Why Pharmaceutical Reps Uses

All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act (Medicaid.gov, n.d.). What this program does is it entails that a drug manufacturer to enter to or put in affect a national rebate agreement with the Secretary of the Department of Health and Human Services, and in return the state provide Medicaid of most of the manufacturer’s drug. In addition to authorization a national rebate agreement, drug manufacturers are obligated to enter into agreements with two other Federal programs in order to have their drugs covered under Medicaid: a pricing agreement for the Section 340B Drug Pricing Program, administered by the Health Resources and Services Administration, and a master agreement with the Secretary of Veterans Affairs for the Federal Supply Schedule. (Medicaid.gov, n.d.) Another program that came into place a little after Medicaid was the Affordable Care Act put into action on March 23, 2010 by President Barack Obama. Basically what the Affordable Care Act did was expanded medical coverage to everyone, making it a law that everyone must have some kind of insurance. This program is for all tax payers in the United States, but individuals not legally present in the U.S. are excluded from this coverage. The law also exempt those who come into conflict with this

In Japan, prices for every procedure and drug are negotiated every two years between the physicians and the government. The prices are fixed and the same regardless of where you go in Japan for treatment (Reid, 2008). In the United States, different healthcare plans offer a variety of coverage for medications but some prescriptions can be denied by the insurance company based on your type of insurance plan. Drug companies are very competitive in the United States and prices are expensive. Frequently, insurance companies might cover a similar or generic form of medication rather than the brand name medication and insurance co-pays differ depending on which drug is prescribed.

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).

The patient is informed about their coverage and the amount of copayment they would have to pay.

The cost of providing health benefits is on the rise. Spending on high-cost specialty drugs is increasing. Placing caps on drug coverage is a strategy for controlling costs. For example, companies could decide to cap their drug coverage at $5,000 per year. Those employees who need expensive medications could pay out of pocket or get reimbursed elsewhere, such as through a government drug

Drugs that treat serious illnesses are fully covered while drugs that treat non-life-threatening illnesses and have little medical benefit get 15% coverage. Finally, drugs that don’t have enough evidence behind them aren’t covered at all while most drugs get 65% coverage

Traditionally, pharmacists had no power of questioning any order made by the physician. It was also stated that a pharmacist had no power of advising the patient on the usage of medication. Currently, pharmacists have been given more power and therefore have the mandate of questioning any prescription from the physician. It has been observed that pharmacist can today share information with the doctor and ensure that patients get the right medication. Laws have allowed pharmacists to be consulted on some medications by patients, allowing patients to trust pharmacist on some simple questions that they do not need to visit their doctor. Pharmacists play a significant role in advising the patient today on the type of medication they are taking they are also held to the same standard when it comes to rules and

When it comes to varies insurance companies such as Medicaid and Medicare insurance company pays very differently. Medicaid will pay for the patient medical billing and patient who has Medicare depending what they have if it’s Medicare plan A or B. There are very different and Medicare A will only covers inpatient care at a hospital, skilled nursing facilities, and hospice. For Medicare B will cover doctor’s visits, and any other health care providers services, outpatient care, durable medical equipment, home healthcare, and there are other services that it may cover. So what not covered by Medicare A and B they will have to pay out of pocket unless they have any other insurance that will pay the remaining. Healthcare providers can have a

Each plan is also followed by a detailed chart that breaks down which tier each medication falls under, estimated full drug cost at each pharmacy, whether any special actions are to be taken to receive the medication. There are 5 tiers that these medications can fall into, and with each plan these medications either fall into tier 3, 4, or 5. Tier 3, also known as preferred brand, are brand-name drugs that don’t have a generic equivalent. Tier 4, also known as non-preferred brand, are the higher-priced brand-name and generic drugs not in a preferred tier. Tier 5, also known as specialty, are the most expensive drugs on the drug list. Looking at drug coverage information and the estimated full drug cost at a retail pharmacy for each plan, it

The five drugs I used are listed here: Diazepam TAB 5MG, Fenofibrate TAB 145MG, Metformin Hcl TAB 500MG, Montelukast Sodium TAB 10MG, and Tramadol Hcl TAB 500MG. The drugs I choose where formulary and did have restrictions, the drugs that I found out had restrictions were Diazepam TAB 50MG with a restriction of 120 TABS every 30 days, Metformin Hcl TAB 500MG with a restriction of 150 TABS every 30 Days, and Tramadol Hcl TAB 500MG with a restriction of 240 TABS every 30 days. One of the main reasons I choose Silver Scripst Choice was because the annual drug deductibles cost was $0 even though the copay is anywhere from $3-$46 or 33%-46% the monthly premium is extremely cheap coming in at only $23.40 which is one of the lowest monthly premiums I saw with no annual drug deductibles. Now if I have to help a friend family member, I know which drug plan would be the best with the lowest price, the main reason I choose this plan was because the other plans were ridiculous and most of the plans annual drug deductibles were anywhere $250-$360 with monthly premiums being from $18.40-$49.20 with the copay not even calculated into that it doesn’t sound like a lot, but it is a lot for prescriptions to most elderly recipients of Medicare who only have so much money to live off of each month and for them every cent

Copay's are fixed amounts the patient is responsible for paying on the medical bill, considering whether or not the patient is insured. Co-pays help keep out-of-pocket expenses down to a minimal. Whenever an insured patient has a doctor's visit or has a covered prescription filled, the co-pay splits the cost between the patient and the insurance company. "Copays split the health care costs between you and the insurance company. After the copay is paid, the insurance company normally pays 100% of the remaining covered expenses. Copays are in place, regardless of whether you have met your calendar-year deductible or not (Goldenrulecom, 2015)."

After the Pharmacy technicians checks the solution for exactness, and may convey it to the patient. The expert then duplicates the data about the endorsed pharmaceutical onto the patient's profile. Specialists likewise may amass a 24-hour supply of medication for each patient. They bundle and mark every measurement independently. The bundles are then set in the drug cupboards of patients until the administering pharmacist checks them for precision, and at exactly that point is the prescription given to the patients.

PharmaCARE will not face any liability over its practices under current federal and state laws. Federal laws are vague and under reaching and in the case of CompCARE, the facility will not be classified as a drug manufacturer, which eliminates almost entirely the possibilities of regulation by current federal laws. The FDA does not consider compounded drugs to be as safe as those manufactured in large plants that have to meet standards for quality assurance and urges consumers to use FDA approved drugs. All though the FDA knows the risk of traditionally compounded drugs, the FDA doesn't know just how many compounding pharmacies exist in the United States. Also, states that do much of the regulation for compounding pharmacies are not themselves

There are other pharmacy staff who also have roles in relation to the safe dispensing of medicines. A pharmacist is responsible for: Overall checking of a prescription to make sure that it is legal and written by a person qualified to do so, dispensing the right quantity of the correct medicine, ensuring that medicines are correctly labelled with the person’s name, the name of the medicine and the dosage, providing advice and treatment for minor illnesses, injuries and health concerns, providing a repeat prescription service in co-operation with GP

PBM negotiates a contract with the pharmacies. Insurance companies negotiate with the PBM on reimbursement and what goes on the formulary. The patient would pay the insurance and the insurance would then pay the PBM to provide the prescription coverage. The PBM would reimburse the pharmacy for the drugs that are dispensed.