Prescription drugs, part Medicare

New content has been added to reflect major events in our profession, such as the implementation of the Medicare Modernization Act and subsequent addition of an outpatient prescription drug benefit (Medicare Part D). 

Every chapter has been updated to reflect the fluid nature of their respective management topic. In many cases, new content has been added to reflect major events in our profession, such as the implementation of the Medicare Modernization Act and subsequent addition of an outpatient prescription drug benefit (Medicare Part D). New trends in the management literature and research studies are reflected in each of the chapters. 

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. 

Many third parties hire pharmacy benefit managers (PBMs) to provide prescription claims processing and other services. Examples of third parties that hire PBMs are insurance companies, employers, Medicare prescription drug plans, and state Medicaid programs. PBMs establish pharmacy networks as part of their claims management services, so many pharmacy third-party contracts are with PBMs. Examples of other ser-... 

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. 

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. 

Medicare Part D has increased prescription drug access for millions of older adults. The private administration of the program has resulted in many choices among plans, which has an impact on both patients and pharmacies. MTM developed in 2007, and it has... 

People receiving Medicaid and individuals receiving the lower-income subsidy will benefit from Medicare Part D plans because their enrollment is subsidized fully or to some extent. Individuals receiving the low-income subsidy are those least likely to have other insurance and have difficulty paying case prices for prescription drugs. 

Evans-Molina C, Rean S, Henault LE, et al. 2007. The new Medicare part D prescription drug benefit An estimation of its effect on prescription drug costs in a Medicare population with atrial fibrillation. J Am GeriatrSoc 55 1038. 

Medical News Today. 2007. University of Texas Study Details Lengthy Payment Delays for Medicare Part D Prescription Drug Claims, Confirming Need For Legislative Fix. Medical News Today, September 8 www. medicalnewstoday.com/articles/81802.php. 

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