MEDICARE Rx: Proposal Would Cover Drugs for Poor Seniors
In "a surprising illustration of how gridlocked the Medicare debate has become," a proposal in this week's New England Journal of Medicine to help poor Medicare beneficiaries pay for prescription drugs is drawing fire from all sides. While advocates for the elderly want full prescription drug coverage despite an estimated price tag of up to $40 billion, the new proposal would cost just $4 billion to cover prescriptions for the 10% of poor seniors who earn too much to qualify for Medicaid but who still "face terrible choices, such as whether to buy medicine or food" (Lagnado, Wall Street Journal, 3/4). Though drugmakers declined to take a position on the new proposal, they fear total prescription drug coverage would allow the government to negotiate lower prices and are pushing instead for a Medicare subsidy for private prescription drug insurance (Convey, Boston Herald, 3/4).
Stephen Soumerai and Dennis Ross-Degnan of Harvard Medical School recommend that seniors earning less than 200% of the federal poverty level ($16,000 a year for individuals) receive prescription drug coverage with copays on a sliding scale of $1 to $5, based on income. The benefit would be modeled after state pharmacy assistance programs and funded like the Children's Health Insurance Program, which has a 30% higher federal contribution than Medicaid (NEJM, 3/4 issue). The authors conclude that "the most vulnerable patients have the least access to medications," a problem likely to grow worse as drug prices rapidly outstrip increases in Social Security income. The authors argue the proposal could save Medicare money by reducing the hospitalizations that ensue when seniors forego life-saving medicines such as insulin, lithium and heart drugs. Drugmakers could also benefit since poor seniors currently use only a "fraction" of the drugs they need. "Let us get them taken care of first -- at least do this," Soumerai said (Wall Street Journal, 3/4).