Abstract
Medical care is an obligation of the government in the United States because all citizens are entitled to the access of healthcare services. Nonetheless, the healthcare programs are not only executed on the premise of providing health services alone; but such services are to be affordable as well. Medicare part D refers to the program where the United States federal government subsidizes the cost of drugs prescribed for the patients. It also covers the drugs and the associated insurance premiums, and all these are executed to benefit the healthcare beneficiaries. This paper analyzes the Medicare Part D and the prescription costs of such drugs. It defines the program and explores the merits and demerits associated with it while factoring in the influence of the prescription costs for the use of the program by the common US citizens.
When looking at the status of the program, more attention is employed to help in understanding the subject into detail. Such include the process of breaking down the beneficiaries and the program by categories. Such categories include but not limited to the young and elderly beneficiaries, there are those who have other insurance plans and those who depend only on the Medicare Part D plan and so forth. There is also analysis that depicts the costs of prescriptions, their changes and why they fluctuate every year.
The Medicare part D
The Medicare Part D program is a prescription program that was meant to increase the drug benefit and access the outpatient health care service seekers. It is a health care program that was introduced by the former US President George W. Bush to ensure that those who sought health care services would not be priced out of getting the prescribed drugs. In a nutshell, this program is interventional, and it is aimed at ensuring that there is increased beneficiary access to the prescribed drugs (Fung et al., 2010).
When the Medicare part D program was invented, the intention of the government was to fund the program. But to some extent, the program may have been strenuous to the federal government owing to the growing number of the health care seekers. Thus, there is some clear-cut channel on how the program is discharged, and it involves the efforts of both the government and the beneficiaries. Research conducted by Fung et al. (2010) revealed that since the government may have a problem in funding in entirety, beneficiaries have to pay or the gaps that exist within the coverage. While some recipients paid to the gaps, approximately 89% of the 22.5 million people who subscribed to the service in 2006 resorted to the survival on the generic drugs (Fung et al., 2010).
Under this program, there are two subcategories of the program that beneficiaries often choose. The first one is the Medicare Advantage Prescription Drug (MAPD) plans. It covers the inpatient, outpatient, and the drugs. The other plan is the Prescription Drug Plan which has attracted the majority. The plan includes the prescribed drugs on the primary basis. Other plans are associated with the employer plans and unions. When using the Medicare Part D program, there are instances in which the gaps that exist in coverage may increase hence leading to the further increase in the spending on the drugs.
When trying to investigate the efficacies of the Medicare Part D which encompasses the take-up program that targets the elderly persons, Levy & Weir (2010) argue that the beneficiaries have been affected in various ways following the attempt to implement the Part D program. The research reveals that the individuals that are on other credible health coverages have been instructed to keep the plans they have because they were deemed to be better or equal in value to the Part D program.
Those on Medicaid have been persuaded to enroll immediately in the part D program. Those on the Medicare Advantage plans had nothing changed because the Part D insurance plan has been just an addition to their plan. The individuals that have the privately bought drug insurance plans such as the Medigap had the option of keeping the plans or going the Part D way (Levy & Weir, 2010). The Medicare Part D would later take the same plans and approaches that were earlier used by these programs. In any case, the Part D plan was more of a copy of the existing insurance plans that had been existing before 2006.
There are numerous ways through which the Medicare Part D is quite different from the other plans such as the Medicare Part A and B and even the other means-tested programs. The primary point of variation is that the as opposed to the Part D, Part A and B have a universal take-up approach. Another difference is that Part D has Food Stamp programs which require evidence of the income contrary to what is in part A and B. In the Part D scenario, the settlement of the premium rests on the shoulders of the beneficiaries (Levy & Weir, 2010).
Medicare Part D as a health care policy or plan was founded with the intention of improving healthcare through better access. Since its inception and implementation, there have been challenges and benefits that it has yielded, given that an idea cannot be acceptable to everyone.
Donohue (2014) argues that the Part D plan was riddled with criticism at the preliminary stages of its implementation. Most of the critics cited poor communication, especially with the beneficiaries on how it would work, there were concerns on the basis of cost, computer problems with documentation and difficult choices on the plans. Apart from these challenges, there are other negative impacts that have been cited in the implementation of the program. The plan has the gaps such as standard gaps which require the beneficiaries to dig deeper into their pockets. Only those who have other insurance plans may survive this problem, especially when they embark on sharing costs with their previous insurers. Nonetheless, the majority of the beneficiaries has been hit hard because they had no previous insurance plans that would help them offset the gaps that already exist. The gaps have also created debates and more problems surrounding the required approach to solving the problem. As some argue that the gaps need to be eliminated, there are those who feel that generic drugs may be used to address the problem (Fung et al., 2010). But at the end of the day, the generic drugs may not give the required results regarding treating the patients.
