tci Medicare Compliance & Reimbursement - 2005 Issue 5

Drug Coverage: Big Risks Await Those Who Offer Medicare PDPs

Prescription drug plans will be unlike anything health plans or PBMs have offered beforeMedicare has again become a profitable market, but it remains to be seen whether offering a prescription drug plan in 2006 will be a good business move.With PDPs, Medicare is essentially creating a product that hasn't existed before, not even in the commercial market, says John Gorman, president of Gorman Health Group in Washington. PDPs will offer a product that offers drug-only coverage to seniors, and it will be up to the PDP sponsors to determine what type of benefits to offer and figure out...

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