The principles derive from the ANA’s position that all Medicare beneficiaries should have reliable and affordable access to needed medications. If a proposal passes this litmus test, the ANA’s support for the bill would be guided by the following:

• Comprehensive coverage: proposals that involve only drug discounts, those that involve only catastrophic coverage, and those that involve significant gaps in coverage do not meet the basic criterion of ensuring affordable access to needed prescription drugs for all Medicare beneficiaries and pose a barrier to access, and the ANA will oppose them or work to minimize the negative effects of any such provisions.

• Eligibility: all Medicare beneficiaries must be eligible for prescription drug coverage. The ANA will oppose any proposals for means-testing eligibility. The ANA supports greater financial protection against the cost of a prescription drug benefit for low-income Medicare beneficiaries.

• Benefits: the proposal must be based on a standard, national benefits package that covers needed drugs and biologicals.

• Cost sharing: cost sharing must not create obstacles to access. These principles should apply to all levels of purchases. Any proposals for substantial cost sharing should be accompanied by stop-loss protection. Assis­tance with cost sharing should be provided to low-income beneficiaries.

Based on these principles, the ANA has expressed serious concerns to the House and Senate about the gap in prescription drug coverage contained in both bills. This gap would leave large numbers of beneficiaries without any coverage for drugs they require daily. Beneficiaries would continue to face prohibitively high prescription drug costs, and as a result many would continue to do without needed drugs. The ANA is urging Congress to provide continuous coverage for needed medications for all Medicare beneficiaries.

The ANA is also concerned that the House bill would force seniors to pay more to stay in traditional Medicare and ultimately drive them into private insurance plans under the Medicare+Choice Program. The ANA believes this will cause more disruptions in service for Medicare beneficiaries because of the volatility of the +Choice programs. According to the U.S. General Accounting Office, of the 309 +Choice plans serving Medicare beneficiaries at the end of 1999, 217 had terminated or planned to terminate their contracts or reduce services in 2000 and 2001, affecting more than 1 million enrollees. The ANA is urging members of Congress to ensure Medicare maintains a standard, defined benefits structure.

The ANA also opposes a provision in the Senate bill that would deny the new Medicare prescription drug benefit to low-income beneficiaries who are also eligible for Medicaid. While most Medicaid plans offer prescription drug coverage, the majority of them are cutting back, which means people eligible for Medicaid could wind up with no prescription drug coverage.

The ANA supports the concept of an outpatient prescription drug benefit for all Medicare beneficiaries and would support legislation to enact a benefit if the ANA’s concerns about comprehensive coverage, eligibility, benefits, and cost sharing are addressed. The final legislative package is expected to be voted on by October. If enacted, this package would make the largest wholesale changes to Medicare since its inception.

The ANA urges nurses to contact their congressional delegations to express their views on an outpatient prescription drug benefit for Medicare beneficiaries. Resource materials and draft letters are available on the ANA government affairs Web site, http://nursingworld.org/gova/index.htm.

Erin McKeon is an associate director of the ANA’s Department of Government Affairs.

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