United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-05-11 monographic deposited born digital 15 p. GA 1.13:T-HEHS-00-112 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-112 P0b002ee180392f89 f:he00112t DGPO 2010-08-12 2011-03-28 GAOREPORTS-T-HEHS-00-112 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-00-112 T-HEHS-00-112 Health insurance Health care programs Pharmaceutical industry Drugs Health insurance cost control Private sector practices Presidential proposals Elderly persons Health resources utilization Medicare Choice Program Medicare Program Medicare Fee-for-Service Program Testimony HEHS Pursuant to a congressional request, GAO discussed the President's proposal to manage the high and rising costs of prescription drugs for the elderly by extending the private sector's prescription drug cost control techniques to the Medicare program.<p/>GAO noted that: (1) private insurers, managed care plans, and employers have tried to manage the high and rising costs of prescription drugs by adopting cost and utilization control techniques; (2) in many cases, insurers and managed care plans contract with a pharmacy benefit management (PBM) company to develop and implement these strategies; (3) if a prescription drug benefit were added to the Medicare program, the federal government would face similar cost pressures and would need to employ methods to control spending; (4) the experience gained in the private sector can provide useful insights into options for managing a possible Medicare benefit; (5) however, the unique responsibilities and characteristics of the Medicare program raise a number of issues and introduce questions about applying private sector tools to the traditional Medicare-fee-for-service program and the appropriate roles of the Health Care Financing Administration and other entities, such as PBMs, in managing a drug benefit; and (6) in adapting these cost and utilization management techniques, it is important to keep in mind that: (a) the size of the Medicare program and the need for transparency in its actions may reduce the effectiveness of some cost control techniques; (b) using private-sector entities to implement a drug benefit introduces concerns related to beneficiary equity and concentrating market power; (c) private-sector management tools require a capacity to process and scrutinize a large number of claims more quickly than is typical of the traditional Medicare program; and (d) strategies involving coverage restrictions impose an obligation to provide beneficiaries with adequate information about the benefit. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-112/html/GAOREPORTS-T-HEHS-00-112.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-112/pdf/GAOREPORTS-T-HEHS-00-112.pdf GAO/T-HEHS-00-112 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-112 Testimony GAO/T-HEHS-00-112; Prescription Drugs: Adapting Private Sector Management; Health insurance Health care programs Pharmaceutical industry Drugs Health insurance cost control Private sector practices Presidential proposals Elderly persons Health resources utilization Medicare Choice Program Medicare Program Medicare Fee-for-Service Program