State-based versus federal-based approaches to reducing the Medicare pharmaceutical coverage gap

Area of Science:

• Health Policy
• Public Health
• Social Insurance

Background:

• The Medicare pharmaceutical coverage gap presents a significant challenge to beneficiaries.
• Existing state-based approaches, like the Immediate Helping Hand proposal, have limitations in achieving universal coverage.
• Variations in state benefits and program reach contribute to inequitable prescription drug access.

Purpose of the Study:

• To evaluate the effectiveness of state-based versus federal-based approaches in addressing the Medicare pharmaceutical coverage gap.
• To advocate for a federal-based universal prescription drug benefit within Medicare.
• To analyze the implications of a federal approach on equity and risk mitigation.

Main Methods:

• Comparative analysis of state-based and federal-based healthcare policy models.
• Review of empirical evidence on prescription drug coverage effectiveness.
• Examination of social insurance principles applied to Medicare.

Main Results:

• State-based approaches are likely less effective in reducing the Medicare pharmaceutical coverage gap.
• Voluntary, state-specific programs perpetuate uneven prescription drug coverage.
• A federal universal drug benefit offers a more equitable distribution of coverage.

Conclusions:

• A federal universal prescription drug benefit for Medicare is recommended based on equity and empirical evidence.
• Implementing a federal benefit extends the social insurance concept across Medicare components.
• This approach promotes equitable prescription drug coverage and mitigates selection risk.