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Health Insurance & Affordable Care Act

Medicare Rx Prices Top VA by Half

Group Blames Lack of Bargaining Power for Difference

The Fight Continues continued...

The group compared VA's lowest prices to the lowest prices available through a multitude of plans operating in the Washington, D.C., Maryland, and Virginia region, and in Ohio -- as listed on the Medicare.gov web site.

Pollack says the prices were comparable to what would be offered in the rest of the country.

Pharmaceutical manufacturers strongly opposed allowing the government to bargain for lower prices when Congress debated the Part D law in 2003. Several lawmakers continue to push legislation granting Medicare that authority.

Estimates of the program's 10-year cost have ballooned from $395 billion in 2003 to nearly $750 billion today.

"If the prices of drugs are high and inappropriately high, that means that benefits are worse than they could be," Pollack says.

Industry groups and Medicare officials did not dispute the findings. They suggested that the wider access to drugs available under Medicare make it more difficult to control costs than under the more restricted drug list of the VA.

"Medicare beneficiaries would never accept a drug benefit with sharply reduced drug choices and very limited access to pharmacies," says Mark Merritt, president of the Pharmaceutical Care Management Association, a group representing companies set to manage Medicare drug benefits.

Gary Karr, a spokesman for the Centers for Medicare and Medicaid Services, says that insurers and management companies have been successful in negotiating cheaper drug prices.

"It's cheaper than it was expected to be and the coverage is better than it was expected to be," he says.

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