Have We Forgotten Who the Medicare Part D Prescription Drug Program Serves?

Every year since 2007, a year after Part D was implemented, the Healthcare Leadership Council has surveyed the people this program serves, Medicare beneficiaries, primarily those Americans who are 65 and older. This survey has served as an important barometer over the years as to how this important lifesaving and life-altering program is perceived by those who are directly impacted by it. I won’t try to go over every survey since 2007 (you are welcome to look at them by clicking here) but I can tell you that the satisfaction level has always been close to or above 90%. That’s 9 out of 10 seniors that think this program is a success. What other government program can claim this kind of constant success over an 18-year period? I highlight this to establish a baseline to reflect on this year’s survey and to point out who the lawmakers are really focused on when they change and continue to propose more changes to this successful program. 

This year’s survey continued the well-established trend, with 89% of the respondents being satisfied with their Part D program. I’m convinced that a big part of this satisfaction has to do with the large number of plans we have to choose from. In Wyoming, the least populated state in our nation, a Medicare beneficiary has 24 plans to choose from. The competition that results from having this many options allows each of us to find a plan that fits our budgets, and our prescription drug needs. This competition was an integral part of the final bill that started the Part D program, it was selected over a government run single payer approach and it has proved to be at the center of its success. This law, which was passed in 2003 and implemented in 2006, has proven its value. While there were many naysayers who warned that there wouldn’t be very many plans for rural patients to choose from, they were shown to be wrong, yet our government is willing to risk this success on unproven changes, both already passed into law and proposed changes. 

Three responses in this year’s survey highlight the concerns that older Americans have about the impact the government’s price-setting approach in the Inflation Reduction Act (IRA) could have on Part D. 

82% of seniors are worried that government price-setting policies will limit access to newer prescription medicines. 

There has been much discussion about the impact of price-setting on the willingness of investors to risk their money on the R&D necessary to discover new medicines. Some say there will be a significant slowing in R&D investment, others say the impact will be minimal. The CBO (non-partisan Congressional Budget Office) has said there will be some impact, and there have already been reports of companies reducing their R&D investment, but the extent of that is unknown, which is what scares me. The government is willing to risk a possible significant reduction of innovation with a broad, ever-expanding price fixing scheme that is untested. 8 out of 10 of us are worried that we and our kids and grandkids will be the victims of this risky plan. 

82% of seniors believe price setting could reduce choice and options for prescription drugs. 

Again, we don’t really know what impact these price-setting actions will have on the whole prescription drug system. Will the initial entry price go up to try and counter the reduced earnings of the inevitable fixed price? Will the tier placement, prior authorization, and fail-first aspects of prescribing be impacted? Once again, we don’t know, but the government is implementing a nationwide program that is scheduled to last at least a decade. A lot of damage could be done in 10 years. 

80% of seniors fear price setting policies would put the government between them and their doctors when it comes to making decisions about what medicine is best. 

Seniors treasure the relationship between them and their doctor and are fearful of anything that gets in the way of that relationship. We don’t need more regulations we need broad guidelines. We need simplification and transparency at all levels of the prescription drug business system. 

It seems that nobody is listening to those who are the beneficiaries of Part D. Nobody is looking at what impact these changes will have on seniors. Respondents gave little support to the idea of restricting access to save Medicare money. Short-term approaches that save Medicare money don’t help older Americans pay less at the pharmacy counter. Free market companies are successful when they listen to their customers and treat them right; politicians have forgotten who the Part D customers are. All I hear in this critical election year is the politicians crowing about how they took on “big pharma”. How does this help older Americans who are on fixed incomes in this time of high inflation? There is still no guarantee that fixing the price of drugs will save seniors money. Once again, no one really understands what this sludge hammer approach will do or what unattended consequences will raise their ugly head. 

Here are some things that are documented results of the Medicare Part D program: 

• Hospital admittance dropped significantly the year Part D was implemented. 

• Part D premiums came in 40% of what was estimated when the law was passed. 

• Since its implementation, the Part D satisfaction rate has hovered around 90%. 

• The United States is the world leader in finding new medicines. 

• The number of Part D plans available to beneficiaries exceeded all expectations. 

These are facts. Part D works. Like I said in this blog, “If it ain’t broke, don’t fix it.”

Best, Thair