Individuals with pre-existing conditions who have been uninsured for six months may now find it easier to obtain coverage through the Pre-Existing Condition Insurance Plan (PCIP). PCIP was created by the Affordable Care Act to provide interim coverage until the Health Insurance Exchanges are up and running in 2014. Twenty-seven states administer their own PCIP. PCIP is administered by the Department of Health and Human Services (HHS) in the other 23 states and in the District of Columbia.

HHS announced on May 31, 2011, that premiums would be reduced by as much as 40% in 18 of the 23 states in which the federal government administers PCIP.

Furthermore, starting this July, applicants in the states where PCIP is administered by HHS will no longer have to establish that they have been turned down for health insurance coverage by an insurance company. They will only have to provide a letter from a doctor, physician assistant, or nurse practitioner verifying that they have or have had a medical condition, disability or illness that qualifies them for PCIP. The letter must be dated within 12 months of the application.

Coverage under PCIP is available to individuals who are citizens or who are living in the United States legally, who have pre-existing conditions, and who have been uninsured for at least the last 6 months. Eligibility is not based on income. PCIP covers hospital care, primary and specialty care, and prescription drugs, even for pre-existing conditions coverage.

Click on the link below for more information on applying to PCIP: http://www.healthcare.gov/law/provisions/preexisting/federal/index.html

The pharmaceutical industry, through its lobbying group PhRMA, has promised to cut drug prices for certain Medicare Part D recipients and others by $80 billion over the next decade. In return, the Obama Administration has promised not to reform the pharmaceutical industry — no new regulations, no Medicare negotiation for lower drug prices, no drug reimportation from Canada.

Sound like a good deal to you?

Well, $80 billion sure sounds like a lot of money. But here are some things to think about –

• President Obama trumpeted the deal without indicating how or whether these savings could be guaranteed; the specific terms are not included in any of the bills in Congress.
• Some analysts estimate that only $30 billion of the $80 billion can be guaranteed.
• Since U.S. prescription drug prices have been rising at three times the rate of inflation, it is unclear whether the promised price cuts will actually reduce prices or simply slow their growth temporarily.
• In accepting PhRMA’s demand for no price negotiations, the government is forgoing what could be as much as $220 billion in savings over the same period, according to a report by the Institute for America’s Future, which matched drug price savings the government negotiated for the Veteran’s Administration.
• Americans spend $200 billion per year on prescription drugs — and rising (even with the $80 billion “discount”).
• We pay more for prescription drugs than any country in the world. The Congressional Budget Office found that drug prices in other countries average 35 to 55 percent below the prices in the U.S. But now that Obama has buckled on Canadian drug reimportation, Americans cannot take advantage of these bargains (at least according to the letter of the law).
• The pharmaceutical industry spends $100 million a year — $1 billion a decade — just on lobbying members of Congress.
• Even in the midst of a recession, Johnson & Johnson CEO William Weldon was paid $29,127,432 in 2008; Abbott Labs CEO Miles White made $28,253,387 and Merck’s Richard Clark made $25,073,555.
• Overall, Americans pay twice as much (or more) per capita on healthcare than all other Western countries, which in many cases have better health outcomes than the United States.

How’s that $80 billion sound now?

Sources: Nader, Redmond

I’ve guess I’ve finally come back to my senses.

After years of being cynical about our political system’s capability of doing anything but accumulating debt, I somehow thought Obama could make a difference. I thought, among other things, that meaningful healthcare reform was finally on its way.

But the system itself is more powerful than Obama … far more powerful.

I didn’t think it was possible that Congress could create a healthcare reform bill that I would oppose. I figured that any change would be a step in the right direction.

But then the White House caved in to Big Pharma on issues like Medicare price negotiations and Canadian drug reimportation. Big Pharma was basically assured that it could continue to charge monopoly prices for brand-name drugs without restraint.

That completely knocks out the promise of controlling skyrocketing prescription drug costs — which should have been a key pillar of healthcare reform.

Obama did this, clearly, as a political calculation. He did not think he could get a bill passed if he had both Big Pharma and Big Insurance against him. So he picked his poison — and Big Pharma agreed to support reform.

