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.
Tseng C, Mangione CM. Medicare Drug Beneficiaries and Cost-Lowering Strategies—Reply. JAMA. 2005;293(5):552–553. doi:10.1001/jama.293.5.553-a
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