Optiond for reducing the deficit

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by MimiMHA, Jan 29, 2018.

  1. MimiMHA
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    MimiMHA Rookie

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    The effects of implementing a cost-sharing health option for pharmaceuticals would turn out to be both beneficial for some as well as costly for others. Hoping to reduce the federal spending / financial on health care the federal government is devising ways to offset costs, such as “cost – sharing”. An example of a recent cost sharing implementation is the Medicare prescription drug coverage, Medicare D. The Medicare D prescription drug program was developed and implemented to assist Medicare beneficiaries with providing them prescription drug coverage and to aide in affording their medications, as well as offset the government’s financial burden. For example, if a Medicare beneficiary is prescribed 1 to 5 low cost medications they will always pay a minimal co pay for the benefit period, entire year. Versus a patient who is on 15 medications per month that are costly will pay a high percentage of the cost of the medications until they reach a catastrophic amount of about $5,000 out of pocket to go back down to 5% of the costs of the medications for the rest of the year. According to Sacks, N. C., Burgess, J. F., Cabral, H. J., Pizer, S. D., & McDonnell, M. E. (2013), “The Medicare Part D coverage gap, which is to be eliminated in phases by 2020, has been controversial since this medication benefit was enacted with the 2003 Medicare Modernization Act. As a form of cost sharing, the gap could induce cost-related medication non-adherence(CRN), adversely affecting health status, particularly among individuals with chronic conditions.” (para. 1).

    The pharmaceutical companies charge a ridiculous amount for new drug therapies such as chemo therapy, Hep C treatments, immunosuppressive therapies and so forth. Some drug manufactures offer discount programs to help offset the cost. There are also some supplemental programs offered by the government such as social security extra help, NJPAAD, and PACE and PACE Net to name a few. All have age and income guidelines that must be met to qualify for such financial assistance. Offering such programs can help curb negative effects of the cost sharing implementation however it only seems to help those who are low income. The families that are not low income seem to pay the most which is typical in todays government. Studies have been done by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice.

    There are always methods to adjust contributions, whether federal or private and where the contributions come from over time. Some programs or ideas seem to work better than others. Many feel reforms are needed however it seems no one really has the correct fix over a large period.

    References:

    Henning-Smith, C., Casey, M., & Moscovice, I. (2017). Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?. The Journal Of Rural Health: Official Journal Of The American Rural Health Association And The National Rural Health Care Association, 33(1), 12-20. doi:10.1111/jrh.12175

    Mayor, S. (2017). Major 2012 NHS reform failed to deliver on promises, finds study. BMJ : British Medical Journal (Online), 359Login

    Sacks, N. C., Burgess, J. F., Cabral, H. J., Pizer, S. D., & McDonnell, M. E. (2013). Cost sharing and decreased branded oral anti-diabetic medication adherence among elderly part D Medicare beneficiaries. Journal of General Internal Medicine, 28(7), 876-85. Login
     
  2. badger2
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    badger2 Gold Member

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