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Compromise Necessary to Alleviate "Crisis Situation"
February 19, 2001 — With drug prices soaring, the State Medical Society of Wisconsin (SMS of WI) is calling for compromise legislation to pass prescription drug assistance for low-income elderly patients this session.
Whatever plan ends up on the Governor's desk, the SMS believes seven guiding principles should be incorporated to assure help for those in greatest need. (The principles urge coverage for elderly couples who earn up to $33,750 or single patients who make a maximum of $25,000)
"Physicians see patients on a daily basis who stay ill or develop other complications because they can't afford their medicine," said SMS President Ayaz Samadani, M.D. "Some patients already are in a crisis situation, so partisan differences must be set aside so legislation is signed into law this session.
If the funds are available, the SMS prefers coverage be extended to those earning more than double the poverty level. "We prefer plans that would cover many more people, but we have to be realistic about what can be accomplished soon," Dr. Samadani added. The SMS also recommends that income eligibility be progressive so those with the least resources get the most help. Other guidelines for a prescription drug plan include:
Participant Contribution: Affordable premiums, deductibles and co-payments are appropriate.
Comprehensive Coverage: The state should examine prescription drug needs of all residents. If everyone had access to necessary medicine, unnecessary hospitalizations and expensive treatments would decrease.
Federal Action: The State of Wisconsin should not wait for the federal government to act, although any plan should consider potential impact on future federal contributions.
Prior Authorization: To keep costs down, prior authorization is acceptable only if off-list medications can be obtained within 24 hours.
Privacy: Patients' prescription and physicians' prescribing records should not be available to any other state, federal or private entity without physician and patient written consent.