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Health Care Reform:

Health Insurance & Affordable Care Act

Seniors Who Max Out Drug Benefits Often Quit Medicare Managed Care


Looking ahead doesn't improve the landscape. In an editorial accompanying the JAMA study, Harvard Medical School professor Joseph Newhouse, PhD, predicts that the future will bring new reductions in managed care pharmaceutical benefits that will make the plans less attractive for those seniors with the most need for drug coverage.

Though nearly two-thirds of Medicare beneficiaries have some form of drug coverage, Sager tells WebMD that Rector's study helps illuminate problems with that figure. "It turns out that many of the two-thirds who do have a drug benefit have terrible benefits that melt like snow on a spring day if you have a substantial need for prescription drugs." He backs a new drug benefit and pharmaceutical price controls.

According to Newhouse, a Medicare drug benefit with high allowances on covered spending is crucial. "Without back-end or catastrophic coverage for drugs, Medicare beneficiaries are likely to continue coverage-motivated changes of their health plans," he writes.

Rector also favors a generous new drug benefit. He tells consumers, "Be aware that if a drug benefit is passed and it is limited financially, that it may cover some of your costs but might not make those medications available consistently enough to cover whatever it takes to treat cholesterol, blood pressure, or infections throughout the year."

"I'm afraid that what is going to happen is we're going to have this patchwork of benefits," he tells WebMD. "Medicare will provide some, and other people will provide some. Then you'll end up like my mom, who is so confused, she can't figure out who is paying for what. She then just quits taking her medications out of frustration."

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