title: State-based versus federal-based approaches to reducing the Medicare pharmaceutical coverage gap.
abstract: A state-based approach, such as the Immediate Helping Hand proposal put forward by the Bush administration, is likely to be less effective than a federal-based approach at reducing the Medicare pharmaceutical coverage gap. In addition, the voluntary nature of a state-based approach, coupled with variations across states in existing coverage benefits and the limited reach of state pharmacy assistance programs, would likely lead to a perpetuation of uneven coverage. This article argues in favor of adding a federal-based universal prescription drug benefit to Medicare on the grounds of both equity and empirical evidence. Adding a universal drug benefit to the currently existing Medicare program would extend application of the social insurance concept across hospital care, physician service, and prescription drug coverage components of Medicare. As a result, a more equitable distribution of prescription drug coverage would be promoted while mitigating the effects of selection risk.
authors.affiliation: Tufts Center for the Study of Drug Development, Boston, MA 02111, USA. joshua.cohen@tufts.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000368:Aged; D035082:Federal Government; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D017054:Insurance, Medigap; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000458:organization & administration*; D013219:State Government; D014481:United States