The Medicare Drug Benefit: Implications for Chronic Disease Care

Avalere Health


This is archived content; for historical reference only.

Part of a series of publications exploring the potential impact of the Medicare drug benefit in California, The Medicare Drug Benefit: Implications for Chronic Disease Care examines the implications for chronically ill patients and offers recommendations for managing and monitoring the transition.

This 2005 issue brief outlines potential risks faced by low-income Californians with diabetes, HIV/AIDS, mental illness, and other chronic conditions as they move to the Part D benefit model.

Many Medicare beneficiaries will face utilization management tools, such as formularies and tiered cost-sharing, for the first time. Potential implications include limited access to medications, new out-of-pocket expenses, and gaps in coverage, particularly for those eligible for both Medicare and Medi-Cal, who have had wide access to medications.

The brief reviews the roles federal and state officials can play in easing the transition. It also makes recommendations to ensure that beneficiaries get the information they need to make decisions about their care; that utilization management tools do not create unintended barriers to drug access or compliance; and that necessary medication regimens and care — particularly for chronically ill patients — are uninterrupted.