Prescription Drug Coverage: A Case Study

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Prescription drug coverage is an essential health benefit that is supported in PPACA. States were mandated to expand their Medicaid programs to provide remunerations to Medicaid eligible consumers while encouraging preventive care treatments. Thus, generating sales and drug coverage within the industry. In 2011, Americans filled an estimated 3.8 billion dollars in retail prescriptions, insinuating an increased usage of prescription drugs due to the enactment of the PPACA (Herrick, 2013, para 2). However, while the accessibility of health care and prescription coverage is provided to consumers, the coverage for many procedures will be denied, diminished or eliminated. Unfavorably, the regulatory involvement of the healthcare reform will adversely…show more content…
This industry has monopolized drug distribution to sustain and control high cost of the brand name prescription drugs. These brand name drugs were covered under patent protections, which stipulate that only that pharmaceutical company awarded coverage can manufacture, market and eventually profit from that specific drug. As long as the patent protections exist, these drugs cannot be sold as generic brands by other companies. The regulations outlined in the PPACA, however, challenged these patents to allow a more competitive field, thus dropping the cost of drugs and sales of brand named prescriptions. This lowered the revenue of high cost drugs and opened accessibility for lower cost options. The PPACA continued to further impose regulations, even on biologic pharmaceutical products. These products, which are versions of the original biologic products “that have the same mechanism of action in the body and are used for the same clinical indication but are not identical to the original product (variously referred to as the reference, pioneer, or innovator product)” (Health Policy Brief, 2013, para 5). The reform also included the Biologics Price Competition and Innovation Act (BPCIA), which encourages to allow competition, as the regulation of the patent protections, in the market for biologic…show more content…
Once the limit for Part D Medicare benefits has been reached, patients are now responsible for the full cost of the drugs. Needless to say, for most people who have Medicare Part D, the donut hole presents unfortunate financial challenges. Inclusively, the additional funding for these provisions also raise prices at a rate higher than inflation. “Such a price-hike penalty already applies to brand medicines, and proposals to extend it to generics are under review by the Health and Human Services (HHS) Inspector General” (Wechsler, 2015, para 2). This change will discourage pharmaceutical companies from entering into specific drug classes, and provide fewer choices that will increase the patient’s reliance on older, originator products and drive up costs (Wechsler, 2015, para

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