As a result, “healthcare reform” has become “health insurance reform.” The health insurance industry, like Big Pharma, is not a sterling example of the free market economy at work. That’s why you don’t see real price competition, and why health insurance companies focus instead on increasing their margins by not paying off claims. It’s also why a public option is necessary for there to be any chance of real insurance reform.

I don’t think Obama’s going to get the public option, either.

I think we’re going to get a bill passed that encourages/forces Americans to sign up for private insurance, and that continues to subsidize drug company profits. It will end up enriching both Big Pharma and Big Insurance. And it will cost us billions or trillions of dollars that we don’t have and must borrow from China.

Borrow and spend. That’s been the core “problem-solving” approach of both Democrats and Republicans over the past 30 years (with the exception of Bill Clinton, the only president to have balanced the budget during this period.) In fact, Obama’s “problem-solving” approach on healthcare is eerily similar to George Bush’s approach on Medicare Part D.

As former Secretary of Labor Robert Reich explains:

The White House confirmed it has promised Big Pharma that any healthcare legislation will bar the government from using its huge purchasing power to negotiate lower drug prices. That’s basically the same deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry. A continuation will be an even larger bonanza, given all the Boomers who will be enrolling in Medicare over the next decade. And it will be a gold mine if the deal extends to Medicaid, which will be expanded under most versions of the healthcare bills now emerging from Congress, and to any public option that might be included. (We don’t know how far the deal extends beyond Medicare because its details haven’t been made public.)

Let me remind you: Any bonanza for the drug industry means higher health-care costs for the rest of us, which is one reason why critics of the emerging healthcare plans, including the Congressional Budget Office, are so worried about their failure to adequately stem future healthcare costs. To be sure, as part of its deal with the White House, Big Pharma apparently has promised to cut future drug costs by $80 billion. But neither the industry nor the White House nor any congressional committee has announced exactly where the $80 billion in savings will show up nor how this portion of the deal will be enforced. In any event, you can bet that the bonanza Big Pharma will reap far exceeds $80 billion. Otherwise, why would it have agreed?

Exactly.

Isn’t it odd, in a day when the political parties are supposedly so different, and people are shouting about non-existent “death panels” at town hall meetings, that the underlying reality is that the political parties are actually so similar? That the Democrats’ “solution” for healthcare may simply be an expanded version of the Republicans’ “solution” for seniors who can’t afford their prescription drugs — Medicare Part D?

Democrats and Republicans enjoy the perks of power. But they ultimately don’t run Washington. They both must answer to the same “paymasters,” as consumer advocate Ralph Nader calls them. Corporate interests.

Show me a grassroots movement that takes on corporate power, and I’ll show you a third political party. You won’t find it within the current two-party system. When we next “water the tree of liberty with the blood of tyrants,” as Jefferson put it, those tyrants will be giant multinational corporations, not their trembling lackeys who hold political office.

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We would still like healthcare reform legislation to succeed this year — but we are not nearly as enthusiastic about it as we were just a few short months ago.

For starters, the Obama Administration isn’t calling it “healthcare reform” anymore. Now it’s “health insurance reform.”

Reformers have lowered their sights. They aren’t trying to fix Big Pharma’s stranglehold on the American consumer anymore. All they are trying to do now is to offer a public alternative to Big Insurance. And even this small measure of reform may not become law.

If it doesn’t, and so-called “universal health care” passes, it will simply be another handout to corporations, paid for by taxpayers, just as Medicare Part D was. The government will simply pay to have everyone “covered,” but won’t fix the underlying problems that make America’s healthcare system so overpriced and inefficient.

What a shame.

I haven’t given up hope that the public option will succeed. But I have given up all hope that the bill will include meaningful improvements in prescription drug prices.

As Ralph Nader explains:

Obama invites (drug companies) to the White House, where they presumably pledged to give up nearly $300 billion dollars over ten years without any specifics about how this complex assurance can be policed.

No matter, in return Obama and his aides agreed not to press Congress to authorize the federal government to negotiate drug prices with the drug industry. Don’t worry: the taxpayers will pay the bill.

