Medicare Part D's Important Influence on Access and Adherence to Medicines

Medicare Part D's Important Influence on Access and Adherence to Medicines

07.10.12 | By Greg Lopes

Medicare Part DThe Supreme Court has ruled, it's the middle of summer, and many people are on vacation and not focusing on healthcare, but I've been thinking about access and adherence to prescription medicines. This shouldn't be too surprising; I think about this issue a lot.

I've written here many times that when prescribed - and taken - properly, medicines help keep patients healthy and control healthcare costs.

So where is this happening? Comprehensive medication management programs are good and work to ensure patients are taking the most effective treatment. But it occurs to me that the best example is the Medicare prescription drug benefit, Part D.

Since it was implemented in 2006, more than 29 million beneficiaries have enrolled in a Part D plan. The result? There are a lot of Medicare beneficiaries now with access to medicines through insurance coverage that wasn't there prior to 2006.

Proper access to medicines implies affordability. This year, the average monthly Part D premium is about $30. That is slightly lower than the average premium amount in 2011 and 46 percent lower than initial projections. Premiums have been around this amount since the program started.

Not only are premiums affordable, so too are medicines that Part D is covering. Don't take my word for it. The March 2011 report by the Medicare Payment Advisory Commission (MedPAC) found that drug prices in the program grew cumulatively at 1 percent over a four-year period.

In this year's report, the commission stated that, indeed, access in Part D is working. "In general, Medicare beneficiaries appear to have good access to prescription drugs. All individuals have access to dozens of Part D plan options, and many continue to receive drug coverage through former employers. Surveys indicate that beneficiaries enrolled in Part D are generally satisfied with the Part D program and with their plan."

Providing such unprecedented access at affordable costs is a testament to the program's unique design of using competing private plans to deliver drug coverage, and basing Medicare Payments to Part D plans on bids submitted by health plan sponsors instead of setting prices administratively. In short, private plans competing with each other for enrollees are keeping costs in check.

And look at what happens within Medicare when beneficiaries have access to medicines. A study in the Journal of the American Medical Association found that Part D saves Medicare about $1,200 per year in hospital, skilled nursing homes and other costs for each senior who previously lacked comprehensive prescription drug coverage. This resulted in an overall savings to Medicare of $13.4 billion in 2007, the second full year of Part D.

Access + Adherence = Healthier Patients & Lower Overall Health Costs. This program is making a big, positive difference in our healthcare system. I'll be discussing Part D further as more information comes out on the program, and the open enrollment period for 2013 period comes around in October.

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