The Citizens Health Prescription: Coping with Rising Drug Costs

Prescription drug prices have climbed to unaffordable levels in recent years, creating a serious public policy problem for lawmakers at both the state and federal levels. The U.S. Medicare program only covers the costs of inpatient prescription drugs, and only seventy-five percent of beneficiaries are receiving coverage through some other means. But because of the tremendous power of the pharmaceutical industry on Capitol Hill, lawmakers in Washington have been unable to agree upon a workable solution. As a result, many states are experimenting with different strategies to provide some relief. Massachusetts has attempted to solve the problem through the Prescription Advantage Program, a first-in-the-nation insurance model that is open to all seniors in the state. While few would disagree that the program is an effective, inexpensive option for seniors to access sufficient prescription drug coverage, many have argued that the state needs to do more to reduce its overall drug costs. After spending two years lobbying the state to implement one cost-lowering option — a bulk-purchasing strategy to lower the state’s drug spending, former Congressman Joseph P. Kennedy II set out to run his own privately run drug discount program, Citizens Health. This study finds that there are lessons to be learned from both Citizens Health and the state’s program, Prescription Advantage. While Prescription Advantage can serve as a model for a government-sponsored prescription drug plan for seniors, Citizen Health can provide insight into how to reach other segments of the population who can’t afford the drugs they need