Drug Assistance Programs

Drug and health plans are major resources to long-term care. Medicare does not cover most of long-term care services, but it may pay a portion depending on selected coverage. Medicaid may step in and help pay as well. “The Medicare Plan Finder tool provides one central point to view and compare all available drug and health plan

The last part of Medicare includes a prescription drug plan, known as Part D.  Part D adds prescription drug coverage to original Medicare, some Medicare Cost Plans and Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.  Insurance companies offer these plans and other private companies approved by Medicare.  Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans (Medicare, 2013).

Everybody reaches out of pocket to pay for different prescription drugs. Parents for children, elderly for health conditions, and pet owners for pets, but there is one extensive concern; the price and outcomes. Transiently, it may be common for someone to come out of pocket for some prescriptions, but when people draw out of pocket every time just to pick up a prescription drug, it becomes annoying and upsetting. Pharmaceutical companies like CVS and Walgreens collect over $1,000,000 dollars just from gouging people for medications. According to David Belk (M.D.), Pharmacies buy medication in mass from pharmaceutical corporations and suppliers, then sell for a profit. What everyone is trying to ask the companies though is why. Why would a top-producing company like CVS or Walgreens sell expensive medications to a group of people like the elderly for profit?

Medicare provides access to health insurance coverage for more than 45 million people who qualify due to disability or age. The three components of Medicare are Parts A, B, and D. Part A is hospital insurance and provides coverage for inpatient hospital services, skilled nursing facility services, hospice services, and post-institutional home health care. Covered services under Part B one component of supplementary medical insurance (SMI) include physician services, durable medical equipment, laboratory services, outpatient hospital services, physician-administered drugs, dialysis, and certain other home health care services. The other component of SMI, Part D, mainly provides access to prescription drug coverage through private insurance plans.

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

One of the problems of Medicare itself is that it doesn't cover the costs of prescription drugs for its members; this has led to one of the major reasons that the program is in danger. A great deal of personal healthcare relies on the use of drugs, and since the program doesn't cover these costs, the individual must bear them. According to the AARP, in 1999 out-of-pocket costs for prescription drugs were estimated to be $450 per person each year (AARP). Obviously, members have joined the program to defray their medical costs, but these figures indicate that they still have large costs to pay. The other problem faced by the Medicare program is that it is also suffering from a lack of funds. According to Governor George W. Bush, the financial health of Medicare is in serious jeopardy and might face deficit as soon as 2010 (Bush). As a result of these major problems, one might wonder why the plan isn't scrapped for another program; well according to polls done by the Public Agenda, an Internet public policy site, American citizens are strongly in favor of Medicare, and would rather see the problems ironed out (Public Agenda). Therefore it is necessary to come up with a solution, so that the Medicare program remains intact.

Medicare Part D is prescription drug coverage. It’s the newest part in Medicare. It adds prescription drug coverage to original Medicare, some Medicare cost plans, some Medicare PPS plans, and Medicare Medical Savings plans. Beneficiaries choose the drug plan and pay a monthly premium.

Medicare part D is the prescription drug plan. Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, if the drug is on a higher tier and the patient 's prescriber (the patient 's doctor or other health care provider who is legally allowed to write prescriptions) thinks the patient needs that drug instead of a comparable drug on a lower tier, the prescriber can ask the patients plan for an allowance to get a lower copayment. In the case of Mrs. Zwick Part D will cover the prescription drugs that she needs that are not covered by Medicare Part A and Part B unless those medications are on the unapproved list. What the patient will be responsible for paying

The Medicare and Medicaid federal programs were put in place as a way to help the less fortunate. Individuals with severe disabilities or over the age of 65 qualify for Medicare. This program helps them with health coverage, so the disabled and elderly who have Medicare do not have to worry about their medical bills and not going to the hospital when they are sick. Medicaid is a similar program, however, it only applies to low income families who cannot provide for their children. Similar to Medicare, this program covers any health related problems and takes away the worry and troubles that come with hospital bills.

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

The rise in costs of prescription medicines affects all sectors of the health care industry, including private insurers, public programs, and patients. Spending on prescription drugs continues to be an important health care concern, particularly in light of rising pharmaceutical costs, the aging population, and increased use of costly specialty drugs. In recent history, increases in prescription drug costs have outpaced other categories of health care spending, rising rapidly throughout the latter half of the 1990s and early 2000s. (Kaiseredu.org, 2012).

On January 1, 1991, The Medicaid Drug Rebate Program was set into place. The purpose of the Medicaid Drug Program was to help manage the cost of prescription drugs. The program allows each state to control a specific list of drugs covered, their generic counterparts, and alternative treatment options (Medicaid History).

Medicare Part D is the prescription drug plan. There are various options under this portion of Medicare and depending on the one that your mother has chosen would base the amount of coverage that she would receive for prescription medications. This does not necessarily cover the full cost of the prescription medications; there are deductibles and copayments that must be met.

Seniors who fall under a coverage hole will start getting some help. Some are saying that seniors may lose Medicare benefits they now enjoy, but that is not true. The health reform act will not cut guaranteed benefits; a person will still be able to maintain the coverage they want. Americans on Medicare will receive free preventive care without co- payments or deductibles. Seniors will also receive $250 to help pay for their prescriptions. There will also be alternatives to nursing home placement, such as day-service programs, home-care aides, meal programs, senior centers and transportation services. A public, voluntary long-term care insurance program known as the Community Living Assistance Services and Supports, have enrolled individuals who have substantial daily needs to receive at least $50 a day. This money is to be used to defray the costs of services such as home care, family caregiver support, and adult day-care or residential care.