One Big Little Change

It\’s just plain stupid.
Why does the government not allow patients with Medicare part D to use pharmaceutical discount cards?  What is the ethical rule broken by making the government pay less?  What is the legal reason that the elderly should be prevented from saving money?

I know there are probably reasons having to do with discounts not being allowed that are not extended to all Medicare participants, but isn\’t that a little silly?  As long as the discount is available to all Medicare participants, why can\’t they receive help from the pharmaceutical industry.

I do my best to prescribe the cheapest medications possible.  I love the $4 list at Wal-Mart et. al., and I try to never use a brand when a generic would do the trick.  But there are times where I have no choice.  These newer drugs are sometimes the only choice we have to help control their blood pressure, diabetes, or pain.  Without these drugs, we end up with worse blood pressure, worse diabetes, and more pain.  What do you think is the consequence of that?  More people:

  1. Develop complications of chronic disease poorly controlled.
  2. Are hospitalized for these complications.
  3. Visit the doctor for management and/or treatment.
  4. Have pain.

What\’s the complication of that?  More money spent by both the patient and the government.

Come on, you government goof-balls!  The pharmaceutical industry actually wants to do something that will reduce cost to both patient and to the plan paying for their care.  The private insurance companies benefit from this, as do the patients without insurance at all.  It\’s not a golden ticket that solves all of our cost problems, and there is the risk of people paying more in the long-run if more branded drugs are used.  I know those things.  But I also know that there are a lot of people paying more money and not taking medications they need.  I know that people have complications that could be avoided and preventable hospitalizations.

If a bill was put forward to change this one thing, who would vote against it?  Who wants to go on record against disease prevention and helping the elderly?  Why not let the pharmaceutical companies help?  Really.  I have a lot of privately-insured people getting necessary drugs that they otherwise couldn\’t afford.

But not my Medicare patients (and Medicaid as well, but that\’s a bit more complicated).

One little change would make a big difference.  Is there anyone in DC willing to do something so sensible?

5 thoughts on “One Big Little Change”

  1. There was a story on Planet Money that touched on this. The drug companies were providing discount cards for the more recent versions of their drugs versus the lower priced alternatives. It may have been less for the end user, but more expensive for the insurers.

  2. My point is that I (and other docs) use lower-priced alternatives whenever possible, but there are some times when it is simply not possible. It happens a good amount of the time.

  3. This is not the same thing as negotiations with pharma. They would just be accepting an discount. Besides, aren’t part D’s formularies negotiated? This isn’t accepting a fixed price. It’s simply allowing Medicare recipients to get what everyone else has access to.
    I do agree that part D was a sham, although I don’t know how my patients would get by without it.

  4. The Medicare part D benefit was a cynical attempt by the Republicans then controlling Congress and the White House to sway the votes of older voters by giving them handouts (something the Republicans are bitterly against when the recipients are the poor or unemployed). Recall that the gov't is specifically *prohibited* by the law establishing this benefit from negotiating with the pharm companies about the cost of the drugs. Medicare part D accomplished 2 things — gave seniors a benefit and big dollars to the pharm companies. And I say cynical because it was entirely unfunded by any tax increase, but a few years later under Obama the same congressman voted to a member against a health plan that was funded.

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