340B helps low income patients receive the medications they need at a price they can pay. 340B Drug Pricing Omnibus Guidance The Health and Services Administration has published the 340B Drug Pricing Omnibus…
Mr. Brownstein gave an update on the Unified Managed Care Strategic Plan and that the Board appointed committee met with County staff and discussions continue around a joint strategic planning process. In that discussion there was an agreement that Mr. Butler and Ms. Tomcala would continue to work on a variety of issues and those discussions are going well. Also discussed was the idea of a strategic planning process and it was agreed to move forward with the idea to have a Managed Care Strategic Plan generated out of that process and has asked for volunteers to be part of the Strategic Planning group. The Board of Supervisors (BOS) had expressed interest in having discussions on Integrated Managed Care and that we would report back to BOS.…
Medication Scenario My client, John, is a single 59-year-old white male. John was recently diagnosed with Major Depressive Disorder and was prescribed Cymbalta. John earns approximately $22,000 per year and says he cannot afford to fill the medication. As John’s social worker, I have been asked to help him find a prescription assistance program.…
On behalf of our member companies, the National Association of Chain Drug Stores (NACDS) writes to request a meeting to discuss the importance of fair and accurate reimbursement for community pharmacies for specialty drugs. As we previously noted, addressing both the cost of the drug product and the cost of dispensing is critical to maintaining patient access to Medicaid pharmacy services, especially when considering the increasing cost of providing specialty drugs and services to the Medicaid population. We are requesting this meeting to speak to you to discuss possible options for CMS to provide further direction and/or guidance to the states in this policy area. We believe that if adequate direction and/or guidance is not provided, states will adopt insufficient reimbursement rates and dispensing fees for specialty drugs resulting in below-cost reimbursement for participation pharmacies.…
Today, the majority of the population does not fully understand the way medical insurance works. Unless you are in the business yourself, it can get pretty confusing at times. Similarly, seniors tend to feel overwhelmed when it comes to figuring out how they will be covered for any medical expenses they might incur. It's no secret that Medicare is the first obvious option, but what happens after Medicare pays its 80%? There are two options available - one can either pay the remaining 20% out-of-pocket or enroll in a Medicare Supplement policy.…
The Dos and Don'ts of Medicare So your birthday is right around the corner, and this year that means you're ready for Medicare. It does, doesn't it? Are there requirements other than age? Where do you even sign up?…
The Wall Street Journal writer, Drew Altman, states that “seventy-six percent of the public blames drug companies for high drug prices – with just ten percent blaming insurers” (Altman). Since the main buyers of medications are private insurers and the federal government, the pricing decision commonly does not consider the patient’s affordability. Pharmaceutical firms such as Medicare are not allowed to discuss prices with manufacturers while the Food and Drug Administration (FDA) does not consider cost in medication approval at all. Rare value and lack of alternatives influence high costs and “although some price increases have been caused by shortages, others have resulted from a business strategy of buying old neglected drugs and turning them into high-priced ‘specialty drugs’” (Pollack).…
Madison Collins Managed care is a health insurance structure. It dominates the United States. Managed care organizations offer incentives to provide fewer services and less expensive care while maintaining quality. This along with MCOs control over delivery, use, quality, and cost of services make managed care favored over FFS. PPOs are the most popular form of managed care.…
1. Why does the Medicaid program receive a great deal of attention each year in the state of Florida? From legislators? From providers? From health plans?…
There are main types of managed care plans: HMO, PPO and point – of – service. Health maintenance organization provides its members health benefits where individual have to pay monthly premium in order to use the benefits. In order the benefits to be covered by HMOs (unless it’s an emergency service) the patient must use health provider within the network. Copay may or may not be require for visit to health service provider.…
“The principle idea underlying manage care has been to control the costs by decreasing “unnecessary utilization” of health care services, which is accomplished through budget restrictions, case management and utilization, incentives to providers for limiting services, and using the primary care provider as the gatekeeper for access to care”. (Berkman, 1996) “Managed care, however, presents social workers with a dilemma of being a patient advocate while, to a certain extent a gatekeeper of resources”. (Moody, 2004)…
Overview: The combination of many issues such as prescriptions cost, patients’ economic status, and lack of health insurance, interfere with the patients’ access to their medications. This creates an environmental problem that puts patients at a higher risk for morbidity and mortality, and consequently, increasing the healthcare cost of treatments on health complications due to non-medication compliance (Duke, Raube, & Lipton, 2005, p. 726). Approximately 50 million people in the United States have inadequate insurance coverage for medical needs. Although many pharmaceutical companies offer assistance to underinsured and uninsured patients with their medications, these programs often are underutilized because of lack of available clinical staff to help with the application process and follow-up with…
The article I choose focus on the growth concern about Canadians that dependent on pubic drug programs that they don't have equal access to emerging new medications for mental disorder compare to those that have private drug insurance coverage, and that there is also discrimination in the public drug plans among the provinces and territories. The authors focus on the facts that contribute to this problem. The first argument is that the Prescription Drug Coverage in Canada play a big role on whether one be able to access the new medication or not because the prescription drug coverage determent whether the medication is cover under the public drug plan. Majority of people that has mental illness are unemployed and they depend on social assistance…
Medicare price reductions are expected to have an effect on the price of drugs in private markets, so if Medicare and Medicaid both had more laxity on making clinically reasonable drug choices, they could actually make a difference. Recently, the Centers for Medicare and Medicaid Services announced that it is going to analyze different approaches to reduce the spending on prescription drugs within the Medicare part B program. Doing this would reduce the the incentives for general markups within the economy that persuade…
What are two issues of physician reimbursement some are the practice expenses, doctor’s income and the reimbursement rates. The physician reimbursement is what the insurance company paid your physician for his services. Physicians cannot negotiate with the insurance company about the cost. Managed care organizations are trying to control the cost of health care but it’s not working.…