Medicare Part D: The First Fifteen Years.

In this month's column, the author reflects on the initial concerns of the Medicare Part D program and the actual results of the program 15 years after it became law.

How the Pharmaceutical Benefits Scheme began.

Seventy years ago, the Curtin wartime government introduced legislation for a Pharmaceutical Benefits Scheme (PBS). It was a response to the need to provide access to a wave of antibiotic drugs - sulfonamides, streptomycin, penicillin - to the whole population, not only to the minority able to afford them. The scheme was immediately and successfully opposed by doctors and the conservative opposition, which saw in universal health care an underhand plan to nationalise medicine. There were two High Court challenges, two referendums and a constitutional amendment; but it was not until 1960 that Australians had the comprehensive PBS envisaged by Curtin in 1944.

Comparison friction: experimental evidence from medicare drug plans.

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction­the wedge between the availability of comparative information and consumers' use of it­is inconsequential because when information is readily available, consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step­providing the information rather than having consumers actively access it­had an impact. Plan switching was 28% in the intervention group, versus 17% in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 a year among letter recipients­roughly 5% of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small and may be relevant for a wide range of public policies that incorporate consumer choice.

Canadian pharmacare: looking back, looking forward.

Despite Canadians' pride in medicare and the values underpinning it, the system is conspicuously incomplete. Universal public health insurance in Canada ends as soon as a patient is handed a prescription to fill; yet prescription drugs are the second largest component of health system costs. We look back at key moments in Canadian healthcare history that shaped our pharmacare system - or lack thereof. We look forward to changes in demography and technology that will increase the need for pharmacare reform in the near future. We conclude that meaningful public engagement in pharmacare design may generate the clarity of goals and level of political support needed should windows of policy opportunity open again.

Pharmaceuticals issue brief: experimental treatments and other prescription mandates.

Mandated pharmacy benefits for managed care enrollees that provide for experimental treatments, off-label drug therapies, diabetic regimens, contraceptives and treatment of inherited diseases that were once routinely denied are now in effect in a number of states.