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?

ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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4 replies »

  1. Rob they do raise the cost to insurance and insurance does not accept it. Contrary to liberal dogma we can’t wake up one day and switch formularies. From the time we fine out exactly what they are doing and what the ramifications are it takes months to come up with a workable responce.
    The discount is to the members co-pay not the price insurance pays. The entire purpose of vouchers is to counter member cost differential, if the cost to insurance was net then they would just lower the price to generic and could skip the entire voucher hassle.
    Why don’t people bashing insurance ever take the time to get the facts strait before posting their rants?
    ” but there are some times THERE IS NO ALTERNATIVE”
    Most times there is an alternative and people still try to take the brand, until you can up with a 100% effective way to seperate those that aren’t needed from those rare times there are no alternatives how can you bash others? If you want to cast blame the whole problem started with doctors pushing drugs paying them kick backs. If you hadn’t screwed things up in the first place there wouldn’t be a problem, sorry we aren’t more efficient at cleaning up your messes.

  2. Why then do the private insurers accept these? They have no more desire for use of non-generics than does the government. People knee-jerk against pharma, but there are some times THERE IS NO ALTERNATIVE. I still use some brand medications in my Medicare population. Spiriva is a good example. There is no equivalent in generic. Because of this policy, the patient either: A. doesn’t get an excellent medication (amazing in my COPD patients), or B. has to pay out of the nose for it, while the insured patients get it way cheaper. This is true for certain types of blood pressure, cholesterol, and diabetes medications.
    The way most vouchers work is that they say “pay no more than $X for your prescription of Y.” This discount is given by the drug company AFTER it has been run through insurance. It does not raise the cost to insurers.

  3. Let’s look at an example of why vouchers are banned.
    Name Brand X: $160
    Generic of X: $24
    Copay: 25%
    Brand Voucher: $5
    Copay of Generic: $6
    Copay of Brand w/o Voucher: $10
    Copay of Brand w/ Voucher: $5
    Cost of Generic to insurer: $18
    Cost of Brand to insurer: $150
    Allowing vouchers often removes or reverses the incentive for a patient to choose a generic over a more expensive brand name. This results in higher costs to the insurer and in the end, reduced benefits or raised premiums. Since the goal of Medicare is to provide affordable insurance to the elderly, the voucher refusal is well designed to ensure that premiums are not pushed up by use of brand name drugs over generics.

  4. I assume that this is a rhetorical question and that you know as well as I that many of our fine legislators who have been bought and paid for by the pharmaceutical industry would vote against this bill.
    Our “free market” system allows corporations to purchase protection for their products and prices from our politicians. Hence we have no “public option”, no insurance company competition, an impenetrable thicket of smoke and mirrors in health care pricing, high costs for everyone and big profits for doctors, insurance companies, pharmaceuticals, hospitals, and all of those medical device and supply equipment vendors.