Strategies to improve medication compliance by Medicare beneficiaries.

In the article in this issue by Choudhry et al,1 the authors assess whether eliminating out-of-pocket costs would be an effective way to improve medication compliance in Medicare patients after they have experienced an acute myocardial infarction (MI). The specific questions the authors raise are whether full coverage would be cost-effective using the traditional values for such measurements and whether full coverage would actually save Medicare money by reducing health expenditures outside of the pharmacy area. For those of us who live in the policy world of Washington, this is an important issue, because if the additional coverage can be demonstrated to save Medicare money elsewhere, the change in coverage would not be regarded as an increase in spending but rather as a savings to the program. Under current Congressional rules, increased expenditures—even useful ones—need to be offset by either reduced expenditures elsewhere or by increased tax revenue. This means that being able to demonstrate the net effect of a change in coverage on overall Medicare spending (as well as on overall health spending) becomes an important budget matter as well as an important health policy issue.