A History of Creating the Medicare Prescription Drug Benefit/ Striking Compromises, Avoiding Past Mistakes, and Minding Budgetary Constraints

Authors: Blum, J.

When the Medicare Modernization Act of 2003 (MMA) was signed into law on December 8, 2003, many of those involved in the development of the legislation remarked that it was the most technically complicated and intricate piece of legislation they could remember ever working on. The MMA is nearly 1,000 pages long and introduced new terminology that has now become commonplace among politicians, health policy analysts, and Medicare beneficiaries. These terms include donut holes, PDPs, risk corridors, and low-income subsidies. Its technical complexity was the result of several confounding forces including: 1) delicate compromises that barely held together upon final passage of the legislation; 2) historical lessons from previously enacted prescription drug legislation; and 3) the Congressional budget process.

This commentary by Jonathan Blum of Avalere Health takes a closer look at these confounding forces that influenced the development of this technically complex piece of legislation.

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