Sometimes there is a double meaning to the term “Medicare reform.” “Reform” can mean improve and strengthen or it can mean change and weaken. One example is a proposed reform of the Medicare Part D Low-Income Subsidy (LIS) Program, also known as Extra Help. This program saves low-income beneficiaries close to $4000 per year in prescription drug costs according to the Centers for Medicare and Medicaid Services (CMS).
The proposed reform would change and weaken the program by requiring low-income Medicare beneficiaries to pay higher copays for brand name drugs while lowering copays for generic drugs. The reform, first proposed by the Medicare Payment Advisory Commission (MedPAC), aims to drive more seniors and individuals with disabilities to use generic drugs, which in theory could lower costs to Medicare.
However, this proposed reform is flawed for a number of reasons. It fails to take into account that many patients, including those at or below the poverty level, require access to brand name drugs because their doctor has determined these medications will produce more positive health outcomes than generic medications would provide. In these instances, patients must have affordable access to brand name drugs or their health and well-being could suffer as a result.
Unfortunately, the proposal would increase cost sharing for these patients. According to analysis by the Leadership Council on Aging Organizations (LCAO), this would deter access to needed medicines which could in turn lead to much higher Medicare costs on other types of health care services.
Further, even if this change provided some exclusion for certain therapeutic classes of drugs, the exclusion may not be broad enough to address the treatment of chronic diseases for which there are often no generic substitutes.
The LIS program must be protected and preserved. This program works to keep cost sharing low for the most vulnerable beneficiaries to ensure patients can access the treatments they need. Adding to those costs could make health care unaffordable for them. The most inappropriate way to celebrate Medicare’s 50th anniversary in 2015 would be to adopt an LIS reform proposal that increases costs for low-income people instead of maintaining its commitment to improve their quality of life.