Medicare Part

Patricia Barry, Medicare Part D How to Avoid Bigger Bills, AARP Bulletin, December 2006, pp. 12-14. Also available online. URL http //bulletin.aarp.org/ yourhealth/medicare/articles/medicare part d how to avoid bigger bills.html. Downloaded April 7, 2009. 

Alternatively, those who belong to Medicare Advantage get prescription drug benefits through their HMO membership rather than Medicare Part... 

Medicare Part D The component of Medicare that covers prescription drugs through voluntary enrollment in one of several plans and saves members money on drug purchases. 

Two clauses seen occasionally in pharmacy contracts are the most favored nation clause and the allproducts clause. The most favored nation clause requires pharmacies to extend their lowest price or reimbursement rate to that third party. It is customary for third parties to require that the pharmacy charge the third party its U C price if it is lower than the third party s reimbursement formula price. However, having to give the third party the lowest reimbursement rate of all the other third-party rates is not customary The allproducts clause requires pharmacies to participate in all the third party s plans if it wants to participate in one plan. A pharmacy may want to choose only some of a third party s plans depending on the reimbursement rate and number of customers affected. Some states prohibit all-products clauses. These clauses became especially problematic with the advent of discount cards and more recently with the implementation of Medicare Part D. Discount cards are given or sold to people who do not have insurance coverage for prescription drugs. People who have a discount card pay a price that is determined by a reimbursement formula rather than the U C pharmacy price. As noted earlier, the reimbursement price usually is less than the pharmacy s U C price, so pharmacies receive less revenue. Some of the discount cards are administered by PBMs and other third parties, and pharmacies may prefer not to accept a third party s discount card even if they accept patients with insurance from that third party. Pharmacies... 

Shepherd MD, Richards KM, Winegar AL. 2007. Prescription drug payment times by Medicare Part D plans Results of a national study. J Am Pharm Assoc 47(6) e20. 

Explain the variety of benefit designs in the Medicare Part D program. 

Identify medication therapy management (MTM) opportunities available via Medicare Part D. 

Consider management issues brought about by Medicare Part D, including stakeholder relationships and financial viability. 

Identify sources of information about Medicare Part D programs. 

Part D was implemented, he has experienced lower profit margins. At the same time, his patients and the community have expressed their gratitude for his assistance during Medicare enrollment periods and for helping them better understand the issues related to the many Medicare Part D prescription drug plans. 

Are patients at Bell s Pharmacy likely to benefit from Medicare Part D ... 

What positive things have happened to Sam Bell since Medicare Part D was implemented ... 

The Medicare Catastrophic Coverage Act of 1988 was passed and included coverage for outpatient prescription medicines under Medicare Part B. Cover-... 

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