You obviously haven’t seen the PDL and other restrictions put in place by some states. In many states, duals would be unable to get more than 4 scripts per month (while in general they average 8 to 10). In other states, access to pain meds is highly restricted. The Medicaid program in many states is simply not suitable for vulnerable seniors (the sickest and oldest). The Part D program has far more flexibility in meeting these needs.

Atlex

Where did anyone say that? The argument is that those that used to be recieving their drugs via the cheaper, more controlled, Medicaid program, are now using the less controlled, more expensive Medicare D program.

Both plans cover their drugs, the discussion is who profits when that switch is made.

Let me get this straight…seniors and the disabled don’t have the right to the medicines they need to treat there illnesses. That’s essentially what you’ve said. It’s not about brand vs. generic. Remember, the Part D program probably has the highest generic use rate of any broadscale drug plan. In fact, that’s one of the reasons that the brand drugs in Part D cost more than in Medicaid and one of the big fallacies of the majority’s report. If a Part D plan is successful in shifting usage over to generics, brand manufacturers won’t offer as large a rebate. That’s one of the reasons that Part D is coming in substantially under budget, while seemingly being unable to extract as great as Medicaid. An individual script for Crestor or Nexium may cost more in Medicare rather than Medicaid, Part D plans have done a better job of appropriately shifting beneficiaries to generics. If the beneficiary and his/her physician believe that a brand drug would work better, there are processes to overcome the plan’s formulary. More importantly, if this makes a beneficiary unhappy, they can change plans.

Atlex

Medicaid isn’t made to be a government program to produce satisfaction or to buttress the free market system.

MEDICAID is a safety net to provide medications/care for those who qualify and have no other alternative because it is a safety net it doesn’t have, nor should it a full formulary but a rigid control system to maximize efficiency. For every dollar paid for a brand med when a generic will do is a dollar that is not providing care for another individual. It isn’t a lifestyle or a satisfaction deal. MEDICAID is an acknowledgement of the need for government to help take of our neediest. But government has limited funds and there are lots of needs.

MEDICAID is not meant to function as a substitute for an HMO. It is not a government insurance program.

You always seem to miss the point–in this case many points. First, Medicaid programs have become exceedingly restrictive. In many states, the list of drugs on the state PDLs don’t meet the needs of seniors. In other states, they limit the number of prescriptions to 2 or 4 or 5–again not meeting the needs of seniors. In both of these cases, beneficiaries have no choice to change plans–there is only one Medicaid program per state. Of course, in Part D, duals can change plans every month in order to meet their needs. Another important point is that without the duals, who have high utilization of medication, the 20M non-duals who enrolled in Part D would have likely received lower rebates (if economists are to be believed), a fact that the majority report didn’t take into account when it looks at costs. I could go on and on…but it really boils down to this: do you prefer to have a free market system where satisfaction rates for duals are in the high 80s and they get the medicines they need, or do you prefer a government run program, with restrictions on access. Sure, a government run program can get a lower cost by setting prices, but as the economist who testified at the hearing discussed, that would simply raise prices on other customers.

Atlex