Granted, the new Medicare D program was filled with lots of holes. The biggest problem was in designing the program. This administration did not want the Medicare drug benefit to be administered directly by the federal government (where Medicare is run efficiently). Instead, it devised a public program run by hundreds of competing private plans, each with its own prices and coverage policies.
Also, a joint Michigan/Harvard study confirmed, before the new Medicare reform, medical oncologists were more likely to choose cancer drugs that earn them more money. Yet a survey published in "Patterns of Care" showed that the Medicare reforms have not solved the problem of variations in oncology practice.
http://www.healthyskepticism.org/news/2007/Jun.php
However, the new Medicare drug benefit plan was part of a much broader message. With oncology drugs accounting for about 69% of total Part B spending on prescription drugs and related services, the new Medicare D plan made it more important for Senior cancer patients.
A study published in the journal Health Affairs discovered that Part D expanded access to cancer therapies and required only low co-payments. Researchers found that the most commonly prescribed cancer drugs were available and when a brand-name drug was not covered, its generic equivalent was.
Apparently Medicare has gone far in accomplishing the task of making many cancer drugs available to our Seniors. Nearly all generic cancer drugs and 70% of brand-name cancer drugs are covered by the Part D plans. Most of the brand-name drugs not covered had generic equivalents that are covered. Also, a number of trusted old generic agents have been found to be just as effacious as the more expensive brand name ones.
According to NCI's official cancer information website on "state of the art" chemotherapy, no data support the superiority of any particular regimen. So, it would appear that published reports of clinical trials provide precious little in the way of guidance. There are many cancer drug regimens, all of which have approximately the same probability of working. The tumors of different patients have different responses to chemotherapy.
Medical oncologists are now be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, radiaiton therapy, surgery and other procedures as necessary, and offer any other support needed to reduce patient morbidity and extend patient survival. In other words, medical oncologists were taken out of the retail pharmacy business. However, as Medicare tried to do this, private insurance plans still go along with the chemotherapy concession.
According to an article published in the New England Journal of Medicine, an unintended effect of the Medicare Part D benefit could be the creation of the world's most valuable resource for understanding how drugs are used, especially by the elderly and the chronically ill, and their risks and benefits.
http://content.nejm.org/cgi/content/full/353/26/2742
Now, if only Medicare would be allowed to negotiate prices, eliminate the doughnut hole, and stop subsidizing private insurance Medicare plans!