title: Providing medications for low-income and indigent patients: success for Medicare Part D walks in the back door.
abstract: Hailed by politicians as long-awaited assistance for seniors and the disabled with the rising costs of prescription drugs, Medicare Part D primarily helps indigent and low-income patients. Moreover, poverty-level patients will find stable prices and versatility in obtaining prescription medications under Medicare D. For low-income patients using pharmacies of their choice--including hospital pharmacies, if they so choose, there are reduced transportation hassles and reduced associated expenses. Poverty-level patients with the additional Social Security subsidy have no deductible and no gaps in their coverage. However, two unintended, unforeseen circumstances occurred with the implementation of Medicare Part D: 1. The exodus of patients from hospital pharmacies and from central pharmacies (e.g., pharmacies serving a particular HMO plan) to neighborhood pharmacies lowered the volume of medications provided and stabilized a teetering and overwhelmed system of prescription drug provision; and 2. Many hospital pharmacies charge on a sliding scale, and the users of specialty medications (e.g., Zyprexa) with large copays under Medicare Part D found minimal costs and big savings at the low end of the sliding scale (for example, $5). The biggest successes for Medicare Part D truly came through an unintended back door and serve as an economic advantage for the poor.
authors.affiliation: Robert Stempel School of Public Health, Florida International University, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Flaer
authors.forename: Mustafa Z
authors.initials: MZ
authors.lastname: Younis
authors.forename: Robert M
authors.initials: RM
authors.lastname: Malow
mesh_terms: D016527:Drug Costs; D006297:Health Services Accessibility; D054524:Medicare Part D / Q000458:organization & administration*; D004364:Pharmaceutical Preparations; D011203:Poverty; D014481:United States
chemical_list: D004364:Pharmaceutical Preparations