Most Prescription Drug Benefit Plans for Medicare Would Exclude ‘Needy’ Seniors, Policy Brief Says

Drug coverage plans that rely on income level alone to determine eligibility for prescription drug benefits would exclude "a significant proportion of beneficiaries with true needs," according to a new Commonwealth Fund policy brief. In the brief, titled "Designing a Medicare Drug Benefit: Whose Needs Will Be Met," Bruce Stuart of the University of Maryland and colleagues examined the 1995 and 1996 Medicare Current Beneficiary Surveys to determine the best indicator of need for drug coverage or a subsidized premium. According to the study's authors, while low-income Medicare recipients who lack health insurance and have high pharmaceutical bills may have the "most urgent need" for a prescription drug benefit, no "single measure" provides an adequate indicator of beneficiaries' "need for consistent and stable" coverage. In addition, they found that both the level of required patient contributions and provided government subsidy would serve as important factors in the effectiveness of prescription drug benefit plans. Forcing seniors to pay high premiums under a Medicare drug benefit proposal -- regardless of whether the government or private insurers administered the plan -- would attract only "high-cost" beneficiaries and "erode the risk pool," the authors warned. They also maintained that a "complicated combination of income, access to drug coverage, drug costs and health status" dictates the need for a prescription drug benefit. Pointing out that no