The Medication Choice Issue In The Dual Eligible Demonstration Projects

Recently we had a couple of readers ask – do the dual eligible demonstration projects managed by health plans affect consumer choice of medication? The short answer is yes. Each health plan creates their own formulary and, therefore, consumer choice of medication varies by plan.

For a quick recap, the dual eligible demonstration projects were created to better coordinate care and ultimately reduce spending on this high-needs, high-utilizing population. To meet this goal, comprehensive health plans that provide all Medicare and Medicaid benefits were created. The health plans receive a blended capitation rate from Medicare and Medicaid to coordinate . . .