Medical Case Management 300
Professor Carole Gdula
April 7, 2013
Prescription Drug Coverage 2003
Prescription drug coverage was signed by the president in 2003, it is an act to provide for a voluntary prescription drug benefits under the Medicare program and to strengthen and improve the Medicare program and for other purposes. This act produced the largest overhaul of Medicare in the public health program’s 38 years history. In the years since the creation of Medicare in 1965, the role of prescription drugs in the United States patient care has increased significantly. Since the years there have been new and more expensive drugs that have been in use and patients, particularly senior citizens for whom Medicare was designed for have found prescriptions harder to afford and with the Medicare Modernization Act (MMA) this act is meant to address this problem. LAW
Medicare Prescription Drug, Improvement, and Modernization Act is an act to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the Medicare program and to strengthen and improve the Medicare program, and for the other purposes. This act adds a new part D (Voluntary prescription Drug Benefit Program), establishing a new optional Medicare prescription drug benefits program that will limit the coverage of certain outpatient prescription drugs, biologicals, and vaccines currently covered under the Medicare program under its original fee-for-service component under both Medicare parts A and B and under its managed care, medical savings account and private fee-for-service component under Medicare part C. Under this new prescription drug coverage it will provide eligible Medicare beneficiaries regardless of income or health status access to more coverage options, options which provide enhanced benefits with cost-sharing, additional beneficiary protections and assistance such as access to negotiated prices, catastrophic coverage limits, and premium subsidies for certain low=income beneficiaries.( http://www.govtrack.us/congress/bills/108/hr1/text). With these options will be available through the new Medicare part C Medicare Advantage (MA) program that integrates basic medical coverage with added prescription drug coverage, including coverage through specialized MA plans for special needs individuals. Also a new spate stand-alone Medicare prescription Drug plan (PDP) program under Medicare part D that relies on private plans to provide coverage and to bear a portion of the financial risk for drugs costs. This new program will take effect January 1, 2006. The Changes to the already existing Medicare plan now under the Medicare Advantage plan is: Now enrollees sign on for a whole year, care can be restricted to networks of providers, formularies can be used to restrict prescription drug choices, prescription coverage can be deferred to the patient or a Medicare Part D prescription plan, care other than emergency care can be restricted to a particular region, and federal reimbursement can be adjusted according to the health risk of the enrollees. The MMA created a new Health Savings Account that replaced and expanded the previous Medical Saving Account law by expanding allowable contributions and employer participation. Medicare Part D is the new prescription drug benefit resulting from the Medicare Modernization Act of 2003, providing all beneficiaries with the option to add prescription drug coverage. A premium will be charged for Part D in the same way there is a premium for Part B benefits. Recipients will have to pay a premium each month for the Part D benefit. The premium for Part D is approximately $35-37 a month. Each enrollee wishing to participate will have to elect Part D coverage and choose a corresponding prescription Drug Plan (PDP) or a Medicare Advantage Plan. Those beneficiaries with limited income and resources may be able to...