Doctors Council SEIU Endorses Addabbo for Senate
Dr. Frank Proscia, Executive Director of Doctors Council SEIU, Joe Addabbo and John Rossi of Rossi Pharmacy, Ozone Park
Gathered at Rossi Pharmacy (84 01 101 Ave, Ozone Park) with the Vice President of the Doctors Council SEIU, Councilman Joe Addabbo laid out his 3 Point Healthcare Plan to address the rising cost of healthcare. Having also earned the endorsement of the New York State Nurses Association, Addabbo has made healthcare a central platform of his campaign.
“Healthcare is one of the primary concerns of the 21st century as the cost of coverage escalates and insurance companies continue to encroach upon the clinic. We need to put health care back into the hands of the doctors and nurses who think first about the patient, and second about the bottom line. But we also need to take steps to improve existing programs and expand our options. In these tough economic times, working families need real solutions to their basic concerns. We must to more and I have a plan,” said Councilman Addabbo.
“Doctors Council SEIU is the largest union of attending physicians and dentists in the country, representing over 3,000 doctors from the public and private sectors in the New York City area. Joe Addabbo has been a strong advocate for the rights of workers. And the proposals he’s making today demonstrate his commitment to providing all New Yorkers with the best possible healthcare. We have worked with Councilman Addabbo in the past and look forward to working with him as a member of the State Senate. Now more than ever, we need elected officials who believe that access to healthcare is a priority,” added Dr. Frank Proscia, Executive Director of Doctors Council SEIU.
With that in mind Addabbo explained his 3 point plan:
1) Convert Life Insurance to Long Term Care Coverage
Addabbo supports a proposal which would allow New Yorkers to convert the anticipated value of their whole life insurance policies into immediate, but discounted, cash to pay for the long term care they require either at the end of their lives or in the event of a disabling health crisis.
This measure would reduce state Medicaid expenditures by providing more liquid assets that New Yorkers can use to pay for their nursing home and home health care needs.
2) Expand the Income Threshold for EPIC (Elderly Pharmaceutical Insurance Coverage)
EPIC is a New York State program that helps seniors pay for their prescription drugs. More than a of a quarter million EPIC enrollees are saving an average of 90 % of the cost of their medicines. Most enrollees have Medicare Part D or other drug coverage, and use EPIC to lower their drug costs even more by helping them pay the deductibles and co-payments required by their other drug plan. EPIC also helps members pay for Medicare Part D premiums.
Currently, the eligibility requirements for EPIC are capped at 35K for an individual and 75K for a couple. Addabbo supports existing legislation (S2257) to expand the income threshold to 50K for an individual and 75K for a couple.
If coverage were expanded, an additional 35,172 seniors in Queens County would be eligible for EPIC.
All of these approximately 35,000 newly eligible seniors would be protected from the gap in Medicare Part D coverage which totals $1,650, the Medicare Part D “blackout” period between $2,400 and $4,050 in prescription expenses.
However, historical trends in EPIC enrollment show that, at the high end of income eligibility, only a small percentage, 10%, of eligible seniors enroll in EPIC. This is primarily due to the availability of alternative coverage and high deductibles at the upper end of EPIC coverage.
Using the historical EPIC participation rate of 10% of those eligible, approximately 3,500 of the 35,000 newly eligible would enroll in EPIC.
However, if only 3,500 Queens seniors were to enroll, they could still see aggregate savings of $5.8 million due to EPIC coverage of the Medicare Part D gap.
The measure would also obviously result in considerable Medicaid savings as well.
3) Single Source Drug Coverage
Addabbo expressed the need for better coverage for all New Yorkers, but emphasized the negative effects of the three-tier drug pricing system on minority communities. According to the NYC Dept. of Health Southwest Queens has one of the highest percents of uninsured adults among the 42 neighborhoods in NYC (23%), and foreign-born residents in this community are less likely to have health insurance than those born in the U.S. Similarly, in Southwest Queens, 23% of residents do not have a regular doctor, which means greater reliance on emergency rooms, and less emphasis on preventative care.
