Medicare Part D in 2008: rising prices and growing confusion

Medicare Part D, implemented in January 2006, has failed in the promise of inexpensive medications for all recipients, including those US citizens aged 65 years or older and the disabled. Conceived as a privatization program for a prescription drug benefit tied to Medicare, the program has brought increased costs to middle- and upper-class seniors. Seniors who are continuing users of expensive brand name or specialty drugs face significantly higher prices. Medicare D recipients must deal with capitation payments, deductibles, subsidies, drug substitutions, and extensive coverage gaps or "donut holes" in which they must pay 100 percent of their medication costs. For low-income and indigent patients, especially those with chronic diseases like HIV or cancer, the Medicare Part D program seemed beneficial. However, for such patients, there is likely to be a growing realization that the old system of receiving medications at public hospitals was less expensive than prescription coverage under Medicare Part D. At Miami's public hospital, Jackson Memorial Medical Center, low-income and indigent patients pay $5 per medication whether it is a generic, brand name, or specialty drug. Return to the public hospital pharmacy system from the neighborhood pharmacy and Medicare Part D plan can mean significant savings to low-income or indigent patients.