Magazine article Drug Topics

Drugs at Risk

Magazine article Drug Topics

Drugs at Risk

Article excerpt

HMOs may drop Medicare Rx coverage if budget is cut

Health maintenance organizations might stop offering outpatient prescription drug coverage in Medicare plans if President Clinton's proposed payment reductions to HMOs are enacted. "We are very concerned that prescription drugs are in danger here," Karen Ignani, president of the American Association of Health Plans, told Drug Topics. "It would be a disaster for Medicare beneficiaries."

Ignani said the retirees enrolling now are likely to have middle to low incomes and are attracted to and dependent on the supplemental benefits HMOs offer that are not covered by Medicare, such as for prescription drugs and eyeglasses. "We know they are not likely to [be able to] afford them themselves," she added. "We are very concerned about the impact on their health care of not having prescription drugs."

The President's fiscal year 1998 budget calls for changing the per capita premium that Medicare pays to HMOs. Currently, it is 95% of the projected average expenses for fee-for-service beneficiaries in a given county. The HMOs must assume full risk for all Medicarecovered services, such as physician visits and hospital care. If Congress approves, the payment would be lowered to 90%, saving $6 billion over five years.

Ignani and her HMO trade association have a somewhat unlikely ally on the proposed payment cuts-the Community Retail Pharmacy Coalition. Ronald Ziegler, president of the National Association of Chain Drug Stores, earlier expressed similar concerns that the reductions are "going to put a squeeze on pharmacy" (see Drug Topics, Feb. 17).

Ziegler and coalition partner Calvin Anthony, executive v.p. of the National Community Pharmacists Association, both view Rx coverage as an overall cost-saver for the health-care system. While neither is convinced that managed care has proven itself as a long-term provider of quality, accessible care, they said at a news conference that community pharmacy is ready to work with managed care. …

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