Medicare Ethical Dilemmas

: Insurance companies have the list of formularies that they agree to help cover but it is a tricky and a hassle to deal with. The patient must get a prescription of a similar drug first to make sure it works on them or even getting the doctor to prove that you need it. This is just to get coverage for an expensive drug. This can take weeks to do. It is a complicated list designed to give the patient the right drug for their conditions and that drug may not even be the first one that the doctor prescribes for them. It is a process to find out which one is right. When you fill a prescription of an approved drug of the formulary then you do not have to pay full price. Patients will have a copay through four different tiers. The first tier the patient pays a $20 copay on generic medications or a low cost medication, on the second tier, the patient pays a $40 copay for low cost brand names or a higher priced generic name drug. The third tier, the patient pays a $60 copay for brand name medication in which there is no generic, and the last and final tier which is number 4, the patient pays a $100 for the highest cost medication and/ or specialty drugs such as ones for chemotherapy. Some health care plan require the patient to pay full price for medication until they meet the deductible and then they can pay copays. Some formularies have coinsurance instead. The patient in these pays a percentage of

The essential target of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was to furnish seniors in the United States with moderate scope for their physician endorsed solutions through the new Medicare Part D professionally prescribed medication advantage. After the MMA was implemented—however before Part D was actualized—there was a disagreement about the cost of the program. In March 2004, the Medicare Chief Actuary affirmed before the House Ways and Means Committee of United States Congress that he was requested by the (Centers for Medicare and Medicaid Services) CMS Administrator to smother his assessments of the ten-year cost of the program, which were considerably more noteworthy than unique Congressional Budget

The Medicare beneficiaries’ contribution to the coverage gap decreases each year, with the majority of cost absorbed by the government and the drug manufacturers. Drug manufacturers also agreed to pay a fee to the federal government health care programs on branded prescription drugs (BPD), based on its sales of BPD’s. There was an expansion of the Public Health Service Act (PHSA), that required drug manufactures to provide eligible entities with significantly reduced drug price. The PHSA, also expanded those entities such as free-standing cancer centers and critical access hospitals (CAH), that were eligible to participate in the 340B program In, addition they also agreed to increase rebates on sales of prescription drugs to the Medicaid program (Spats, 2010). The rebate was increased from 15.1 percent to 23.1 percent. In addition, drugs, such as those used for pediatric care and clotting factor drugs there was a 17.1% rebate. Perhaps, most importantly, the firms extended the rebates to Medicaid patients enrolled in Managed Care Organizations (MCO). This new agreement allows plans to negotiate rebates in addition to the new ones

Managed Care is a system of health care in which patients agree to visit only certain doctor and hospitals, and in which the cost of treatment is monitored by a managing company. David, a clinical supervisor of one pad was responsible for the clinical supervision of eight clinical case managers. On typically day, he receives around 40 phone messages about clients that are in need of his services. His job is to field calls from mental health providers seeking authorization to provide treatment for clients. There are those who believe that managed care is simply another example of corporate America discovering a means to increase profits for shareholders of insurance companies, at the expense of individuals seeking mental health treatment. (pg.

The passage of the Medicare Drug Price Negotiation Act will also inadvertently increase access to many types of medications for individuals who qualify for Medicare Part D. There is a clause within the bill that would establish rebates to be paid by pharmaceutical companies for low-income beneficiaries. These rebates, in addition to lowered costs, would considerably lessen the financial burden placed on low-income beneficiaries. This will allow more individuals greater access to expensive medications. As an example, each year, financial reasons hinder about 16% of diabetic Part D beneficiaries from filling at least one of their prescriptions (Williams, Steers, Ettner, Mangione, & Duru, 2013). This increase in access will help mitigate the occurrence of cost-related nonadherence to prescription medications, and other such consequences

In addition, the article highlighted the issue of litigation and policy context under the Employee Retirement Income Security Act’s (ERISA’s) preemption provision. It stated that “when a law or legal action involves the administration of plan benefits, such as a state law mandating certain benefits or a patient’s challenge to the denial of a plan benefit, ERISA preemption is triggered” (Jacobson, 1999). Therefore, the states block the litigation against the managed care organizations. Lastly, the courts and public policy have been a challenge of the implementation of cost containment initiatives. Some prominent commentators have been arguing for years that health care delivery should be guided by market principles as determined through contractual

Five different levels of classification for approved prescription medicines are included in the formulary; drugs in lower tiers cost the patient less than those listed in higher brackets. Medicare plans and patients copay for drugs, if a pharmacist decides that a drug listed in a higher bracket is needed over one listed in the lower price range, the patient can file an exception with the plan, as reported by medicare.gov.

In 2003, President George W. Bush signed a bill called the “Medicare Prescription Drug Improvement and Modernization Act” which provided an optional prescription drug benefit plan. Prescription drugs have come a long way since 1965, meaning that they are much more effective today than ever before and provide greater life-enhancing benefits than ever before. The Medicare program therefore had to be reformed as a result of this additional legislation to allow for access to needed medications while trying to minimize the risk of high expenditures for those affected individuals. The program was reformed once more in 2010, with the aim of attempting to keep the costs low while also increasing the revenue earned by Medicare.

The growth of managed care in the United States has been paralleled by a rising tide of anti–managed care sentiment. The “managed care problem” is understood generally as the need to protect individuals against large companies that care more about their bottom line than about people. The premise of the BEST (Best Ethical Strategies for Managed Care) project is that the “managed care problem” is best understood as an ethical problem—a conflict of values that arises as the country changes from a patient-centered to a population-centered approach to health care. The BEST project team worked with nine managed care organizations to identify their most intractable problems. The team redefined these problems in terms of ethical dilemmas, and then

We have so many questions when it comes to pharmaceutical prices continuously rising here in America.

Pharmaceutical companies also show a key role in the healthcare system because many patients trust their products. The values for drugs are increasing, and there are no covers to

One of the underlying issues of rising costs lies in the hands-off role that the government is given in regards to the price-setting of drugs offered through prescription drug plans (PDPs). The Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 is the essential piece of legislation that created what Medicare Part D provisions (Frank & Newhouse, 2008) are in place currently. While this provision provides low-income older Americans with necessary medications, within the initial bill, the governmental program suffers a loss of autonomy. Under this bill, the government is barred from engaging in negotiations with pharmaceutical companies through the “noninterference” clause (Cubanski and Neuman, 2015). This prohibition

Medicare and medicaid are both federal programs that provide health insurance for citizens, but there are a few differences between both programs. Medicare is aimed for people who are older than 65 or with severe disabilities regardless of their income and medicaid is for those with really low income. Although, these federal programs help individuals to receive proper health care, there is still an issue growing despite having these coverages and that is affording medication. Since medicaid only covers certain medication and obtaining Medicare Part D adds additional costs it has made it difficult for individuals to obtain their required medication because of their high prices, especially those without insurance. These has created concerns

Over the years, there has been an immersive increasement in the cost of medication. These high prices have created disputes between individuals, who wish for more affordable medicine and those who believe that the prices are necessary. The cost of medication may be excessively high, but it is important for a variety of reason. The prices of the medication are set in order to fund for research and development, so that researchers can produce more efficient and safer drugs for patients. Although it may be excessive, it may be necessary in order to continue the fundings.

Medicare part D covers prescription drugs (https://www.medicare.gov). Those who are eligible for parts A or B are eligible for Medicare part D. Medicare part D, unlike parts A and B, does not have standardized coverage. Instead, different plans can choose which drugs they will pay for, but all Medicare part D plans are regulated on what they can and cannot cover.