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February 2, 2005

Medicare Drug Beneficiaries and Cost-Lowering Strategies—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(5):552-553. doi:10.1001/jama.293.5.553-a

In Reply: We strongly endorse the use of direct generic substitution and “rational prescribing” when they are based on rigorous scientific information, because these are important ways to help people manage their drug expenditures. This is based on our own finding that seniors who exceeded their drug benefit caps decreased their use of essential medications, as well as on estimates from others that 1 in 4 Medicare beneficiaries will face the “donut hole” in the new Medicare drug benefit.1 This “donut hole” represents the gap in coverage when beneficiaries’ annual drug expenditures exceed their benefit cap but are not yet high enough to qualify for catastrophic coverage. Better mechanisms to help people manage their drug costs must be found. We thank Drs Bjarnason and Kampmann for highlighting these programs in Denmark.

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