The Lincoln Plawg - the blog with footnotes
Tuesday, September 28, 2004
Pharma and insurance fight over Medicare swag
No honour among thieves beats dog doesn't eat dog:
Splitting the loot provided by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003  in the form of the Medicare drug benefit has led to a tussle between the drug and insurance companies, according to the New York Times (September 26). At issue, which drugs should go on the approved lists:
In general, drug companies want as many drugs as possible on each list, known as a formulary. Many doctors and consumer groups agree. But insurers and drug benefit managers generally want to limit the number of drugs, and the types of drugs. Otherwise, they say, the new drug benefit will quickly become unaffordable.
The relevance of the lists to the patients:
A health plan generally does not have to pay for drugs excluded from its formulary, and while beneficiaries can use their own money to buy such drugs, the costs will not count toward the annual limit on their out-of-pocket expenses. After reaching that limit ($3,600 a year in 2006), the beneficiary is entitled to catastrophic coverage, meaning that Medicare pays about 95 percent of drug costs beyond that amount.
Out-of-towners may be surprised to learn that
Until now, Medicare had no outpatient drug benefit.
The writer, Robert Pear, looks like the paper's health correspondent; although he can only give a flavour of what look like some awesome complexities, it's refreshing to get away from the horse-race to look at a different sort of politics in action.
My guess is that the story was buried in the paper , as being so much less sexy than the presidential back-and-forths. Will he get space to expand on the topic? According to the NYT search page, Pear has had ten bylined pieces in the last month, so it's possible...
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