NEJM -- Medicare Part D Update -- Lessons Learned and Unfinished Business

Patricia Neuman, Sc.D., and Juliette Cubanski, Ph.D. Since 2006, more than 40 million elderly and disabled people have had the opportunity to enroll in a Medicare Part D prescription-drug plan, as established under the Medicare Modernization Act (MMA) of 2003. Members of Congress, deeply divided by policy and ideological differences, debated several features of the proposed legislation before its passage.1 Issues that received particular scrutiny were the unprecedented way that the benefit would be delivered (exclusively through private plans) and its design, featuring an unusual gap in coverage (sometimes called the "doughnut hole"). Policymakers questioned whether insurance companies would be willing to offer stand-alone drug plans, how many beneficiaries would choose to enroll in a voluntary program, and how the program would affect drug prices and overall Medicare spending.2 With the fourth year of Medicare Part D under way, the Obama administration and the Democratically controlled Congress have an opportunity to review the program and identify areas for improvement. In this article, we return to several key questions raised during the 2003 congressional debate and in the years leading up to the start of the program. We review evidence that has accumulated since the benefit launched in 2006 and discuss issues that may emerge on the policy agenda. Read More