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Report: Medicare-Administered Drug Benefit Would be More Affordable, Comprehensive, Stable than Current Private Insurance-Run Drug Benefit
Date:10/23/2007

find the current Medicare drug benefit available only through private plans is unnecessarily costly, has coverage gaps, is unstable and leaves consumers vulnerable to marketing fraud because of the number of plans offering such divergent benefit packages.

The consumer groups report that a Medicare-administered drug benefit can lower drug prices and reduce the overall cost of the Medicare coverage program by harnessing the purchasing power of the 43 million Americans with Medicare to negotiate prices. It costs private insurers 9.8 percent of the drug benefit's total cost to administer the program, yet it costs Medicare only 1.7 percent of the total costs to administer hospital and outpatient coverage. Prices for the Veterans Administration's most commonly prescribed drugs are half as much, or less, than the prices offered through private drug insurance plans.

Consumers Union and the Medicare Rights Center recommend using a national evidence-based formulary for a Medicare-administered drug plan option that would help guide doctors to prescribe in a way that improves health care outcomes, reduces costs and facilitates a fair and efficient drug appeals system. The Veteran Administration's formulary is broader than the drugs covered under Medicare private drug plans and also covers non-formulary drugs prescribed according to evidence-based guidelines.

Legislation to give consumers a Medicare-run drug option was introduced today by Senator Richard Durbin (D-IL) and Representatives Marion Berry (D-AR) and Jan Schakowsky (D-IL). The Medicare Prescription Drug Savings and Choice Act would utilize price negotiation and the best evidence about the safety and effectiveness of drugs to give older adults and people with disabilities the choice of a stable, consistent and affordable drug coverage plan.

The consumer groups also report that the current, private drug plan appeals system is dysfunctional, with a lack of information from the private plans a
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SOURCE Consumers Union
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