The future of Medicare Part D drug plans--results from a roundtable discussion.
BACKGROUND
The Medicare Prescription Drug, Improvement, and Modernization Act, signed into law in 2003, provided access to prescription drugs for elderly Americans. The Part D benefit continues to evolve. Changes in plan designs, the impact of the doughnut hole on beneficiaries, and increased cost shifting have the potential to hamper the future of the Part D benefit.


OBJECTIVE
To discuss factors that will likely have the most impact on the future of Medicare Part D from a patient and payer perspective.


CONCLUSIONS
The continued growth of the elderly population is expected to place an increasing burden on the services provided through Medicare. Given the current financial situation, it has been predicted that Medicare's Hospital Insurance Trust Fund will be depleted by 2019. To provide quality benefits and remain competitive, health plans are continually evaluating and redesigning their Part D benefits. However, the current regulatory environment is preventing plans from offering innovative products and designs that could lower costs to beneficiaries. The growing number of beneficiaries hitting the doughnut hole is also becoming a concern for both beneficiaries and health plans. More beneficiaries are reaching the doughnut hole, and this has resulted in changes in beneficiary behaviors, including stopping medications, switching to alternative drug classes, and reducing medication use. Because of the increasing concerns about Medicare's sustainability, it is anticipated that the government may become more involved.


CONCLUSIONS
As the health care landscape continues to change, payers will be challenged to offer benefit designs that are affordable to elderly beneficiaries. For its part, the government must allow plans to design benefits that will improve the overall quality of care. Additionally, closer attention must be given to the growing number of beneficiaries hitting the doughnut hole and its potential adverse clinical and economic consequences.
Balfour
Donald C
DC
Sharp Rees-Stealy Medical Group, San Diego, California 92101-2600, USA. donald.balfour@sharp.com
Evans
Steven
S
Januska
Jeff
J
Lee
Helen Y
HY
Lewis
Sonya J
SJ
Nolan
Steve R
SR
Noga
Mark
M
Stemple
Charles
C
Thapar
Kishan
K
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D011307:Drug Prescriptions / Q000191:economics*; D033161:Government Regulation; D006801:Humans; D007342:Insurance Benefits / Q000191:economics* / Q000639:trends*; D054524:Medicare Part D / Q000191:economics* / Q000639:trends*; D017008:Negotiating; D014481:United States