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Medicare drug coverage gap
Throughout Medicare's existence, the basic federal health insurance program for seniors and disabled people has never paid for outpatient drugs. Medicare beneficiaries who are not covered by a supplemental drug insurance plan, corporate retirement program, Medicaid, or a Medicare HMO must use their own money for prescription drugs taken outside the hospital.
The medicare drug coverage gap to cover poor, near-poor, and low-income Medicare beneficiaries, not eligible for Medicaid, with incomes up to about $16,000 for a single person. Such a program would target about 4 million elderly and disabled people with the greatest economic and clinical need, and would build on the best existing federal and state pharmacy assistance programs. Their plan also includes federal financial contributions to states to encourage their participation; lower patient charges for the lowest-income enrollees; access to a comprehensive list of effective drugs; and enhanced education of physicians to reduce over- or under-use of medications.
The medicare drug coverage gap to offer universal Medicare drug coverage as well as another bill. New data show that among Medicare beneficiaries with incomes less than $10,000, almost two thirds have no drug coverage and purchase only half as much medication as those with employer coverage--despite being sicker. With drug expenditures continuing to escalate, Medicaid programs and managed care organizations across the U.S. have capped some drug benefits.
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Limits on prescription drug benefits have made it more difficult for the low-income elderly to afford the prescription drugs they need, which often increases health care costs and may result in poorer patient outcomes. For example, in New Hampshire, a Medicaid policy change curtailed unlimited drug coverage to a limit of three prescriptions per month. While the cap was in effect, excess nursing home and hospital stays cost Medicaid more than the statewide savings in drug expenditures.
Studies suggest that coverage gaps are causing millions of low-income elderly and disabled to reduce their use of clinically essential medications. Further another research has demonstrated clearly that not only does this make people sicker, but there are increased hospital and nursing home admissions, and more costs to the health system as a whole. Without timely federal and state Medicare policy reform, the problem of inadequate coverage for costly prescription drugs among low-income elderly and disabled Americans will soon become a human and economic catastrophe.
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