Kevin Piper summarizes the good, the bad, the ugly, the winners and losers from the new Medicare Part D program in his blog "the Piper Report". As more information has become available, it is clear that there will be substantial changes to the pharma supply chain, with most entities seeking to better understand utilization and price drivers and squeeze margins wherever possible.

Piper notes winners will include:

--low income Medicare recipients without Rx coverage today
--private employers with generous retirement medical plans will reap a multi-billion dollar windfall, although legislation may reduce this.
--large national insurers seeking to expand market share in this rapidly growing market of seniors
--lobbyists actuaries and consultants.

That may be true, but the fundamental problem of adverse selection still exists. It is getting lonelier by the day out here in the "but the business model just does not make sense" woods, but I have yet to hear anything that makes it sound like Part D providers will be protected from adverse selection.

What does this mean for you?

I'd be very careful of Part D; just because others seem to believe in this does not mean you should not carefully assess the risks.