Friday, November 17, 2017
Medicare Plans Must Re-Classify Gout Medication
By Loretta Jones
Published April 28, 2011

Whenever a group of seniors gathers together, the conversation inevitably turns to health issues as they begin comparing medical conditions and giving reports on their various maladies. This is often jokingly referred to as an “organ recital,” but believe me, the ailments and difficulties that develop as we age are no laughing matter. My particular illness, and one that affects thousands of sufferers across our state and nation, is an excruciatingly painful form of arthritis known as gout.

Recently, due to changes brought on by the enforcement of well-intended FDA rules, unapproved products containing the key ingredient colchicine, which is the only remedy to effectively treat the acute flare-ups associated with this disease, have been removed from the marketplace. Unfortunately, Medicare Part-D enrollees who are in need of this medication now find that Colcrys, the only FDA approved colchicine product is offered by most Part-D plans in a higher priced prescription category and is unaffordable for many.

Medicare Part-D insurance plans are offered to help seniors pay for their prescription drug needs. There is a tiered pricing formula for different drugs, with those at the lower end of the scale such as tier-1 or tier-2 being the least expensive. Previously, colchicine products were priced within these categories, but with the removal of unapproved products Colcrys has now been priced as a tier-3 drug, leaving seniors to make up the difference out-of-pocket.

As Founder and CEO of Healthy African-American Families (HAAF), a non-profit agency with the mission of improving the health outcomes of the African-American, Latino and Korean communities, I can tell you this has had a devastating effect on gout sufferers living on fixed incomes, many of which are minorities at or near the poverty level. These unfortunate seniors are being forced to suffer with debilitating pain or to significantly impact their budgets simply to attain medication which was previously affordable through their Medicare Part-D plans.

It is unconscionable for Medicare Part-D providers to sit by as seniors are forced to make these tough choices, especially when they enrolled in their specific plan based on the presumption that their necessary medications were covered at an affordable level. And because enrollment for Medicare Part-D plans takes place only once a year, they are unable to change to a more suitable insurance plan until November. This kind of bait-and-switch tactic is unfair to beneficiaries and must not be tolerated.

Though it is clear that the intent of the FDA in removing unapproved colchicine products was to improve the safety of the drug supply and to protect the public at large, the only fair and equitable thing to do at this point is for all Part-D plans to reclassify Colcrys as a tier-2 drug so that Part-D insurers will cover a larger amount of the patient’s costs for these drugs. At the very least, this should be done until the next enrollment period begins. By then, seniors like me will have been given notice and can change to a new plan which offers the drugs we need.

In the meantime, it is essential that our lawmakers be made aware of this situation and become more involved in the process. If the Part-D insurance providers fail to make Colcrys available to seniors in need, our Senators and Representatives must step up to make sure that gout sufferers gain affordable access to the medication we need and deserve.

HAAF advocates for the health promotion and disease prevention of minorities in Los Angeles County.


Categories: Op-Ed

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