Keeping Prescription Drugs Accessible


Ray Parisi Jr.

22 January 2014

The Medicare Prescription Drug program, Medicare Part D, has been a successful public-private program that has literally changed lives by providing improved access to prescription drugs.  We believe it works for the seniors who rely on it and that its competitive, market-based structure has kept overall program costs low.  For these reasons, we have suggested:  Don’t mess with success.

We do not support policy proposals that suggest altering the benefit structure for those who receive Part D’s low-income subsidy (LIS).  These patients are among the most vulnerable in the program and stand to be harmed by proposals that would lower nominal co-pays on generics, while increasing brand drug co-pays.

Changing Part D prescription drug cost-sharing policies may have negative consequences for the people the program serves.  First, decreasing or eliminating some co-pays while increasing others can impact the prescribing decisions of physicians who are best suited to provide care and make clinical treatment decisions for their patents.  Second, a policy to encourage generic medication use by increasing co-pays for brand medicines assumes that patients’ financial considerations drive physicians’ prescription choices, as opposed to severity of illness or other health factors.

At AstraZeneca, we believe in the right medicine for the right patient.  Sometimes the right medicine will be a generic drug and sometimes a patient will require a branded product.  This decision is made by the  physician, and when a branded product is recommended, arbitrary cost-sharing proposals should not render the medication out of reach for the patient.  Generics are not always medically appropriate substitutes for brand medicines in a given class of drugs, and for the treatment of some diseases, a generic version of a branded drug may not even exist.

It should be noted that MedPAC, an independent Congressional agency that advises Congress on issues affecting Medicare, shows high generic use among Part D enrollees – approximately 74 percent of LIS beneficiary prescriptions in 2011.

LIS beneficiaries  – a group that MedPAC says are more likely to be disabled and tend to have a greater disease burden than non-LIS enrollees – would as a result be gravely impacted by any proposed changes to increase brand medicine co-payment amounts.  These proposals unfairly penalize patients who need brand medicines rather than generics, and patients who need multiple brand drugs, including those with chronic conditions who need medications on a regular, sometimes monthly basis.

If faced with higher out-of-pocket expenses, the most vulnerable Part D patient population may attempt to switch to less costly alternatives or worse – may delay or forego their use of prescribed medicines.  Such an outcome may actually lead to higher overall Medicare costs.  In 2012, the Congressional Budget Office (CBO) acknowledged that policies that increase the use of prescription medicines would decrease Medicare medical spending, and we believe the converse to be true as well. We want to encourage adherence, not discourage it.

In the end, it comes down to choices we like and those we don’t.  Medicare Part D beneficiaries have an increasing number of plan options in 2014 from which to choose – that’s a good thing.  Beneficiaries making choices that vary from their physicians’ recommendations, likely leading to higher overall healthcare costs – that’s a bad thing.  That’s why we return to the same refrain about Medicare Part D:  Don’t mess with success.