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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
- From the University of Michigan, Ann Arbor, MI 48109, and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48113.
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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).
Allison B. Rosen, MD, MPH, ScD
A. Mark Fendrick, MD
University of Michigan; Ann Arbor, MI 48109
Sandeep Vijan, MD, MS
Ann Arbor Veterans Affairs Medical Center; Ann Arbor, MI 48113
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
