I’ve been promising lmsinca a post on MedPAC for quite some time. They’re meeting again next week and will have a session (benefit redesign) that I think will be of more interest. So I’m going to combine the two meetings into one post.
Until then, a little nugget:
Just like the rest of the program, a small percentage of Part D (the drug benefit) beneficiaries account for the majority of program spending. For Part D, 8 percent account for 40 percent of total spending and 20 percent of the total prescriptions. In 2009, on average the “high-cost” beneficiary filled 111 prescriptions over the year. Each prescription cost an average cost of $110. The lower-cost beneficiaries, by comparison, filled 41 prescriptions at a cost of $42 each during the same time period. “High cost” tended to use more brand-name drugs (as opposed to generics).
It’s the same story over and over. There’s a small percentage of beneficiaries who are the cost drivers. Until we figure out how to control costs in this area the rest is rearranging the deck chairs.
Also, Medicare is estimated to reach six percent of GDP by 2040, and the Hospital Insurance Trust Fund will be unable to pay full benefits after 2024. That’s 13 years from now. The growth in expenses means that a beneficiary’s average out-of-pocket costs will increase faster than Social Security benefits.
Update: Slight edit to answer lms’ clarifying question.
Update II: A lot of criticism regarding Part D is directed at the non-interference clause, which prohibits the government from direct negotiation. Repealing this would have a negligible effect, according to CBO. Part of the reason is that it would not be a true negotiation, because the biggest tool the government could use, a restrictive formulary, is left off the table because it’s a political nonstarter. Also, before the MMA was enacted various prescription drug bills were kicking around congress for many years. The vast majority of them — republican and democratic — included this provision. As it stands, drug manufacturer negotiate with the prescription drug plans, who have every incentive to get a good deal. But again, they’re hamstrung by the requirement to have very inclusive formularies. In some class of drugs they’re required by law to include the vast majority of the available prescriptions — in every therapeutic category its at least 2 drugs.
Regarding re-importation, the law gives HHS the authority to do it, provided that the department can certify it can be done safely. FDA is worried about counterfeit drugs, tampered drugs, etc. There’s also the R&D argument. Haven’t spent too much time on this issue, but the NIH looked at it a few years back. Personally, I think it’s a band-aid approach to more systemic problems in the overall health care system.
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