Tier 3 Vs Tier 5

In 2013, pharmaceutical cost per capita in the US was $1,112 compared to Switzerland’s $730. Private insurance plans widely vary on medication coverage. However, there are programs that are no cost to the individual that can decrease the cost of medications for people without

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

The prices of prescription drugs in the United States are by far the highest in the world. [1] On average, Europeans pay 40% less than Americans for the same medications. [2] Consumers have been resorting to several ways, sometimes putting themselves in harm’s way, to alleviate the burden of high prescription drug costs. Some buy their medications online or cross the borders to neighboring countries so they would be able to afford buying their needed medications. Others have resorted to the illegal act of selling their unused medications in online forums just to recover part of their expenses. Many factors contribute to the increased drug prices in the United States including research and

Managed care plan is another significant health care plan that gives options that may either make it easy or limit medical care services by the patients. This is the type that most people embrace. It covers a wide spectrum of health services in a cheaper and most convenient way. Costs are relatively lower when patients utilize the doctors and other stake holders. Mostly this cover does not require one to fill out any insurance forms or give out any claims to the company that has given you the cover when one uses the in-network providers. One pays a co pay each time he visits the doctor or any hospital. This co pay varies depending on who you visit and whether you receive brand name or generic prescription drug. Various managed care plans adopt a mail-order pharmacy alternative. In this alternative, one sends for the doctor’s prescription for

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

Within the formulary the drugs are divided into tiers. Co-payments are based on the tier that the drug is in and range from tier 1, the least expensive drugs, to tier 3 the most expensive drugs. Each insurance company plan is allowed to add or drop drugs from their formularies and move drugs from one tier level to another throughout the year. An insurance company can also drop a drug in the middle of the year, but must continue covering the drug for anyone taking it until the next reenrollment period, at which time a new plan will have to be chosen that covers that drug (Gustaitis, 2007). Although not used a lot there is a fourth tier that is for specialty drugs only. Some plans use a flat-rate or assign a percentage co-pay to the higher tier drugs (Gustaitis, 2007). Other characteristics of the insurance company plans that they have control over are requiring prior authorization for a drug, using step therapy, limiting the quantity, participating at certain pharmacies, and having preferred pharmacies (Gustaitis, 2007).

tier, they can ask the patient’s plan for an allowance for a lower co-payment. Mrs. Zwicks’s part

The generic prescription drugs that Plan A provides Impatient RX and does not give Outpatient RX. In Plan B, the generic prescription drugs are not covered. I would take generic prescription drugs for less serious illnesses such as headaches and pain. The Brand Prescription Drugs for Plan A are impatient RX are covered and Outpatient RX is not covered. Plan B’s Brand Prescription Drugs are not covered. Brand Prescription Drugs are medications that I would use for minor illnesses that are branded and patented by a company.

What does it cover? “It cost around fifty dollars to see the primary doctors, and specialize doctor seventy-five dollars.” (www.ehealth.com, 2014) “The prescriptions cost from range from fifteen dollars for generics to out of the pocket on some name brand drugs.” (www.ehealth.com, 2014) Some the name brand drugs are mental disorder and they cost up to thousands of dollars for this one of those prescriptions alone. “Surgeries, x-rays, cat-scans, M.R.I’s all them are half of the cost of the procedure. That does not count price of ER is five hundred dollars and every day you stay in the hospital it extra five hundred dollars you pay every day that you are in there.” (www.ehealth.com, 2014) It would be cheaper than paying out the pocket for a hospital stay or most of those things besides the name brand prescriptions it the same price.

The metal tiers deliver basic understanding for consumers of health coverage categories such as Bronze, Silver, Gold, and Platinum that will greater or lesser cover health care costs, but not include quality of care. In other words, the higher the metal level, the highest payment from health plan will be received for users care overall. On the other hand, the lower the metal level the more users have to pay for provided care. Out of four categories Platinum and Gold (higher premium) compensate higher costs of health care than Bronze and Silver (lower premium). Bronze and Silver categories have lowest monthly insurance bill for users, however highest deductibles and out-of-pocket costs. In opposite site Platinum and Gold categories offered highest monthly payment and lowest deductible and out-of-pocket costs. Based on the consumer income after enrolling in a Silver plan user could qualified for cost-sharing reductions benefits of that is fairly low premium, lower deductible, and pay lower from out-of-pocket costs when care needed.

Providing Over-The-Counter medicine Allstar targets people who have common health problems. The best way to segment Allstar’s customers would be by the following two major categories: illness (cold, cough, allergy) and demographics (young singles, young families, mature families, empty nesters, retired). Allstar Brands invests in marketing research to learn about the ever changing preferences and trends of the market. The information the Company gathers from this research is then used to make according decisions to satisfy each particular category of customer.

Health plans cover care for members who have different levels of expected cost and utilization due to differences in demographics and diseases.

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).

The Commonwealth Fund, New York. (2006). US Medicare Prescription Drug Coverage. Retrieved from US Me

Agent went over the drugs that the consumer gave her to look up that was important to him as well as the most expensive drug. The original plan that he was looking for did not cover that drug, but the enhanced plan did even though it was a higher monthly premium