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ACP-ASIM Releases Recommendations for Medicare Prescription Drug Benefit

(Washington, DC): The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) has released a series of recommendations for Congress to consider when it begins designing a Medicare prescription drug benefit.

"ACP-ASIM recommends that the highest priority should go toward providing voluntary prescription drug benefits for those most in need: low income beneficiaries who do not have access to drug coverage under other plans," said ACP-ASIM President William J. Hall, MD, FACP. "If sustainable, predictable financing is available, an optional Medicare prescription drug benefit should be provided to all beneficiaries, regardless of income and health status."

The ACP-ASIM's recommendations include:

  • Drug benefit plans should be voluntary, and seniors should be able to opt out of the program and maintain their existing Medicare coverage.

  • Congress should consider: (1) increasing general revenues or payroll taxes to support a Medicare prescription drug benefit, and (2) income-related premium contributions, co-payments, and deductibles to support the program.

  • The maximum allowable Medicare reimbursement for prescription drugs should balance the need to restrain the cost of the benefit with the need to create financial incentives for manufacturers to continue to develop new products.

  • If therapeutic safety and equivalency are established, then generic drugs should be used, as available, for beneficiaries of a Medicare prescription drug benefit.

  • Research should be conducted into the use of evidence-based formularies with a tiered co-payment system and a national drug information system, as a means to safely and effectively reduce the cost of a Medicare prescription drug benefit, while assuring access to needed medications.

  • Decisions about which drugs are chosen for formulary inclusion should be based on effectiveness, safety, and ease of administration rather than on cost.

  • Formularies should be constructed so that physicians have the option of prescribing drugs that are not on the formulary (based on objective data to support a justifiable, medically-indicated cause) without cumbersome prior authorization requirements.

  • If Pharmaceutical Benefit Managers (PBMs) are used to administer a Medicare prescription drug benefit, consumer protections should be instituted such as government regulation and industry self-regulation of PBMs; and the disclosure to patients, physicians, and insurers of the financial relationships between PBMs, pharmacists, and pharmaceutical manufacturers.

"If a Medicare prescription drug benefit administered by private entities is established, ACP-ASIM supports uniform coverage, rules, eligibility and co-payments across plans," said Dr. Hall.

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership encompasses more than 115,000 internal medicine physicians and medical students.


Jack Pope, Washington Office, (202) 261-4556
Jennifer Whalen, Washington Office, (202) 261-4575

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