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Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors
Allison B. Rosen, MD, MPH, ScD;
A. Mark Fendrick, MD; and
Sandeep Vijan, MD, MS
20 December 2005 | Volume 143 Issue 12 | Page 918
IN RESPONSE:
Dr. Velakaturi raises an important point: Prices for medications vary depending on the venue where they are purchased. We used a commonly cited metric, the average wholesale price, in our base-case estimates. However, in sensitivity analyses, as prices of angiotensin-converting enzyme inhibitors decrease, overall Medicare savings increase. For example, the Medicare savings of $1606 per beneficiary at the average wholesale price would increase substantially (to $2943 per beneficiary) if these particular drugs were purchased according to the federal supply schedule ($39 per year for lisinopril)—the substantially lower government-negotiated prices for medication that are available to the U.S. Department of Veterans Affairs and the U.S. Department of Defense. However, a much-debated clause in the legislation that enacted the new Medicare drug benefit prohibits the Medicare program from directly negotiating prices with drug manufacturers (1). As a result, increasingly more Americans will probably face financial barriers that lead to the underuse of essential medications and other medical interventions (2).
In addition to providing recipients the opportunity to purchase drugs at lower prices, Medicare could lower or eliminate financial barriers (copayments) for essential medications—which would markedly improve its value. A benefit-based copay in which patient cost-sharing is set to the level of projected benefit of a drug, not its acquisition cost, is a more rational system that will optimize the use of our increasingly scarce health care dollars (3).
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Author and Article Information
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From the University of Michigan, Ann Arbor, MI 48109, and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48113.
Potential Financial Conflicts of Interest: None disclosed.
1. Centers for Medicare & Medicaid Services. Medicare Prescription Drug, Improvement and Modernization Act of 2003. Washington, DC: Centers for Medicare & Medicaid Services; 2003. Accessed at: http://www.cms.hhs.gov/medicarereform/ on 6 September 2005.
2. USA Today/Kaiser Family Foundation/Harvard School of Public Health. Health Care Costs Survey, August 2005. Accessed at http://www.kff.org/newsmedia/pomr090105pkg.cfm on 6 September 2005.
3. Fendrick AM, Smith DG, Chernew ME, Shah SN. A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost. Am J Manag Care. 2001;7:861-7. [PMID: 11570020].[Medline]
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Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors
Vinod N. Velakaturi
- Annals 2005 143: 918.
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