Prescription Drug Coverage
Prescription drug coverage has become one of the more important factors in choosing which insurance and benefits package is the right one for you. In fact, prescription drug coverage has grown to the point that it is now essential to health care. For many, many Americans, prescription therapies and medicines are needed for their health and ability to function in society. Though relatively speaking, prescription drug coverage retains a small share of overall health spending at about 11%, it’s become a key driver in health spending trends and has grown almost as twice as quickly as all other health services in recent years.
Much public attention has gone to prescription drugs because of the rapid growth of drug costs and because a good chunk of the population lacks proper prescription drug coverage to cover these costs even though they need the prescription drugs. Older Americans, who use a disproportionate amount of prescription drugs, tend to be less likely than younger people to have prescription drug coverage because Medicare didn’t generally used to cover outpatient pharmaceutical costs. These higher drug costs put a good deal of stress on public and private prescription drug coverage programs and are a huge part of the recent growth in state Medicaid spending. Formularies, requiring generic rather than brand name drugs, tiered co-payments, and other methods of controlling prescription costs are being used and tested. All of these prescription drug coverage issues are being examined and discussed while policymakers explore ways to expand Medicare’s coverage to include outpatient drugs. And they have come up with something.
Those who need prescription drugs and can’t afford them have some hope for better prescription drug coverage now, at least if they have Medicare. The Medicare Prescription Drug Improvement and Modernization Act of 2003, which was enacted on December 8, 2003, requires the Social Security Administration to undertake a number of additional Medicare-related responsibilities. The Social Security Administration and the Center for Medicare and Medicaid Services (CMS) work together to provide persons with limited income and resources extra help in paying for prescription drug coverage. Social Security’s role in this partnership is mainly to help the public understand how they may qualify and apply.
Medicare beneficiaries become eligible for the extra help if they have limited income and resources. This extra help may increase their cost savings by paying for part of the monthly premiums, annual deductibles, and prescription co-payments under this new prescription drug coverage program. The extra help could be worth up to $3,600 annually.
In January 2006, Medicare Prescription Drug Coverage started providing insurance coverage for prescription drugs, paying for both brand name and generic drugs. Health care professionals, of course, need to be aware of this benefit and how it impacts their patients and their health. Information is available concerning prescription drug insurance grievances, coverage determinations, exceptions, appeals, and other guidance along with information on State Health Insurance Assistance Programs (SHIPS) at http://www.cms.hhs.gov/MLNProducts/23_DrugCoverage.asp.
As with anything, it’s important both for patients and health care professionals to keep up with the changing medical world, how it impacts prescription drug coverage, and how that affects both the patient and the health care professional.
