NYT,pg1,lead:Medicare Rules Set Off Drug Choice Battle(pharms v insurers)

[DeepModem Mom]

Medicare Rules Set Off a Battle on Drug Choices
By ROBERT PEAR

Published: September 26, 2004


WASHINGTON, Sept. 25 - The new Medicare law has touched off a huge battle between insurance companies and drug companies that could determine how many medicines will be readily available to Medicare beneficiaries.

Under the law, Medicare will rely on private health plans to deliver drug benefits to the elderly and disabled. The government will not specify precisely which drugs must be covered. Rather, each plan will develop a list of drugs approved for reimbursement.

In general, drug companies want as many drugs as possible on each list, known as a formulary. Many doctors and consumer groups agree. But insurers and drug benefit managers generally want to limit the number of drugs, and the types of drugs. Otherwise, they say, the new drug benefit will quickly become unaffordable....

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The Bush administration has retained a private nonprofit organization, the United States Pharmacopeia, to develop a list of the types of drugs that should be covered. The guidelines, which serve as a model for private plans providing the new drug benefit, list 146 distinct categories and classes of drugs....

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The formularies could have a major impact on the success of the new law, determining how many people sign up for drug benefits and how many private plans participate. Before enrolling in a plan, beneficiaries will presumably check to see if it covers the drugs they are taking....


http://www.nytimes.com/2004/09/26/politics/26medicare.html