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Commentary

Three simple solutions to cure Medicare prescription-plan ills
Richard G. Stefanacci, The Philadelphia Inquirer, 4-16-06

Stefanacci probably overstates his case, but his article is a short, cogent analysis of concerns that have dogged the Medicare drug plan since its inception. Unfortunately, his "simple solutions" would most likely prove to be counterproductive.

Basically, the difficulties are in the areas of enrollment and access to drugs. Seniors are confused about how to determine the most appropriate plan and then, once enrolled, how to get their medications...

Finding the ideal plan is a personal decision based on current and future medication needs, pharmacy preference, and other variables, so having options is helpful—but only if one is expert in determining which is best...

First, the government should give seniors eight weeks beyond the May 15 deadline to enroll. Also, during that time, let seniors change plans if they're finding their first choice inappropriate.

Second, the government should get health–care providers involved in the selection process. Family and friends were encouraged to play a role, but the expertise needed to assess the options and make evaluations is often outside their reach.

Better to involve a health–care professional. For example, Connecticut is paying pharmacists to provide this personalized service for seniors enrolled in the state's pharmacy assistance program.

The other problem, lack of access to medications, is being caused by the private companies operating the drug plans. They have a limited list of medications available and they put restrictions on these meds that make them difficult to obtain...

These simple steps—extending the enrollment process, providing the resources health–care providers need to help seniors find the right plan, and letting health–care providers determine what's medically necessary—would assure that seniors have access to all the prescription drugs they need.

Stefanacci is surely correct to point out that the complexity of the sign–up process for Medicare Part D slowed initial enrollment. Still, recent surveys show that seniors are generally satisfied with the plans they have chosen, and that picking a plan was actually less complicated than they expected. Medicare officials are already discussing ways to streamline the number of drug plans offered in the program, so seniors will have fewer, more clear cut, choices in the future.

Medicare should probably also stick to its May 15 deadline. This will encourage seniors—presumably healthy seniors with modest drug costs—who are sitting on the sidelines, to sign up for a drug plan now. Getting these seniors to choose a drug plan while they have low health care costs will help keep the Medicare drug benefit financially sound, and presumably, keep these seniors more healthy as they age.

Finally, there is already a review process in place for seniors to get access to medically necessary medications not covered in plan formularies. Private plans should be able to set their own formularies—seniors who want the broadest possible access to medicines can sign up for a plan with a higher premium or deductible, and seniors who want lower costs can choose a program with a lower premium, but more formulary restrictions.

Choice and competition will help every senior find a drug plan that fits his or her situation and medical needs. Medicare certainly needs more reforms, just not the ones that Stefanacci is proposing.



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