A May report released by Senator Jeff Klein (D-Bronx/Westchester) revealed that New York’s biggest HMOs are denying or restricting access to single source drugs with no generic equivalent. Drugs like Lipitor, Plavix, Lexapro, and Advair treat common conditions such as high cholesterol, cardiovascular disease, diabetes, depression, and asthma.
Lipitor, for example, is the most commonly prescribed prescription drug to reduce cholesterol and prevent heart disease. It is also a single-source drug with no generic equivalent. While there are other medications (called “statins”) that reduce cholesterol, it is believed that Lipitor’s unique active ingredient makes it especially effective for certain patients, particularly those with acute coronary syndrome or those that have already had a heart attack
In many cases, minority communities are disproportionately impacted by the practice. According to the Center for Disease Control and Prevention’s Summary Health Statistics for U.S. Adults: 2006, 31.6% of non-Hispanic blacks, age 18 and over suffer from heart disease as compared to only 22.4 %of non-Hispanic whites. The American Hearth Association lists diseases of the heart and stroke as the No. 1 killer of Latino/Hispanic Americans. They claim the lives of 28.6 percent of the more than 122,000 Hispanics or Latinos who die each year, with cancer follows, at19.7 percent. On average, Hispanic Women develop pre-hypertension indicators such as obesity ten years earlier than White women, at a rate of 32% contrasted to the incidence in White women at 17%.
Similarly, there is repeated evidence of the connection between poverty and poor health such as obesity, a high sugar diet which can lead to diabetes and heart disease, exposure to pollution and other toxins which contribute to respiratory ailments and asthma, as well as depression.
Insurance companies use formularies to categorize drugs. Formularies are typically comprised of three tiers with Tier 1 consisting of generic medications, Tier 2 consisting of proprietary (brand name) medications, and Tier 3 including proprietary drugs for which no generic exists as well as other more expensive medications.
Patients pay the least for Tier 1 drugs, while paying more for Tier 2 drugs, and even more for Tier 3 drugs which are typically called non-preferred. For some employee and individual benefit plans, Tier 3 drugs may not be covered. Other restrictions include: Medical Exception; whereby a patient and doctor request a medical exception, which must then be granted by the insurance company; Prior Authorization/Pre-Certification of the drug by the insurance company, Quantity Limitations, and Step Therapy (Step Protocol): prerequisite medications (one or more) prior to approval of the physician-prescribed drug.
Of the major HMOs operating in New York, 14 place restrictions on medications that are disproportionately required by African-American and Hispanic-American New Yorkers.
Of the largest Insurers, Oxford had the most restrictions on drug coverage, placing restrictions on 13 of the 19 single source drugs needed to treat conditions from which African Americans and Hispanic Americans disproportionately suffer, and 18 restrictions overall.
Aetna and Health Net are tied at second place with a total of 17 restrictions each on 10 and 13 drugs respectively. Finally, Independent Health Association restricts access to 12 drugs for a total of 16 restrictions overall.
Oxford and Independent had the most drugs listed under the expensive third tier, 9 and 4 drugs respectively.
GHI, Aetna, and Excellus listed the largest requirement of step therapy, while Independent required prior authorization most frequently.
Health Net had the highest incidence of quantity restrictions, placing limits on 13 medications, followed by Aetna (10) and Oxford (9).
Of the drugs surveyed Lipitor and Singulair are the most restricted. Lipitor was restricted by 8 of the 15 companies, with a total of 19 restrictions. Singulair, a preventative medication for asthma, has 14 restrictions by 11 companies that limit access.
For the 9 medications for mental health-related conditions, 12 companies had restrictions in place. There was a total of 14 restrictions placed on Lexapro by 10 different companies. Abilify and Cymbalta were restricted by 8 HMOs totaling 10 and 11 restrictions each.
Addabbo supports existing legislation, which would require that all medically necessary prescription medications approved by the FDA be covered by the insurance company.
