Lock-In Locked-Out by Medicare

Last week, the Wall Street Journal reported that the acting administrator of Medicare's Center for Medicare and Medicaid Services predicted that new regulations will "reduce what [patients] pay at the pharmacy counter."

Under the new regulation, the calculation of when a patient reaches the donut hole will use the actual amount paid by the insurer to the pharmacy, not what the insurer pays to the benefits manager, which includes a potential profit for the benefits manager.

As one might expect, a benefits manager complained, using the stalking horse of less competitive plan design choices. My interpretation is that the complaint reflects the benefits' manager's concern about its profits and no real concern about patients who reach the donut hole.