[Extensions of Remarks]
[Pages E1879-E1880]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

INTERNATIONAL COMPARISON OF PRESCRIPTION DRUG COVERAGE FOR THE ELDERLY
SHOWS UNITED STATES LAGS FAR BEHIND MAJOR INDUSTRIALIZED NATIONS

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HON. FORTNEY PETE STARK

of california

in the house of representatives

Wednesday, September 15, 1999

Mr. STARK. Mr. Speaker, my staff recently conducted an analysis of
eight industrialized nations and found that the United States is the
only country lacking government-sponsored prescription drug coverage
for its senior citizens.
The chart I am submitting today clearly illustrates our Government's
failure to provide pharmaceutical coverage for seniors who need it
most.
Canada, the United Kingdom, Germany, Japan, France, Sweden, and the
Netherlands all provide universal prescription drug coverage for the
elderly. The UK and France fully exempt the elderly from copayments for
certain prescription drugs. Sweden provides a similar exception, but in
no case charges seniors more than a $10 copayment for prescription
drugs or more than $200 in annual out-of-pocket expenses. The findings
clearly show that elderly Americans are being denied a fair system of
drug coverage.
Further, recent analyses show that drug prices in the United States
are surging by 18 percent per year, with the result that more seniors
will be unable to purchase needed medications. Yet the elderly have a
particular need for prescription drug coverage, as seniors purchase
one-third of all prescription drugs while they only comprise 12 percent
of our population.
As employer-sponsored retiree health coverage in the United States
rapidly erodes and Medicare HMO's pull out of many markets and lower
existing drug benefits, it is time to recognize that the private sector
will never be able to guarantee drug coverage for all seniors. In
contrast, adding an outpatient drug benefit to Medicare would do
exactly that.
If so many other industrialized nations can provide prescription drug
coverage for their senior citizens, why can't we?
I urge you to support legislation to add a prescription drug benefit
to Medicare. If we do not, we will do great harm to millions of seniors
who lack any drug insurance to pay for medications their doctors
prescribe.
Contrary to what the pharmaceutical industry would have you believe,
the debate is not about price controls. The debate is about coverage.

[[Page E1880]]

GOVERNMENT SPONSORED PRESCRIPTION DRUG COVERAGE FOR SENIOR CITIZENS
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Country--
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United States Canada United Kingdom Germany Japan Netherlands France Sweden
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National Policy................. No outpatient All provinces Prescription drug Copayments range Free medical care Patient cost ``Essential No charge for
prescription drug provide coverage with co- from $5 to $7, for all sharing of 20 drugs'' (e.g., pharmaceuticals
coverage for prescription drug payments; depending on the individuals over percent, up to a cancer treatment) for treatment of
seniors under plans for senior exemptions from prescription. age 70 (over 65, maximum level. In require no cost chronic diseases.
Medicare. citizens, with some copayments Patients also pay if bedridden), addition, sharing; ``Normal $10 co-payment
Medicaid provides copayments that for people over the difference with nominal co- patients pay prescriptions'' for all other
prescription drug vary by province. age 60. between payments. Free difference (e.g., prescription
coverage for some government care includes between maximum antibiotics) drugs. Annual
low-income reimbursed price ``supply of reimbursed price require 30% cost copayments capped
seniors; policies and the market medications'' and the market sharing; at $200, for
vary by state. price (typically Additional price, similar to ``comfort'' drugs combination of
the difference nominal co- Germany. (e.g., prescription
between generic payment for tranquilizers) drugs, physician
and name brand. individuals require 60% cost consultations,
taking more than sharing. Elderly physical therapy,
one, two to individuals with and hospital
three, or six or a need for inpatient care
more prescription multiple drugs
drugs per day. are reimbursed
for all costs.
Does this coverage exist for non- No. Low-income No. Extent of Yes. However, Yes............... Yes. However, Yes............... Yes. However, Yes
elderly?. individuals may coverage varies coverage for coverage for coverage for
be covered under by province. elderly is more elderly is more elderly needing
Medicaid. Varies generous. generous. multiple drugs is
by state. more generous.
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Source: The Boston Consulting Group, Inc. ``Ensuring Cost-Effective Access to Innovative Pharmaceuticals: Do market Interventions Work?'', April 1999. Graig, Laurene A., Health of Nations: An
International Perspective of U.S. Health Care Reform. (Congressional Quarterly Inc. Washington, DC: 1999). Lassey, Marie L., Lassey, William, R., and Martin J. Jinks. Health Care Systems
Around the World: Characteristics, Issues, Reforms. (Prentice Hall, New Jersey: 1997).

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