When Medicare Part D took effect on January 1, 2006, nobody anticipated it would create a system that was messy at best, and disastrous at worst. Just five years after the Medicare Prescription Drug, Improvement, and Modernization Act created Medicare Part D, there are already clamors for a Medicare Part D White Paper to create a solution to a burgeoning problem.

Medicare recipients are able to join Medicare Part D through either of two plans types: (a) a stand-alone Prescription Drug Plan (PDP) or a (b) MA-PD plan or a Medicare Advantage Plan with prescription drugs benefits.  Not all Part D plans are created alike. Each plan provider has an individual set of tiered formularies. What this means is that while your prescription drugs may be covered under one type of plan, it may not be covered at all in another.

 

There have been a lot of complaints on Medicare Part D, which are just incidental to the fact that the government had intended for Medicare Part D to be managed by the private sector. Chief of these complaints is the fact that there are just too many plans – in some places there are 100 tiered plans from 50 different providers.  Another complaint is that drug prices are commercial, meaning the federal government has been unable has been unable to negotiate the prices of drugs with drug companies. In effect, Medicare Part D recipients do not have adequate access to the drugs that they need.

THE JUICE VS MEDICARE PART D

The main juice against Medicare Part D is that the overall system has been, well, unsystematic for the most part. Oh sure, the Centers for Medicare and Medicaid Services does reimburse plan providers for prescription drug claims. But between Part D plan providers the formularies have been unregulated. Commercial prescription drugs overall have not been that accessible and the quality of healthcare for Medicare recipients has been compromised.

All other Medicare programs are managed by each state while private plan providers manage Medicare Part D. (The Centers for Medicare and Medicaid Services reimburses them.) The result? States are cut off from accessing data related to prescription drug claims of Medicare beneficiaries. This bars states from managing more effectively the total healthcare of their constituents, especially those who are dual eligible, or eligible for both Medicare and Medicaid.

Should we then scrap Part D then and start over with the old Medicare program of Part A and Part B? The answer is a resounding NO. Why? Because before Part D, Medicare beneficiaries could only access prescription drugs if they were incidental and necessary to the beneficiary’s hospital and outpatient care. Back then, there were also a lot of restrictions on access to prescription drugs.

What the federal government can and should do is regulate the formularies of Part D plan providers and, in the process, create a more integrated and systematic national health care system. In doing so, the federal government would be making more prescription drugs more available to the vast majority of Part D recipients. Medicare Part D should be catering to needs of Medicare recipients than to profit-loss margin of drug companies.