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Return to Expedite-Rx Home Page The Medicare-Funded Drug Benefit – "A Horse Designed by a Committee" Tom Curb, R.Ph. (There is an old adage that "A camel is a horse that was designed by a committee." The same applies to the funded Medicare Drug Benefit. After a less than auspicious start highlighted by outright misrepresentations of cost followed by a misleading member handbook, now special interests - the drug cartel, legislators, the administration, lobbyists, PBMs, actuaries, and anyone else with a "dog in the fight" have begun adding their versions of humps, eyelid flaps, split lips, and big flat feet to good ol’ Trigger – the initial, less costly version of the drug benefit that the administration sold to Congress, taxpayers, and underwriters – including "Part D" employers.) New York Times -June 14 –"As companies devise insurance policies for the new Medicare drug program, federal officials are pressing them to offer a surprisingly generous array of…drug choices. Insurers worry that Medicare…will make it hard for them to control the costs of the program (by) requiring prescription drug plans to cover more drugs than anyone expected, increas(ing) costs and upward pressure on premiums. (The administration’s initial 15% to 30% projected "savings" would require greater restrictions on patients' choices.) Note: While this larger selection may seem good for enrollees, the inevitably higher-priced drugs will also "eat up" enrollees insured benefit, and many more will reach the self-pay "donut hole" faster, after which enrollees will have to cover the next $2850 in costs out of their own pockets.Then, on June 27, Associated Press reminded us that "although s topping their use abruptly can lead to seizures and dangerous, life-threatening problems, Medicare won't cover some drugs commonly used to treat anxiety, insomnia and seizures. People on Medicare who take Xanax, Valium, Ativan and other types of the benzodiazepines will have to look elsewhere for coverage or switch to a different, less addictive medication." (Gosh, do you think this coverage denial could have been designed to force folks to Ambien and its ilk - which of course will generate billions more for manufacturers. By the way, my utilization reviews indicate that Ambien is just as subject to abuse as any of the cheaper, generically-available benzodiazepines.)And now, horror of horrors, CNN reports – "The House voted overwhelmingly Friday to ban Medicare…from paying for erectile dysfunction drugs like Viagra." (Although I have consistently recommended that "my" plans not cover these drugs, most did – and still do – and some patients really believe they work. This Medicare denial, which like its denial of some anti-anxiety drugs, creates a serious healthcare crisis that none of the above-mentioned "interested parties" seem to want to talk about – potential for dangerous and even-deadly drug interactions.) Many enrollees "looking elsewhere" for their non-covered drugs will obtain them from less-expensive sources outside their Medicare plan’s provider network, and in doing so will create corrupted patient profiles. And, all of these drugs – I repeat – all of them - have the potential to interact dangerously with many Medicare-covered drugs that enrollees might be taking. In addition to the obvious risk to enrollees, such "benefit holes" present a huge potential for increased medical costs for every involved insurer – Medicare, insurance companies, and Part D employer benefit plans. This Funded Medicare Drug Benefit is turning into a perfect example of why there should never be "too many cooks in the kitchen."
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