NEJM Perspective Pieces Examine Medicare Drug Benefit

The New England Journal of Medicine on Thursday published two perspective pieces about the Medicare prescription drug benefit. Summaries appear below.

• "The First Months of the Prescription Drug Benefit: A CMS Update:" In the NEJM perspective piece, CMS Administrator Mark McClellan and Peter Bach, a senior adviser at CMS, write that after "substantial problems" at the beginning of the Medicare drug benefit's implementation, the benefit is "widely used." According to McClellan and Bach, of the 42 million Medicare beneficiaries eligible for drug coverage, more than 31 million were enrolled in the benefit by early May, including 6.2 million dual eligibles. CMS has been working to fix the problems in implementing the benefit, the authors write, adding that by April 1, reports of problems at pharmacies decreased by 95% and that the wait time for Medicare's telephone hotline was fewer than two minutes. McClellan and Bach write that there are three goals for the benefit as it moves past the implementation phase: "ensuring that competition promotes simplicity as well as better benefits, minimizing drug prices while providing access to needed drugs and intensifying outreach to lower-income beneficiaries who do not yet have comprehensive drug coverage." The authors conclude that the administration "still ha[s] our work cut out for us," adding that CMS must ensure beneficiaries have easy-to-comprehend choices available to them and must work with physicians and other providers to make the benefit available to low-income beneficiaries (Bach/McClellan, NEJM, 6/1).
  
  
• "Medicare Part D: The Product of a Broken Process:" In the NEJM perspective piece, Rep. Louise Slaughter (D-N.Y.) examines the problems with the Medicare prescription drug benefit, arguing that they are a result of the "undemocratic way in which the plan was authored and passed." According to Slaughter, the benefit focuses more on the needs of drug company and insurance lobbyists than on the needs of beneficiaries by not allowing the purchase of drugs from Canada and by adding patent protections for brand-name medications, measures that Slaughter says will increase profits for the drug industry by $139 billion over the next eight years and cause states and taxpayers to lose money. Slaughter adds that as of April, six million beneficiaries had not yet enrolled in the benefit, including 80% of beneficiaries who have the lowest annual incomes. The 2003 Medicare law "violates the tradition, spirit and intent of Medicare," Slaughter writes (Slaughter, NEJM, 6/1).