GOVERNMENT & MEDICINE

Medicare drug benefit gains momentum in House, Senate

Plans would not force beneficiaries into HMOs to get prescription coverage.

By Markian Hawryluk, AMNews staff. June 30, 2003.

Washington -- After years of failed attempts, Congress appears ready to provide Medicare beneficiaries with outpatient drug coverage -- a move that would be welcomed by many physicians.

Few lawmakers seem to believe that the House and Senate plans are a perfect solution. Nevertheless, Washington is abuzz with optimism that a Medicare reform bill that includes the drug benefit could pass by the July 4th recess.

"It is a big initiative, and it's going to take the very best of our deliberative process," said Senate Majority Leader Bill Frist, MD (R, Tenn.). "It's going to be modified, but there's a general consensus being reached that now is the time."

At press time, the Senate was debating its measure, and two House committees had begun consideration of a similar plan.

The amount of coverage differs between the Senate and House bills. Both have varying benefit levels that change as a patient's drug spending increases.

The two measures include a gap in coverage in which beneficiaries would have to pay the full cost of their prescription drugs. But then once their drug spending reached a certain level, "catastrophic" coverage with better benefits would begin.

Under the two bills, private insurers would compete to provide Medicare-approved drug plans to beneficiaries. The Senate legislation would require the federal government to provide a fallback drug plan if a region attracted fewer than two private insurers. The House plan includes no such option but contains other incentives that lawmakers are confident would attract plans to all areas of the country.

[...]

Full text of AMNews content is available to AMA members and paid subscribers.

Access details

Join the AMA