John Kensinger on the Percent Need Bill
My name is John Kensinger, a registered pharmacist and candidate for the 2012 U.S. Republican Senatorial election in Pennsylvania
I have developed a method of delivering a Medicare prescription drug program called Percent Need. I drew on my twenty five years of experience in Health care and business management to create the Percent Need program.
Percent Need is a method of qualifying individuals for prescription drug coverage based on the percentage of income used to purchase their medication. To illustrate the program in round figures, I will use ten percent as the qualifying percentage of income necessary to be eligible for coverage. For example: If a married couple has a post retirement income of $30,000 per year and a prescription drug expense equaling or exceeding $3,000, then they would qualify for the program since their medication costs would be at least ten percent of their income. Conversely, if a retired couple’s total income was $100,000 and had a medication expense of $3,000; they would not qualify since this expense would equal just three percent of their income instead of the required ten percent.
Let’s look at an example that illustrates the flexibility of the Percent Need program. Take a married couple with a post retirement income of $50,000 per year, but lacks prescription drug coverage. Fifty thousand dollars appears comfortable, but let’s now assume that one or both suffer a catastrophic illness that will raise their prescription drug purchases to $6,000 for the year. Under my plan, this couple would qualify for prescription drug coverage since their drug purchases would equal twelve percent, thus exceeding the ten percent required to qualify for coverage. If the following year their illness was gone and their prescription drug purchases were below ten percent, they would not qualify for coverage since there would no longer be a demonstrated percentage of need.
This approach will provide a safety net for older Americans lacking prescription coverage based on their percentage of need. An advantage of this program is that it doesn’t discourage the private sector from continuing to provide post retirement medical benefits to their employees, since not everyone will qualify for this program. This will ease the tax burden on the working class, and the financial burden on Medicare while protecting our Health care industry from socialization.
The program would be implemented by using existing computer data bases. The Federal Government currently has IRS income tax records filed by social security numbers. With patient consent, type into an authorized computer, the social security number of a single senior or married couple to bring up their current tax return, therefore verifying their income. Next, use the existing MAC (Maximum Allowable Cost) database currently used by insurance companies to determine drug cost for reimbursing pharmacies. (Pharmacy reimbursements are currently based on MAC instead of retail prices). Your doctor or representative of the doctor would then type in the names, strength, and quantities of the maintenance medication that would be required for one month. The computer would then assign a dollar value to these medications needed for the month, and extrapolate this sum into an annual dollar figure. This figure would then be compared to your tax return to determine your percentage of need. Eligibility can therefore be determined quickly by a computer on line with existing databases.
Another advantage of this program is that it is dynamic. Since MAC's are updated regularly throughout the year, someone who didn’t qualify before may become eligible as new medications are given or the drug prices rise in relation to their income. This is a program that is there when you need it, for as long as you need it.
Guidelines for the Percent Need program:
1. Once someone qualifies for coverage, re-enrollment will be done on an annual basis depending on need.
2. No drug formulary: Your family doctor would be the one making the decisions as to which medications best meet your needs as a patient instead of a bureaucrat on a formulary committee. My personal experience with formularies is that they slow the delivery of Health care and create an increased administrative burden on Health care professionals. By eliminating the use of a formulary, prescription drug delivery would be streamlined while preserving the doctors’ judgment on medical issues.
3. Medicare should always be the payer of last resort. If prescription insurance exists, that insurance should be the primary payer, and Medicare would pick up the rest provided that the non-covered expenses meet or exceed ten percent of the recipient’s total income.
4. Qualifying seniors could choose to participate in Percent Need by paying a monthly fee like is currently done with Medicare Part B.
5. A copay structure should exist that provides seniors with savings when generic medications are used. For example, a $15.00 copay for generic drugs and a $25.00 copay when a brand name is dispensed.
6. The use of generic medications should be mandatory except where the doctor determines that the brand name is medically necessary.
7. Death: If a spouse should die during the year, a Death Certificate would be required to deduct that income from the current tax return to qualify the surviving spouse.
The use of a monthly enrollment fee, drug copays, and generic medications will help to control some of the costs of the Percent Need program.
Percent Need is a fair, efficient, cost effective way to target need and improve the quality of life of older Americans, while preserving their patient rights by granting their doctor the freedom to select the medications that best meet their individual needs.
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