Medicare drug benefit could do harm to poor, elderly, and disabled

December 28, 2005

A perspective article by Stephen Soumerai, professor in the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care), suggests that the new Medicare Drug Benefit may be harmful to the health of the poor, elderly, and disabled, the so-called "dually eligible" beneficiaries enrolled in both Medicare and Medicaid. This article appears in the Dec. 29 New England Journal of Medicine, and was lead by Rachel Elliott, a Commonwealth Fund Harkness Fellow at DACP.

The short time frame that dually eligible beneficiaries, currently about 7.2 million people, were given to choose and transition to a new drug formulary--only six weeks--raises several concerns, Soumerai writes. This includes the risk that beneficiaries may have difficulty transitioning and navigating the complex system.

"This group of dually eligible beneficiaries are especially challenging to reach and educate about coverage changes," Soumerai writes. He suggests that the transition period should be extended to at least one year, creating a longer "crossover" period where beneficiaries can continue to obtain medication through Medicaid.

Additionally, a potential long-term problem is that these beneficiaries may discontinue use of essential medications because of increased copayments for drugs in many states. There is also the risk that some essential drugs are now not covered, which could create significant health problems in the future.

"The Center for Medicare and Medicaid Services (CMS) should commission rapid studies to examine the impact of formulary restrictions and changes in cost sharing on the use of essential medication and health outcomes," Soumerai writes. He suggests that CMS should also modify policies that cause underuse of essential medications or harmful health effects.
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Harvard Medical School

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