The downside of 'Part D'


THE new Medicare drug benefit has been a prescription for confusion for millions of older people who must choose coverage from a complex variety of plans, each with different benefits, premiums, deductibles, and pros and cons.

Despite frustration and snafus galore during the enrollment period, the bumpy road should smooth out in the months ahead. Medicare Part D probably will meet its goal and make it a little easier for seniors to get prescription drugs without paying those sticker-shock prices.

The new benefit, however, is having an unforeseen side effect that could block access to prescription drugs for many low-income Medicare patients. Among them are seniors who don't sign up for coverage and individuals who choose an inexpensive prescription drug plan, where benefits lapse after reaching a limit of $2,250 annually.

Low-income senior citizens long have benefited from Patient Assistance Programs, drug company programs that give free or discounted drugs to low-income people.

PAPs are among the pharmaceutical industry's notable expressions of social consciousness. The public all too often overlooks these generous efforts in its preoccupation with drug pricing.

But industry giants like GlaxoSmithKline, AstraZeneca, and Eli Lilly reportedly plan to end their patient assistance programs. Other pharmaceutical companies are moving in the same direction.

The problem is the drug industry's reading of a guidance from the Inspector General's Office in the U. S. Department of Health and Human Services, which runs Medicare.

Drug company assistance programs that subsidize Medicare patients may violate federal laws barring kickbacks, HHS said. Assistance programs could be interpreted as efforts to steer patients to the manufacturer's own brand-name drugs, rather than less-expensive generic products.

That reasoning is specious and sophistic, at best. Where's the kickback, the big bucks to pocket, when a drug company provides free or minimal-cost medicine?

HHS and the pharmaceutical industry should work together on a compromise. If that fails, it's up to the Congress to fix it so that this new benefit is not allowed to hurt low-income Medicare patients.