Medicare Part D: Good for Patients and an Opportunity for Pharmacists

y almost any measure, the Medicare prescription drug benefit (Part D) is a resounding success. Twenty-five million Medicare beneficiaries enjoyed guaranteed access and choice of a drug benefit in 2008. 1 Based on the bids submitted by Part D plans for 2009, the Centers for Medicare and Medicaid services (CMS) estimates that the average monthly premium for standard Part D coverage will be $28, an amount 37% lower than originally projected when the benefit was established in 2003. 2 More than 85% of Medicare Part D beneficiaries report being satisfied with their drug benefit.3 Finally, the program has been far less costly to taxpayers than expected-now estimated to be 38.5% ($243.7 billion) less than the originally projected budget for the period 2004-2013.4 A key reason for the economic success of Part D is that it uses competition among Medicare prescription drug plans (PDPs) and pharmacies to control costs.4 The PDPs are free to use formularies and cost-sharing incentives (e.g., multi-tier copayment structures) to encourage use of generic medicines, preferred brands, and choice of pharmacies for long-term therapies.Plans negotiate rebates with manufacturers and reimbursement with pharmacies in order to offer competitive premiums to beneficiaries.To optimize the use of appropriate medicines, Part D also established a mechanism for enrollees with multiple chronic conditions and high drug costs (estimated to be 8%-14% of beneficiaries) 5 to receive medication therapy management (MTM) services from health professionals, including pharmacists.