What Is The Medicare Drug Price Negotiation Act?

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

The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable

Rising health insurance premiums have made healthcare unaffordable in the United States. Health insurance premiums in this country have undergone a steady rise over the past few years while incomes have remained the same. More than 50% of individuals with low incomes holding private insurance in the United States are unable to afford their healthcare costs (Collins, Gunja, Doty & Buetel, 2015). In addition, costs related to healthcare are equally unaffordable to 25% of working-age individuals who hold private health insurance policies (Collins et al., 2015). According to the Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) survey on employer health benefits, employer-sponsored health insurance plans have also had moderate rises in premiums in 2013 for both individuals and family coverage (Claxton et al., 2013). While

Those who utilize the Medicaid system range from low income families to the over 65 age group. Within this population is also those who are disabled due to physical or mental problems. This is among the sickliest of our American population. A paper based on a study in Oregon stated that “Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication as well as high blood pressure and high cholesterol.”(Baicker et al., 2013, p. 1715). Much of this is due to the struggle that the Medicaid beneficiary has

President Obama’s pledge to pay for the program by taxing the rich, who is anyone that makes more than $1 million a year (which would include President Obama) and will make for “a marketplace that provides choice and competition” (Conniff, 2009). He also proposes that reform is about every American who has ever feared losing their coverage if they become too sick, lose their jobs or even change their jobs. It’s realizing that the biggest force behind our deficit is the growing costs for Medicare and Medicaid programs.”

In 2008, upon the commencement of The Affordable Care Act, the idea was to help millions of uninsured Americans gain health insurance, especially those who are at or just above the federal poverty level. Although the idea behind a universal health care system was great at the time, many citizens are struggling to find a doctor that will accept the subsidized health care insurance, such as Medicaid, and Passport. Furthermore, doctors choose to opt-out of accepting government based health insurance because the reimbursement rates are too low. “It is estimated that private plans pay $1.00 for a service, Medicare pays $0.80, and the ACA exchange plans are paying about $0.60.” (Harvey 1) That shows that the government based subsidized programs are significantly lower than the average market value. A

Mrs. Jones, like many older adults, is on a fixed income, has Medicare for health coverage, but lacks prescription drug coverage. She was recently prescribed a new medication by her physician, which she cannot afford. As Mrs. Jones nurse, it is my responsibility to advocate for her by providing education and sharing information on the multiple different avenues available to decrease the cost of the medication prescribed. I will identify three strategies in which I can help Mrs. Jones afford her medication. First, I will provide education on her insurance plan and explain Medicare Drug Plans and their enrollment process. Secondly, I will identify a financial assistance program which she might qualify for. Finally, I will identify different ways to lower the cost of the medication such as coupons, drug discount cards, switching to a generic medication, and store programs ("Prescription Drug," 2014). All of these options are a solution to Mrs. Jones problem. In the meantime, it may be beneficial to obtain free samples from the physician 's office if possible, but this only makes sense if there is a strong likelihood that she will eventually be able to afford the new medication.

Kirby’s (2002) proposal calls for the federal government to pay for 90% of a person’s prescription drug expenses that exceed $5 000 of out-of-pocket and provincial monies combined (Chapter 7, pp. 9-10). There would also be a personal spending cap of 3% of the individual’s total family income (Kirby, 2002, chapter 7, p.9). Private insurances are also accounted for via formulas that give a patient either a rebate or may deny a person government assistance depending on their drug costs.

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

Often, when an individual is buying their own plan, the premiums are very high and are not able to be met. Some of these people who cannot afford premiums on their own do not qualify for government funded programs either. Many of these people are left uninsured or under-insured. Health insurance programs have started to increase deductibles. Cost has become an increasing issue with the current ACA, as well as quality for these government funded program’s patients, caused by the physicians contracted to provide care to these individuals.

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.

Threat one, was direct federal negotiations with drug manufacturers over prices paid under Medicare for prescription drugs. Threat two, was the approval for the importing of drugs from Canada and Europe, where the drugs were sold at lower prices than in the United States.8 To address these concerns of interests, PhRMA's president Billy Tauzin, boasted in private meetings that the association had a $200 million war chest, which the association could use to run TV ads either to support health-care reform or to oppose it, depending on whether negotiations worked out.”9 Obama, remaining cognizant of the Clinton administration's previous attempt at health care reform being stifled by interest group opposition, took PhRMA's demands seriously.10 Subsequently, Obama compromised and PhRMA got what it wanted: the legislation would not include direct negotiations over Medicare prices, importation of cheap drugs from abroad, or several other measures the industry opposed.11 In return, however, PhRMA would provide $8o billion of cost savings on drugs and pay for an advertising campaign in support of reform.12 Thus, Obama's willingness to make deals with conservatives and opponents of the bill, underscore the key reason why reform passed in 2010: commitment to compromise and pragmatism.

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.

The U.S. spending for healthcare has risen to astronomical heights leaving consumers and taxpayers to, yet again, pay more money for premiums and medication hikes. In 2000 average annual family premiums were $6,500 and by 2008 alone they almost doubled and by 2016 they have almost quadrupled (Forbes). It has become a monopolized borderline competition with less business environment. Many manufactures of medication state there is no set price to what the selling price will be for a medication. The selling price is determined by a supply and demand basis and what the insurance companies are willing to pay for it. Large providers are buying local locations to gain further leverage on the insurance providers. Often dropping them from their customer’s access if the prices are not paid. Very large insurance providers have more leverage for a better deal than smaller providers that most

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.