Inadequate Prescription-Drug Coverage for Medicare Enrollees — A Call to Action

Abstract

The demise of both the Medicare Catastrophic Coverage Act of 19881 and the 1993 Clinton plan for health care reform2,3 resulted in missed opportunities to correct a glaring defect in the American health care system — inadequate coverage for costly prescription drugs among low-income elderly and disabled persons. Although sometimes misused, prescription drugs are effective treatments for many illnesses.4,5 Most Medicare enrollees do not have adequate coverage for outpatient drug expenditures, since Medicare covers only drugs prescribed for inpatient use. Lack of coverage for outpatient drug expenditures is a formidable barrier to effective therapy. In this article, we describe the problem of inadequate coverage for outpatient drug expenditures among elderly and disabled persons in the United States, recent trends that have exacerbated the problem, and the economic and clinical consequences of the underuse of medications. We then propose a potential solution to this problem.