Part "D" for "Defective" — The Medicare Drug-Benefit Chaos (NEJM)

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Good article and polling data from the Kaiser Family Foundation. If you're unfamiliar with the Kaiser Foundation and interested in Public Health, they are worth a look.

Part "D" for "Defective" — The Medicare Drug-Benefit Chaos

Jerry Avorn, M.D.


A recent survey by the Kaiser Family Foundation quantifies what many of us have seen firsthand: the new Medicare drug benefit is having a troubled infancy (see bar graphs). The data reflect the experience of elderly people who were well enough to participate in a survey; other reports make clear that matters are far worse for those with medical or cognitive disabilities.

http://www.kff.org/kaiserpolls/upload/7463.pdf

(Data are from the Kaiser Family Foundation Health Poll Report Survey, conducted February 2–7, 2006.)

True, the program provides drug benefits for some Americans who previously had none. But because of its strange design, enrollment is falling far short of expectations. Officials in the Bush administration boasted that 25 million people are receiving benefits through Medicare Part D. But the government's data reveal that about 20 million of them already had adequate drug coverage through Medicaid, their employers or unions, or health maintenance organizations; as of late February, the new benefit was providing only 12 percent of the elderly with coverage they did not already have.1

In many cases, the program worsened patients' situations, with a particularly heavy burden falling on indigent Medicaid enrollees. Before the new entitlement, most had virtually all their medications covered fully by the states. But on January 1, 6.2 million of these vulnerable elderly were reassigned to one of the private insurance companies designated by Medicare to run its program. Word of these arrangements didn't always reach the patients, insurers, or pharmacies accurately, and tens of thousands of indigent patients were told to get prior authorization, pay a large initial deductible, or make substantial copayments for regularly used medicines they previously received at no cost.2 Thousands discovered that the drugs they had been taking for years were not covered by their new insurers. Clinical crises ensued, and 37 states had to provide emergency payments for frail citizens.3

Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation. Proponents of the first explanation suggest that Medicare and its private insurers were not ready for the millions of applicants and hundreds of millions of prescriptions that poured in early in January, in a flood that they were ill prepared to handle. The layer of insurance companies inserted into the process in the name of efficiency exacerbated the confusion. An administration and Congress guided by Ronald Reagan's principle that "government is not the solution to our problem; government is the problem" put his vision into practice in a chillingly convincing way.

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http://content.nejm.org/cgi/content/full/354/13/1339?query=TOC


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