At a meeting on July 7 at the White House between drug company executives, Obama’s chief of staff, Rahm Emanuel, and Senate Finance Chairman Max Baucus (D-MT), the industry, according to The New York Times, was promised that the final legislative package would not allow the reimportation of cheaper medicines from Canada or other countries even if they meet our drug safety standards.

Do you see anything odd about the pharmaceutical industry promising “X dollars over X years” in lower prices to consumers? Does that sound like a free market process to you?

In other words, if I had a business selling apples, and I sold them for 25 cents each, you would assume that this price would be based on what the market would bear. That is, if I sold them for 30 cents, I would not sell them all and some of them would rot. But if I sold them for 20 cents, I would sell them all too fast and not make as much money as I could have. That’s the market setting the price.

Big Pharma doesn’t operate by such rules. It has a friend — the U.S. government — that decides how much money it can make on the drugs it develops.

The government decides this by giving drug companies patents, and then extending these patents again and again, so that they can have a monopoly on the drugs they sell.

If I’m the only one in the world who’s allowed to sell apples, I can probably get a lot more than 25 cents an apple, can’t I?

In fact, I can start marketing apples as a sweet, juicy alternative to Russian caviar if I want to. I can sell them for $100 each if I want, right?

And what would be even better is if your doctor informed you that, for your health, you had to have an apple every day. Then you would have to find a way to get one, whether you could afford it or not, wouldn’t you?

Gee, it’s great to be in the apple-selling business, isn’t it?

So here I am, selling my apples at an outrageous profit, buying G4s to fly me around, spending billions of dollars on TV ads to ensure that consumers “ask their doctors” whether they need to eat more apples, when all of a sudden President Obama calls.

“Hey,” he says, “what would you say about selling your apples for $95 instead of $100 for a few years? And maybe selling them for $50 to seniors in the Medicare Part D doughnut hole? That way we could say that you have contributed $X billion in cost savings to our healthcare reform bill.”

“Hmm,” I think. “Why not? It’s good PR — and how funny that people will think they’re actually getting a bargain by paying $95 for an apple.”

If you want to pay $95 for an apple, you can wait for the benefits of Obamacare. Otherwise, you should seek the immediate benefits of licensed Canadian pharmacies.

Did you ever see “Invasion of the Body Snatchers”? Well, I’d like to report the snatching of two bodies — those of Harry and Louise. As our friend John Mack reports:

Remember those Health Insurance Association of America “Harry and Louise” TV ads that were instrumental in scuttling Hillary Clinton’s health reform efforts in 1993? Well, Harry and Louise are back! This time, however, they support health reform. “A little more cooperation, a little less politics, and we can get the job done this time,” says Louise as a halo swirls around her head and eventually forms the URL: HarryandLouise.org. Seems to me we could have gotten the job done in 1993 with a little less Harry and Louise!

Here’s the ad that started running this weekend:

Ironic, huh?

But the real irony here is not that proponents of healthcare reform are using the same characters who effectively opposed it in 1993. It’s that while the 1993 ads were predictably funded by the Big Insurance lobby, the new ads are funded by Big Insurance’s longtime partner in crime — the Big Pharma lobby, PhRMA.

So, whose body has actually been snatched here? Harry’s? Louise’s? Or PhRMA’s?

Alas, PhRMA hasn’t turned over a new leaf and suddenly become a populist organization committed to ensuring healthcare justice for all. The fact is, because the Obama Administration knows the president’s reelection probably depends on swift passage of healthcare reform, it has given away the farm to corporate interests — including giving Big Pharma everything it wants.

If anybody has turned into a pod person, in fact, it’s Obama.

What does it say about corporate power in the United States when even a president whose party has 60 seats in the Senate and a huge majority in the House can’t oppose it?

When all is said and done, will Obama’s healthcare reform legislation be much different than a bigger, more bloated version of President Bush’s Medicare Part D boondoggle?

Just cross your fingers, close your eyes, and keep telling yourself, “It’s only a movie. It’s only a movie.”

