Affordable Care Act and Part D

Many proposals to reorganize Medicare could increase the financial and health risks faced by the vulnerable elderly. Turning Medicare into a premium-support system a voucher set randomly at the value of the second-least-expensive insurance plan could shift costs to elderly households. Increasing the Medicare eligibility age from 65 to 67 will leave many Americans ages 65 and 66 without insurance. The basic idea of part A Medicare payment is simple. The patient pays a deductible that approximately equal to the cost of the first day in the hospital;

Medicare Part D Drug Plan was created by Congress in 2003 to aid the elderly, disabled, and sick persons in affording their medication. Coverage for the drug plan went into affect January 1, 2006. This plan was called the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) (Cassel, 2005). The final bill that passed, was influenced by drug-company and health insurance lobbyists and focused mainly on the needs of those industries instead of the seniors it was meant to serve (Slaughter, 2006). These plans are operated by insurance companies and some private companies that have been approved by Medicare. Part D is optional only if a person carries health insurance that includes prescription coverage. If at retirement

In a 2017 draft, CMS is introducing new policy changes and rate revisions for Medicare Advantage and Part D. Medicare Advantage rates may increase 1.35% based on predictions where revenues are expected to increase 3.5%. Medicare Advantage plans with a 4, 4.5, and 5-star rating will qualify for an estimated 5% in quality bonus payments. Those with less than 3 stars to 3.5 stars are not qualified. Proposed adjustments in the star rating system include socioeconomic and disability status.

The major purpose of this work is to completely discuss about the Medicare Part D which will set an influence on the different interest groups and all the entities of government which have been set under the policy changing process. There has been a complete set environment which involved and shape the policy to make efforts as to how all the groups of the stakeholders are influences with the Medical Part D. All the legislation and the specific strategies are made in correspondence to the politics. (Powell et al., 2015). The Medicare Part D is also said to be Medicare prescription drug benefit which directs to setting the United States Federal government programs to work on the subsidizing costs of all the drugs of prescription which insure premiums for the Medicare in US. There is a great enactment which has been based on Medicare Modernization Act of 2003. In December 2003, there are major Medicare Prescriptions which have become into the Improvement and Modernisation Act to become a proper law. There has been a great benefit from the drugs which provides an entire coverage to all the disables and the elderly people who could not have the ability to manage it.

Analyses of pharmaceutical pricing are complicated by the intricacies of this market. The process by which drug prices are determined is highly complex, involving numerous interactions and arrangements among manufacturers, whole salers ,retailers, insurers, pharmacy benefit managers (PBMs), and consumers. There are many instances, a manufacturer will provide a cash rebate to an insurer or PBM if the manufacturer’s drugs are used by the insurer’s or PBM’s enrollee. Consequently, information about the size, prevalence and

Advancement in e-Prescribing: This method of prescription is very beneficial to providers, doctors, pharmacists, and patients as it is a time-saving method and it enables physicians “to prescribe in a single form electronically” and instantly allows pharmacies to receive and archive information electronically.

For many years the debate about lowering the cost of healthcare such as insurance overpriced medications and how it affects patients, pharmacies and physicians. Most patients have prescription drug plan that will cover some of the cost of medications. Patients with a prescription drug plan are given a prescription drug formulary. The prescription drug formulary is a list of medications that their insurance will cover. The Formulary has a list of Preferred (covered) and Non-Preferred (not covered) medications. The Preferred list of medications are then broken down into tiers, usually four, with the first tier being the cheapest and the fourth tier being the most expensive. The formulary will have a list of generic and brand name medications.

Medicare and Medicaid are the largest health insurance system in the United States that provides to Americans age of 65 or older. It is also provided to certain younger people with disabilities, and people who are suffering from end stage of renal disease (ESRD). Medicare, Title XVIII of the Social Security Act, was signed into law in July 30th, 1965 by President Johnson. The program was originally called “Health Insurance for the Aged and Disabled” [1]

The Center for Medicare and Medicaid (CMS) was established in 1967 in efforts to increase health coverage. For that matter, Medicare was purposely established to increase health coverage and as well as allow the less fortunate/vulnerable individuals in the society access quality and affordable healthcare (CMS, 2015). Today, Medicare and Medicaid collectively cover about one hundred million Americans. Among the largest group covered by Medicare are the elderly persons. At the old age, the vulnerability to various illness increase. Despite an increasing elderly population in the country, the majority of them cannot afford to pay out of pocket for health care services or pay for a private health insurance. As a result, Medicare aims at providing different coverage plans that are also affordable (CMS, 2015). For that matter, this paper will focus on the various coverage plans offered by Medicare and the ease with which elderly persons can make decisions regarding the coverage plans.

My group’s focus is on e-prescribing, therefore I decided to search strengths and weaknesses of e-prescribing. I found a reviewed article addressing this by going onto the U of M libraries website and using the Ovid Medline database. From the Ovid Medline database, I typed in the keyword “e-prescribing” and selected electronic prescribing. I refined my search by adding the keyword “strengths” to the search. I selected this article because it includes a study on different pharmacists and their experiences with e-prescribing. The study was conducted for two months on seven different pharmacies in Wisconsin that met the

Medical clerks should consult patients on more affordable healthcare plans while also recommending generic medication over brand name medication. Someone taking three brand-name drugs spends about $1,900 more annually than those who use generic name drugs (ABC News, 2014). In the case of high cholesterol levels, Lipitor is a brand name drug that is often prescribed. Healthcare providers should recommend Atorvastatin, which is the generic brand and is 20-40% cheaper. It is a common myth that brand name drugs are more effective than generic drugs; they have the same active ingredients, but are just made and distributed by different companies. Previous estimates showed that enrollees in the standard Medicare Part D drug plan paid between 42 and 69 percent of their annual drug expenses (Stuart, et al., 2005). Many seniors go without taking the medications they need to maintain

Healthcare today is considerably different than it was over 50 years ago when Medicare was signed into law. Since that time, the United States government has invested billions of dollars into heath care every year. The Medicare program has led to better health care, but has also created the need for continuing re-examination and revision of Medicare policies. This is due to ongoing changes in medical care and the growing population of older Americans. Despite the evolution of the health care industry, the goal of Medicare has stayed the same--to ensure that aging adults have access to the medical care they need. As part of the Medicare program, Medicare Part A provides assurance that a patient's inpatient care needs will be met as they

Medications are a critical player in the healthcare system, and are necessary to maintain or improve a certain level of health and wellness. As discussed in chapter one of our text, prescribed medications are considered a tertiary prevention in that they are to "reduce the impact of an already established disease by minimizing disease-related complications." (Niles, 2018, p.3) Medications are either brand name (meaning that the manufacturer has completed necessary research and development, marketing, as well as promoting) or generic. (Stoppler, n.d.) According to the FDA's web page on this topic (Center for Drug Evaluation and Research, n.d.), generic medications are developed when a manufacturer's exclusivity period is close to expiring,

After the generic is down for use, the pharmacy that used to buy a brand and pays four hundred dollars for just a hundred pills, now pays from one to ten dollars for a hundred pills which makes the expenses of the pharmacy decrease. (Belk David MD)

What is Medicare Part D? Medicare Part D, which is also known as the Medicare prescription drug benefit, is a United States federal government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries (medicareinteractive.org, 2016). In this paper I will synthesize my understanding of why Medicare Part D passed and the influence of the various interest groups and governmental entities during the process, as well as discuss how various stakeholder groups influence the final outcome of Medicare Part D legislation, what the specific strategies and tools that were used most effectively as well as advise if the Medicare Part D passed corresponds with my understanding of policy and