Medicare Drug Plan Still Needs Work

July 23 -- WEDNESDAY, July 22 (HealthDay News) -- The number of older Americans with access to prescription drug coverage has ballooned since Medicare's Part D program was rolled out almost four years ago, a new analysis finds, yet seniors' ability to pay for needed medications remains a concern due to limitations in coverage and rising drug plan costs.

"Based on nearly four years of experience, the Medicare drug benefit has helped seniors by expanding access to prescription drug coverage and lowering out-of-pocket costs, particularly helping those who previously lacked drug coverage," said Tricia Neuman, director of the Medicare Policy Project at the Henry J. Kaiser Family Foundation, who led the analysis. "But Medicare Part D is still a work in progress."

Neuman's review of the program, which assesses access and affordability, appears in the July 23 issue of the New England Journal of Medicine.

David Lipschutz, staff attorney for California Health Advocates, a nonprofit advocacy and education outfit, said the analysis of the program, while thorough, was "a little more positive" than he might have given. "I think when looking at Part D, you clearly have to acknowledge a lot more people have access to prescription drug coverage. But Part D has also had a significant impact, too, and has actually left some people worse off."

He noted that low-income seniors who are "dually eligible" for both Medicare and Medicaid were switched from Medicaid drug coverage to Medicare Part D. In California, that shift resulted in seniors losing a relatively rich array of benefits. In general, the commercial plans in which they were forced to enroll offer more-limited drug formularies, greater cost-sharing and the potential for greater barriers to accessing care because of various utilization review techniques, he explained.

Unlike Medicare's hospital and medical insurance programs, Part D benefits are offered through private insurers and drug plans that contract with the government. Often seniors must choose among dozens of plans in a region.