For starters

December 22, 2003

A FULL-DRESS launch of the new Medicare prescription drug program is more than two years away, but a starter benefit is due this spring, promising to bring a little relief to older Americans most in need.

It's a Medicare discount card, and it could become an election year hors d'oeuvre, reminding voters that President Bush made good on his promise to help the elderly with pharmaceutical costs. As the discount plan is currently structured, though, Mr. Bush is running the risk that it won't come close to meeting the expectations of this potentially potent voter block.

More perilously, he's asking people in their 60s, 70s and 80s to become savvy Internet shoppers - a tall order for those who have managed to get through much of their lives avoiding direct contact with computers.

Memo to the gang in the White House political shop: This bears watching! In fact, some quick adjustments to the program before the cards become available would be advisable - such as making sure discounts go to beneficiaries, not just the private companies trying to make money off of them.

Medicare drug discount cards sound like a good idea. For an annual fee of $30 or less, they will allow beneficiaries with no other access to prescription drug coverage to save 10 percent to 15 percent on their medications until coverage becomes available through Medicare in 2006. Low-income beneficiaries not poor enough to quality for Medicaid will get a $600 annual credit toward their drug purchases through the cards.

Any number of private companies might qualify to offer such cards, competing for customers by offering the best deals on certain categories of drugs, such as blood pressure or cholesterol treatments. Smart shoppers - with advice from Medicare phone lines and Web sites - will be able to find the combination that best suits their needs.

But Republican queasiness about any step that smacks of price controls may render the cards of such little value better deals could be found through discount programs already available through mail order or online.

As designed by Congress, the Medicare cards don't mandate any minimum discount, don't require private companies using Medicare's name to negotiate with pharmaceutical companies to pass on all the savings to beneficiaries, and offer no guarantee that advertised prices for drugs remain in effect once the card is purchased.

Smart business tactics may be enough to persuade the pharmacy benefit companies to offer generous savings to card customers. After all, their chief ambition at this point is to build a list of satisfied customers who will pick them to manage their Medicare drug benefits once the full program kicks in.

But to be safe, Mr. Bush should build tighter consumer protections into the discount card program now as it's being drafted.

The most effective use of Medicare's purchasing power would be to allow the agency to negotiate with drug makers on behalf of all 41 million beneficiaries, instead of dissipating their leverage through the vast array of middlemen. But the GOP Congress, under pressure from the drug makers, specifically prohibited that.

If Mr. Bush doesn't want to face an angry mob of disappointed drug buyers in the fall, he should make sure the discount cards offer the best possible deal that's been left to them.

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