In her opinion contribution, "Senate budget deal benefits insurers at the expense of sick seniors," Sally Pipes gets it wrong. I initiated this reform in Medicare Part D. It was motivated to allow Medicare Part D beneficiaries to have parity in drug expenses with commercial insurance patients. HHS quickly adopted it because an Annals of Internal Medicine review of the subject, among others, showed that patient non-adherence to their prescribed medications results in unnecessary ER visits and hospital admissions.
A New York Times piece showed that statin use by Medicare beneficiaries dropped from 58.9 percent at 6 months down to 41.6 percent at 2 years. Lower cost of medication was identified as one way to alleviate this problem. Worse, a third of kidney transplant patients do not take their anti-rejection medication as prescribed, 41 percent of heart attack patients do not take their blood pressure medications as prescribed, and half of children with asthma do not use their inhalers as prescribed.
In addition, the above mentioned Annals of Internal Medicine analysis that reviewed the current data showed that 125,000 deaths per year, 10 percent of hospitalizations, and an unnecessary excess cost to the healthcare system of between $100 and $289 billion, is annually due to non-adherence to prescribed medications. Not being able to afford their medications is a leading, if not the leading, reason for non-adherence with prescribed medications given by chronically ill patients. Removal of the donut hole and copayments should significantly alleviate this non-adherence to prescribed medications.
As far as benefiting Part D insurers, Pipes missed that removing the copayments effectively eliminates the tier system that is used to dictate which medication a patient takes. Increasing copayments for non-preferred medications is the tool they use to dissuade patients from using them. The concept of preferred medications has over the years been one tactic to take away the physician from determining what is best for his/her patient and placing that decision upon the whim of insurance companies. Attempts to remove non-preferred medications from covered medications by Part D plans may bring the wrath of the public and Congress upon them.
While pharmaceutical companies will welcome the demise of the tier system, they will face having to give the same copayment benefits that commercial insurance patients currently have onto Medicare patients. Failure to do so may bring down that same wrath of the public and Congress onto the pharmaceutical industry.
Although the New York Times states that there may be an increased cost to CMS of $82.1 billion over the next decade due to this reform, it should meet or exceed this burden with savings from unnecessary admissions to emergency rooms and hospitals. Do not forget the improvement in quality of life for Medicare beneficiaries and reduction of unnecessary deaths due to non-adherence to prescribed medication that this reform will bring. Both of them are priceless.
Kenneth Braunstein is a doctor from Sandy Springs, Ga., near Atlanta.