Government Regulations and Elder Care

The recent array of Medicare proposals on Capitol Hill focus on the provision of prescription drugs. While this sounds good, seniors should be aware that most of these proposals also include restrictive drug formularies, or preferred drug lists. These would restrict their access to new and effective prescription drugs.
The purpose of these formularies is to control costs. However, research has shown that restrictions on prescription drugs will increase overall health care costs; drive up the utilization of other medical services, including hospitalization; and result in adverse outcomes for patients' health. The evidence also indicates that restrictive drug formularies have a greater negative impact on senior citizens than the younger patients
Seniors have a large stake in the design of a Medicare prescription drug benefit because some of them think that they will still be able to have any drug that they need, without restriction, but they are gravely mistaken.
The major Medicare prescription drug bills that are now under consideration in Congress focus on controlling the cost of medications. In order for this to happen, they would rely upon three basic methods: 1. restricting new drugs in favor of generic drugs; 2. limiting patients to one or two drugs of a particular kind (based on the assumption that all medicines in a group are more or less interchangeable); and 3. replacing the judgments made by physicians and their patients with those of a committee far removed from the actual medical problem.
Most members of Congress support these formularies. They are ignoring studies that suggest that limiting the elderly to older drugs or restricting their access to certain medications would compromise their health and ultimately increase their total health care costs. While the most expensive drug is not always the best drug for a medical condition, research clearly shows that the introduction of new drugs has been associated with a general improvement in patients' well-being, better care, and a decline in total treatment costs in dealing with numerous diseases. These diseases include depression, schizophrenia, cancer, HIV, heart disease, and also ear infection. (Horn, 1998)
Formulary restrictions are likely to provide only "second-best" drug therapy, especially in the case of the elderly. Restricted formularies limit the choices a patient has within a particular class of drugs. In some cases, seniors could be forced to choose a drug that leads to other illnesses that require a doctor's attention or even hospitalization.
Not only do formulary limitations and therapeutic substitution place the elderly at particular risk, they also ultimately increase the total cost of their medical care.
The significant associations between formulary restrictions in a drug class and the greater utilization of health-care services were often greater for elderly patients.
In comparison with younger patients, seniors who were faced with formulary restrictions were twice as likely to be hospitalized or to go to the emergency room for treatment.
The fewer drugs seniors were able to choose from, the more likely they were to use inappropriate and more expensive medical services.
Greater limitations for the drug class of anti-ulcer drugs were associated with higher total drug costs for both elderly and non-elderly patients. However, greater limitations within the drug classes of propionic acids, immediate-release theophylline, and diuretics were associated with higher medical costs for elderly patients, but not for non-elderly patients.
Most of these proposals would limit patient choice. They would take the decisions regarding the drugs that should be prescribed out of the arena of physician-patient consultation. Such provisions for prescription drugs in Medicare would have adverse outcomes including a rise in total health care costs and the well-being of millions of Americans would be jeopardized. Horn, 1996)
In order to resolve these issues, Congress should go back to the drawing board to develop a plan to provide prescription drug coverage to Medicare patients. They should not tinker with restrictive formularies or try to design a stand-alone benefit with separate premiums and co-payment arrangements. Legislators should work to place prescription drug coverage into existing insurance plans. This will allow the health plans to develop a regimen of disease-management programs that incorporate drug treatment.
A model for such Medicare reform already exists in the Federal Employees Health Benefits Program, the consumer-driven health program that covers Members of Congress and federal workers and retirees. All of the health plans of the FEHBP provide prescription drug coverage, and the enrollees can choose the specific prescription drug coverage that best meets their needs. (Antos & Turner, 2002).

Reference Page 1. Antos, Joseph R., & Turner, Grace-Marie. (September 5, 2002). “What Congress Should Do About Prescription Drugs for Seniors”. American Enterprise Institution. 2. Horn, S.D., Sharkey, P.D., & Phillips-Harris, C. (August, 1998). “Fomulary Limitations in the Elderly: Results from the Managed Care Outcomes Project”. American Journal of Managed Care. Vol. 4. No.8. 3. Horn, S.D., Sharkey, P.D., Tracey, D.M., James, B., & Goodwin, F. (March, 1996). “Intended and Unintended Consequences of HMO Cost-Contained Strategies: Results from the Managed Care Outcomes Project”. American Journal of Managed Care. Vol. 2. No.3.