An estimated 108,000 additional seniors would be eligible for the state's discount prescription drug program under a plan announced yesterday by Gov. Ed Rendell.
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Gov. Ed Rendell talks with reporters after unveiling a plan to expand the state's prescription-drug program for senior citizens. (Carolyn Kaster, Associated Press)
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The income limits for the Pharmaceutical Assistance Contract for the Elderly would increase slightly under the plan, although co-payments by seniors in PACE, as the program is called, also would increase.
Many more seniors would become eligible for a related program called PACENET, which serves those with slightly higher incomes.
Money for the program expansion would come in part from drug manufacturers, who would be asked to give deeper discounts. PACE would also change the way it reimburses pharmacists who fill prescriptions for generic medicines. Those changes, along with increased revenue from co-pays, would bring in an additional $85 million a year to the program, said Tom Snedden, PACE director.
Equally important is the continued success of the Pennsylvania Lottery, the proceeds of which fund PACE.
During a news conference yesterday in Harrisburg, Rendell said the lottery grossed $1.9 billion last year and that, within two years, the figure could be $2.6 billion.
Rendell also said he wants to see more retailers selling lottery tickets, in part by installing player-activated machines at convenience stores, drugstores and other retailers.
Currently, individual seniors who make less than $14,000 a year or couples with an income of less than $17,200 are eligible for PACE. Those seniors pay a $6 co-pay per month per medicine. Under the proposal, the income limits would increase to $14,500 for individuals and $17,700 for couples and the co-pay would increase to $8.
The PACENET program currently asks the higher-income seniors to pay a $500 deductible before getting drug coverage. Under the new plan, those seniors would be asked instead to make a $40 deductible payment each month.
"The $500 up front, out-of-pocket deductible is a real barrier to people getting in the program," said Snedden. "With a $40 a month deductible, we're pretty sure people are going to see this differently."
The income limits for PACENET would increase from $17,000 to $22,500 for individuals and go from $20,200 to $30,500 for couples. PACENET co-pays of $8 per generic prescription and $15 per brand name prescription would remain unchanged.
Under the plan, PACE seniors would also have an option to use a mail-order pharmacy, which would reduce their co-pays.
The mail-order option, which could take business away from some state pharmacies, is just one of the reasons the Pennsylvania Pharmacists Association doesn't like the plan, said Pat Epple, executive director of the Harrisburg group. Epple also said the change in how PACE reimburses pharmacies for filling generic prescriptions is unfair because the reimbursement could be lower than the pharmacist's cost for the medicine.
Andrew Nannis, spokesman for the Pharmaceutical Research and Manufacturers Association, said his group doesn't want to give the PACE program higher rebates. What's more, for some high-priced medications prescribed by doctors, the state Department of Aging would require that seniors use "therapeutically equivalent" medicines, which Rendell described as "the lowest priced drug that will achieve the goal of the doctor's prescription."
"You're breaking that doctor-patient relationship," Nannis said.
Snedden said the details of this provision haven't been worked out. But most health plans take similar steps to cut costs, he said, adding that there would be some mechanism for patients and doctors to appeal substitutions suggested by the PACE program.
Snedden had similar words for the pharmacists, saying the change in reimbursing pharmacies for filling generic prescriptions matches one that most health plans have already implemented. As for the concern about mail-order pharmacies, Snedden said he expected few seniors would actually take advantage of the option.
State efforts to pressure manufacturers to grant price rebates to reduce costs for uninsured residents received qualified approval earlier this month from the U.S. Supreme Court. That ruling was seen as giving Pennsylvania leverage in its negotiations.
Rendell's plan will find its way into legislation by way of a bill already introduced by Rep. Pat Vance, R-Cumberland. The plan incorporates many of the ideas put forward in Vance's bill as well as in a bill by Sen. Jane Orie, R-McCandless.
"Everyone is for increasing eligibility levels and maintaining the program," said Joanne McGreevy, executive director of the Senate Aging and Youth Committee, which Orie chairs. "The only concern is whether the money is really there. ... If you're basing revenue on what you think is going to happen, we all worry that that might not happen."
Post-Gazette staff writer Johnna A. Pro contributed to this report.
Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412-263-2625.
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