The pharmaceutical industry is beginning to reap a windfall from a surprisingly lucrative niche market: drugs for poor people. The windfall, which by some estimates could be $2 billion or more this year, is a result of the transfer of millions of low-income people into the new Medicare Part D drug program that went into effect in January. Under that program...the prices paid by insurers, and eventually the taxpayer, for the medications given to those transferred are likely to be higher than what was paid under the federal-state Medicaid programs. Analysts expect it to generate hundreds of millions of additional dollars this year for the drug companies. Drugs tend to be cheaper under the Medicaid programs because the states are the buyers and by law they receive the lowest available prices for drugs. But in creating the federal Part D program, Congress -- in what critics saw as a sop to the drug industry -- barred the government from having a negotiating role. The windfall for the drug makers was made possible by a provision of the 2003 Medicare law that exempts Part D drugs from best price" rebates that the drug makers have been required to give to the state Medicaid programs. Those rebates are meant to make sure that state Medicaid agencies pay no more than the best prices drug companies offer to any big commercial insurer. Now, under Part D, all sorts of price deals will be negotiated by dozens of Medicare drug plans. The prices will be reported to Medicare, but under a provision of the law pushed by industry lobbyists, they will otherwise be kept secret.

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