Even with the ongoing controversies that may cloud the implementation of the Part D plan, there are indications that point to its successful implementation and fruitful results. Donohue (2014) adds that within a span of two years after its invention inv2006, the subscription to the program grew to 35.7 million with many people under this program becoming attached to other plans like the retirement benefits. It is a depiction that the drug coverage initiative has tremendously grown. Another landmark achievement that has been made by the Medicare Part D is the inclusion of the new insurance plans.
This helps in limiting the fears that are associated with the possibility of having fewer choices. At the moment, the Part D program has successfully invited the insurers to sell their policies to the beneficiaries. This has enabled 1169 plans to roll out and this translates into 39 plans per state (Donohue 2014). Such plans are complementing the efforts made by the government in Part D to avail the cheap quality health care services. With the existence of other plans coming into play, there is the indisputable eventuality that beneficiaries can embark on the cost-sharing to survive during the gaps that are within the policy. Another benefit that has been associated with this program is on the out-of-pocket spending. It indicates that the many beneficiaries have had the push to adhere to the drugs that they have acquired because of the cost assigned to them (Donohue 2014). It is a case of getting the value for the money and ensuring that a positive result is achieved.
The essence of having health care plans such as the Part D is to redistribute the health care benefits to the minority groups such as the elderly. It is on this premise that the Part D health care program has targeted the elderly beneficiaries through programs such as the take-up plan. The elderly persons comprise the highest percentage of the beneficiary group. They have benefited from the programs such as the MAPDs and the PDPs and much more. Perhaps, the higher enrollment of the elderly persons has been responsible or the swelling number of people leading to higher crowd rate (Lichtenberg & Sun, 2007). Another significant result associated with the Part D program is that as the bid to reduce the prescription spending is stepped up; there is an increase in the expenditure on the drugs, but that may not be in vain. This produces another positive result. It leads to the improved compliance to the drugs and the treatment plans. As a result, most beneficiaries will get better services.
The prescription cost has been the trigger point of controversy that surrounds the consumption of the Part D program. If such a program is not benefiting the beneficiaries; it will be an inevitable baggage on the intended consumers. Prescription cost always falls on the gaps. In 2010 as an instance, the gap that spelled the prescription was at $ 2830 to $ 6440 which can be described to be higher and equivalent to the amount paid by a cancer patient. Also, there was more $ 3610 to be paid. This amount can be described as the most catastrophic level (Martino, 2010).
In the year of its inception, the Part D healthcare plan had various kinds of costs assigned to varying programs. In 2006, the MAPD subscribers paid $2,250 for the total cost of the drugs. There was also the out-of-pocket payment of the $3,600. Other fees included the $10 on the generic drugs and the $40 meant for the copayments. These costs are subject to the yearly amendments or changes that have to take place because of the policy changes (Fung et al., 2010). The costs of prescriptions are mostly affected by not only the prices of drugs, but there are many other factors. For example, the increase in the number of enrollees also has the trickle down impact on the costs because it affects the gaps.
Every year there has to be changed in the way the Part D program is priced. In 2017, the beneficiaries pay $400 which is the deductible, then they pay the 25% of the costs which may arise to $ 925. This is would then be followed by the payment of the 75% of the plan. When the beneficiary has the total drug cost amounting to $3,700 that is the point that the coverage gap may be experienced (Grubbs, 2016).
Conclusion
The Medicare Part D has taken a decade with mixed fortunes because some beneficiaries have had their lives changed by the program. On the flip side, some critics have voiced concerns that the program has not given much fruit being that there are gaps that require the recipients to dig deeper into their pockets. The federal government has improved access to prescribed drugs through this plan. As much as there are numerous cost to be met, it has prevented exploitation by the health care providers and has made access better.
References
DeMartino, J. K. (2010). Changes to Medicare part D: who benefits? Journal of the National Comprehensive Cancer Network, 8(Suppl 7), S-4
Donohue, J. M. (2014). The impact and evolution of Medicare Part D. New England Journal of Medicine, 371(8), 693-695
Fung, V., Mangione, C. M., Huang, J., Turk, N., Quiter, E. S., Schmittdiel, J. A., & Hsu, J. (2010). Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes. Health services research, 45(2), 355-375.
Grubbs, J. (2016). Many changes to Medicare Part D in 2017. Fort Morgan Times. Retrieved from: http://www.fortmorgantimes.com/fort-morgan-local-news/ci_30545402/many-changes-medicare-part-d-2017
Levy, H., & Weir, D. R. (2010). Take-up of Medicare Part D: results from the Health and Retirement Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65(4), 492-501
Lichtenberg, F. R., & Sun, S. X. (2007). The impact of Medicare Part D on prescription drug use by the elderly. Health Affairs, 26(6), 1735-1744.
