richard, R-Joplin.

"I filed the bill to get some discussion started," Wasson says. "It's like an insurance policy in case the Supreme Court does not throw out the (health reform) law. This bill offers 15 to 20 talking points of what should be in the bill."

If the court leaves all or part of the law in place, he said, "the governor could call a special session and we would already have a blueprint of what an exchange in Missouri could look like."