The eDrugSearch.com e-book “99 Ways to Save Money on Your Prescription Drugs, 2009 Edition” is now available on Scribd, where you can see a preview of the book’s first 10 pages before purchasing.

Check it out and start saving on your prescription drugs now!

As readers of this blog know, we have been following the proposed Pharmaceutical Market Access and Drug Safety Act carefully as it wends its way through Congress. So far, neither the House nor Senate versions of the bill have gotten very far since their introduction in early March, although there has been some talk that the Senate bill may be put to a vote within a matter of weeks.

For those of you who would like to learn more about this proposed legislation, which would allow American consumers to legally purchase prescription drugs from Canada and other Tier One countries, you can read the full text of the House bill here, and a summary here.

Why do we need this legislation passed? The bill makes the case in seven points:

And what would passage of the bill achieve? Here’s a summary:

Pharmaceutical Market Access and Drug Safety Act of 2009 – Amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to revise provisions governing the importation of prescription drugs. Waives the limitation on importation of prescription drugs that have been exported from the United States.

Prohibits the importation of a qualifying drug unless such drug is imported by: (1) a registered importer; or (2) an individual for personal use.

Establishes registration conditions for importers and exporters. Requires the Secretary of Health and Human Services to inspect places of business, verify chains of custody, inspect facilities, and determine compliance with registration conditions.

Sets forth provisions governing the importation of qualifying drugs that are different from U.S. label drugs, including standards for judging such differences.

Prohibits manufacturers from: (1) discriminating against registered exporters or importers; (2) causing there to be a difference in a prescription drug distributed in the United States and one distributed in a permitted country; (3) engaging in actions to restrict, prohibit, or delay the importation of a qualifying drug; or (4) engaging in any action that the Federal Trade Commission (FTC) determines discriminates against a person that engages or attempts to engage in the importation of a qualifying drug.

States that the resale in the United States of prescription drugs that were properly sold abroad is not patent infringement.

Requires the Secretary to educate consumers regarding prescription drug importation.

Sets forth provisions governing the sale of prescription drugs through an Internet site. Includes the dispensing or selling of a prescription drug in violation of this Act as a prohibited act under FFDCA.

Prohibits the introduction of restricted transactions with unregistered foreign pharmacies into a payment system or the completion of such transactions using a payment system.

We wholeheartedly support the Pharmaceutical Market Access and Drug Safety Act, and we encourage you to contact your Congressman and Senator to show your support as well.

You are probably aware by now of Medicare Part D, which provides a prescription drug benefit to seniors. But did you know that you also may be able to qualify for extra help from Social Security?

If you are covered by Medicare but have limited income and resources, Social Security may step up to pay part of your monthly premiums, annual deductibles and prescription co-payments. The extra help is worth an average of $3,900 per year.

You can qualify for extra help if you have income limited to $16,245 for an individual or $21, 855 for a married couple living together.

Even if your annual income is higher, however, you still may be able to get some help depending on your specific circumstances. These include:

• Supporting other family members who live with you;
• Having earnings from work;
• Living in Alaska or Hawaii; and/or
• Having resources limited to $12,510 for an individual or $25,010 for a married couple living together. Resources include such things as bank accounts, stocks and bonds.

Social Security has an online application for those interested. You can also call Social Security at 1-800-772-1213 and ask for the Application for Help with Medicare Prescription Drug Plan Costs, or go to the nearest Social Security office.

To learn more about the Medicare prescription drug plans and special enrollment periods, visit www.medicare.gov or call 1-800-MEDICARE.

You probably didn’t know it, but May is officially Older Americans Month. Since many members of the eDrugSearch.com community are seniors, and we are keenly aware of their struggles in managing their prescription drug costs, we thought we would take this opportunity to share some facts about the older population that might surprise you, courtesy of the Department of Health and Human Services Administration on Aging –

• The older population — persons 65 years or older — represents about 12.4 percent of the U.S. population, about one in every eight Americans.
• By 2030, there will be about 71.5 million older persons, more than twice their number in 2000, representing about 20 percent of the U.S. population.
• In 2006 older consumers averaged out-of-pocket health care expenditures of $4,631, an increase of 62 percent since 1996. In contrast, the total population spent considerably less, averaging $2,853 in out-of-pocket costs.
• Older Americans spent 12.7 percent of their total expenditures on health, more than twice the proportion spent by all consumers (5.7 percent).
• Health costs incurred on average by older consumers in 2006 (the latest year for which data is available) consisted of $2,770 (60 percent) for insurance, $859 (18 percent) for drugs, $844 (18.5 percent) for medical services, and $159 (3 percent) for medical supplies.

