What You Should Know About Insurance Policy Legislation?


Prescription Drug Insurance Policy Legislation

Under Part D, Medicare recipients could have drug benefits by joining either of two types of plans:

A. Prescription Drug Plan or PDP

B. Advantage Plan from Medicare along with prescription drug coverage (MA_PD).

Part D plans come in tiered formularies, indicating that not all prescription drugs are treated the same, and Part D enrollees are given an
incentive too choose certain classes of drugs over others.

The implementation of prescription insurance has not been without its pitfalls. One of the main concerns that affect all Part D recipients is that there are just too plans to choose from and that the rates of medicine has mostly been for profit. These essentially means two things:

1. The federal government has been unable to negotiate costs with big firms in pharmaceutical industry and with the pharmaceutical industry as a whole.

2. The private sector is a great force that implements policies from behind Medicare and Medicaid recipients, which is really in line with the federal government’s intent to have the sector manage Part D.

Problems, Complaints, Solutions

If you look at the Internet today, you will see that there are many articles that tend to put down insurance coverage for prescription drug. Some sectors are wont to call it Part D for “disaster” instead of “drugs”.

One of the main problems in the implementation of Part D is that the system for accessing and utilizing Part D plans has been very chaotic and unregulated, thus compromising the overall accessibility of commercial prescription drugs and the quality of healthcare.

There is also a problem of tracking the data of Part D recipients, especially those who are eligible for both Medicare and Medicaid or the so-called dual eligibles. Picture this: the management of data is fragmented because while the state manages the Medicaid programs, the private Part D plans manage their own programs and only get reimbursed centrally by the Centers for Medicare and Medicaid Services. Thus, all states in the United States are cut off from most data pertaining to drugstore (prescription drug) claims of Medicare recipients, effectively barring them from managing more effectively their Medicare health services.

So, does this mean we should scrap Part D altogether and revert to the good old Medicare program minus the alphabet soup? Not quite. Why? Because in the old days prescription drugs could only be covered if they were necessary and incidental to a patient’s hospital and outpatient care. Plus there were restrictions on drugs at that time.

A more realistic approach to Part D is to set up a more systematic national system, which may entail regulating the formularies of Part D plan providers to make more prescription medicines available. In sum, every effort must be undertaken to make Medicare Part D more in tune to the needs of patients than to the bottom line of pharmaceutical companies.