The demise of both the Medicare Catastrophic Coverage Act of19881 and the 1993 Clinton plan for health care reform2,3 resultedin missed opportunities to correct a glaring defect in the Americanhealth care system inadequate coverage for costly prescriptiondrugs among low-income elderly and disabled persons. Althoughsometimes misused, prescription drugs are effective treatmentsfor many illnesses.4,5 Most Medicare enrollees do not have adequatecoverage for outpatient drug expenditures, since Medicare coversonly drugs prescribed for inpatient use. Lack of coverage foroutpatient drug expenditures is a formidable barrier to effectivetherapy. In this article, we describe the . . . [Full Text of this Article]
The Problem
Poverty and Lack of Coverage
Rising Costs and Poorer Access
Adverse Consequences
Current Proposals
A Feasible Solution
Standardized Eligibility
Shared Financing
Progressive Cost Sharing
Comprehensive Drug Formulary
Vigorous Control Mechanisms
Summary
References
This article has been cited by other articles:
Madden, J. M., Graves, A. J., Zhang, F., Adams, A. S., Briesacher, B. A., Ross-Degnan, D., Gurwitz, J. H., Pierre-Jacques, M., Safran, D. G., Adler, G. S., Soumerai, S. B.
(2008). Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D. JAMA
299: 1922-1928
[Abstract][Full Text]
Wroth, T. H., Pathman, D. E.
(2006). Primary Medication Adherence in a Rural Population: The Role of the Patient-Physician Relationship and Satisfaction with Care. J Am Board Fam Med
19: 478-486
[Abstract][Full Text]
Hsu, J., Price, M., Huang, J., Brand, R., Fung, V., Hui, R., Fireman, B., Newhouse, J. P., Selby, J. V.
(2006). Unintended consequences of caps on medicare drug benefits.. NEJM
354: 2349-2359
[Abstract][Full Text]
Kronish, I. M., Federman, A. D., Morrison, R. S., Boal, J.
(2006). Medication utilization in an urban homebound population.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 411-415
[Abstract][Full Text]
Wang, P. S., Avorn, J., Brookhart, M. A., Mogun, H., Schneeweiss, S., Fischer, M. A., Glynn, R. J.
(2005). Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives. Hypertension
46: 273-279
[Abstract][Full Text]
Spertus, J., Decker, C., Woodman, C., House, J., Jones, P., O'Keefe, J., Borkon, A. M.
(2005). Effect of Difficulty Affording Health Care on Health Status After Coronary Revascularization. Circulation
111: 2572-2578
[Abstract][Full Text]
Strum, M. W., Hopkins, R., West, D. S., Harris, B. N.
(2005). Effects of a medication assistance program on health outcomes in patients with type 2 diabetes mellitus. Am J Health Syst Pharm
62: 1048-1052
[Abstract][Full Text]
Klein, D., Turvey, C., Wallace, R.
(2004). Elders Who Delay Medication Because of Cost: Health Insurance, Demographic, Health, and Financial Correlates. Gerontologist
44: 779-787
[Abstract][Full Text]
Grant, R. W., O'Leary, K. M., Weilburg, J. B., Singer, D. E., Meigs, J. B.
(2004). Impact of Concurrent Medication Use on Statin Adherence and Refill Persistence. Arch Intern Med
164: 2343-2348
[Abstract][Full Text]
Rector, T. S., Venus, P. J.
(2004). Do Drug Benefits Help Medicare Beneficiaries Afford Prescribed Drugs?. Health Aff (Millwood)
23: 213-222
[Abstract][Full Text]
Gottlieb, J. L.
(2002). Helping Low-Income Patients Obtain Prescription Medications. Arch Ophthalmol
120: 1575-1576
[Abstract][Full Text]
Kennedy, J., Erb, C.
(2002). Prescription Noncompliance due to Cost Among Adults With Disabilities in the United States. Am. J. Public Health
92: 1120-1124
[Abstract][Full Text]
Chisholm, M. A., DiPiro, J. T.
(2002). Pharmaceutical Manufacturer Assistance Programs. Arch Intern Med
162: 780-784
[Abstract][Full Text]
Lewis, J. H., Schonlau, M., Munoz, J. A., Asch, S. M., Rosen, M. R., Yang, H., Escarce, J. J.
(2002). Compliance among Pharmacies in California with a Prescription-Drug Discount Program for Medicare Beneficiaries. NEJM
346: 830-835
[Abstract][Full Text]
Federman, A. D., Adams, A. S., Ross-Degnan, D., Soumerai, S. B., Ayanian, J. Z.
(2001). Supplemental Insurance and Use of Effective Cardiovascular Drugs Among Elderly Medicare Beneficiaries With Coronary Heart Disease. JAMA
286: 1732-1739
[Abstract][Full Text]
Borson, S., Bartels, S. J., Colenda, C. C., Gottlieb, G. L., Meyers, B.
(2001). Geriatric Mental Health Services Research: Strategic Plan for an Aging Population: Report of the Health Services Work Group of the American Association for Geriatric Psychiatry. AJGP
9: 191-204
[Abstract][Full Text]
Mitchell, J., Mathews, H. F., Hunt, L. M., Cobb, K. H., Watson, R. W.
(2001). Mismanaging Prescription Medications Among Rural Elders: The Effects of Socioeconomic Status, Health Status, and Medication Profile Indicators. Gerontologist
41: 348-356
[Abstract][Full Text]
Tamblyn, R., Laprise, R., Hanley, J. A., Abrahamowicz, M., Scott, S., Mayo, N., Hurley, J., Grad, R., Latimer, E., Perreault, R., McLeod, P., Huang, A., Larochelle, P., Mallet, L.
(2001). Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons. JAMA
285: 421-429
[Abstract][Full Text]
Adams, A. S., Soumerai, S. B., Ross-Degnan, D.
(2001). Use Of Antihypertensive Drugs By Medicare Enrollees: Does Type Of Drug Coverage Matter?. Health Aff (Millwood)
20: 276-286
[Abstract][Full Text]
Reichert, S., Simon, T., Halm, E. A.
(2000). Physicians' Attitudes About Prescribing and Knowledge of the Costs of Common Medications. Arch Intern Med
160: 2799-2803
[Abstract][Full Text]
Kasiske, B. L., Cohen, D., Lucey, M. R., Neylan, J. F., for the American Society of Transplantation,
(2000). Payment for Immunosuppression After Organ Transplantation. JAMA
283: 2445-2450
[Abstract][Full Text]
Rector, T. S.
(2000). Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries From Managed Care Organizations. JAMA
283: 2163-2167
[Abstract][Full Text]
Rochon, P. A., Gurwitz, J. H.
(1999). Prescribing for Seniors: Neither Too Much nor Too Little. JAMA
282: 113-115
[Full Text]
Rowe, J. W.
(1999). Geriatrics, Prevention, and the Remodeling of Medicare. NEJM
340: 720-721
[Full Text]