Unfortunately, our seniors too often bear the brunt of our overpriced healthcare system. While the issue of skyrocketing drug costs for seniors has received less media attention since Medicare Part D was introduced in 2006, the truth is that this costly new entitlement program has helped insurance companies and pharmaceutical companies far more than it has helped individual seniors (as Suddenly Senior explains).

What’s more, many seniors are unaware that they may qualify for additional financial assistance with their prescription drugs and other medical bills.

To commemorate Older Americans Month, we encourage you to tell a senior you love (and that can include yourself!) about BenefitsCheckUp, a service of the National Council on Aging that helps match seniors with benefits programs. BenefitsCheckUp has helped more than 2.2 million people find over $7.2 billion worth of annual benefits.

Take your BenefitsCheckUp here.

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I read an op-ed in the Dallas Morning News last Thursday that really impressed me, giving me hope that true healthcare reform may be just around the corner.

The piece was co-written by Republican Senator John Cornyn of Texas and Democratic Senator Tom Harkin of Iowa. Its purpose was to advocate the proposed Healthy Workforce Act, which the senators introduced last month with the White House’s endorsement.

This bill is a perfect example of the kind of legislation that both parties can get behind. It gives substantial tax credits to businesses that offer a comprehensive wellness program to their employees, encompassing employee gyms, smoking-cessation support, nutrition programs, and other initiatives.

Sounds like a no-brainer to me. Some excerpts from the op-ed (which we’ve re-formatted into bullet points):

• Corporations are spending untold tens of billions on illness, hospitalization, absenteeism and lost productivity. Wouldn’t it make better sense — and better profitability — to shift a large share of those health care dollars toward wellness and disease prevention?
• Chronic diseases account for more than 75 percent of current U.S. medical expenditures. This includes heart disease, cancer, diabetes, stress and depression — many of which are preventable by changes in diet and lifestyle. Yet less than 3 percent of our health care spending goes toward prevention and wellness.
• Today’s negative health trends are having a profound impact on the profits and competitiveness of U.S. businesses. Average employer medical costs increased 72 percent between 2000 and 2006 — more than 10 percent a year. Employers are bearing the cost of diet-related chronic disease and obesity — through costlier health care plans and higher absenteeism rates.
• Research shows that, on average, it costs four times more to ensure an employee who has diabetes than one who does not. Even worse, productivity losses due to poor employee health are more costly to businesses than medical costs.
• Workplace wellness programs are economical, typically costing $20 to $200 per employee. And they are a good investment, with some programs producing $10 in returns for each dollar invested.

I checked out the bill at WashingtonWatch.com and saw that 93 percent of those voting in their online poll supported it. That would seem to be a good sign.

However, the bill does have its opponents. As the New York Times reports:

Under Mr. Harkin’s proposal, employers could obtain tax credits for programs that offer periodic screenings for health problems and counseling to help employees adopt healthier lifestyles. Programs could focus on tobacco use, obesity, physical fitness, nutrition and depression, he said.

Growing numbers of employers have adopted wellness programs after finding that they can lower health costs and increase the productivity of workers. Financial incentives include gift certificates and premium discounts or surcharges. Critics say that holding people financially responsible for their health behavior is potentially unfair and that employers have no business prying into their employees’ private lives.

Lewis Maltby, president of the National Workrights Institute, a research and advocacy group, said financial rewards and penalties were often a form of lifestyle discrimination. “You are supposed to be paid on the basis of how you do your job, not how often you go to the gym or how many cheeseburgers you eat,” Mr. Maltby said.

Let’s hope that common sense will win out over “cheeseburger-lovers’ rights” in this instance.