Introduction
‘Medicare Part D’ is the US central government program which aim is to decrease the amount of drugs by governmental support, drugs which are prescribed by a doctor to a patience, also called Medicare prescription of drug benefit. From first January, 2006, it is included as a part of law of ‘Medicare Modernization Act’. All those people can get benefit from this law if they are entitled either ‘Medicare Part A’ or Part B or both of them. There are two ways to get benefits from ‘Medicare Part D’. First, they can privately plan to join for ‘Prescription Drug Plan’ which only subsidizes the amount of prescribed drugs and secondly, they can enrolled in the ‘Medicare Advantage Plan’ which not only subsidizes the amount of drugs prescribed by a doctor but also for the medical services. ‘Medicare Advantage Plan’ is different in many ways to the original Medicare, and in fact it is a part of ‘Medicare Part C’. About 66% of the beneficiaries of ‘Medicare Part D’ have joined ‘Prescription Drug Plan’. Mostly disabled and senior citizens, who previously did not have Medicare plan, are taking benefits from this plan. Basically this program is aimed to increase in Medicare the importance and job of private Medicare plan. The success of this program is based, is to what degree it achieves its objectives .
Influences in legislation and policy making
- Democrats
Lawmakers from Democratic Party may bring many changes in the legislation of ‘Medicare Part D’; of which some are, that they will add some more drugs to increase the coverage of the Medicare. The initial deadline for the open enrollment was May, 15 2006 for the Beneficiaries to benefit from the drug plan. They then delayed this deadline so that more people also join it. After the deadline, Beneficiaries who wanted to enroll to this plan had to pay higher premium. The amount of the premium was more than one percent of the amount of premium for every month whose were supposed to take participation in this program at their time of enrolment. To give benefits to people who became eligible from 2006 for Medicare, their dates for eligibility were advanced by three months so they cannot get penalty by late enrollment in the program. Democrats are in the view that the time was not enough for the beneficiaries to choose their plan and therefore they needed more time. They also gave the suggestion that steps should be taken to standardize the ‘Medicare drug plan’ and there should be provision in the law that will stop ‘Insurance Plans’ to delete drug from the formulas they have made in a calendar year, also time was needed to those states to reimburse the cost that have occurred on the low income and dual eligible beneficiaries drugs whose ‘Medicare Part D’ coverage have some problem and therefore they don’t start on time .
It was also proposed by the Democrats that the ‘Medicare drug plans’ will be such that it will provide beneficiaries any drugs, that are not included in the plan, for two months and if the beneficiaries’ enrollment in the plan is not confirmed by the pharmacist, still it will provide drug supply for two months. A standardized procedure should be created for the appealing, and during appealing drug will be provided to the beneficiaries. Other proposals which the democrats wanted to give included, the drug plans once the beneficiary have made a plan for himself, then there will be no change or deletion of the drugs from that plan, and also that the change in prices of the drug will only be made at the end of the year for one time, also beneficiaries can change their drug plan if the plan doesn’t cover the drug they needed at any time they need. It is also in the proposition of the Democrats that the Medicare should be such that it can reimburse charity organization, family members and those states which due to administrative problems don’t obtain drugs and it cover the drug cost. If due to administrative issues there is problem in conformation of beneficiary enrolment then pharmacists can bill Medicare for cost of prescription of beneficiaries directly. Senator Max Baucus and Harry Reid have put strong request to the Federal Government to bring ease in the implementation and they have suggested that that precise information should be provide to the beneficiaries and plans.
Advocacy groups
Many advocacy groups like the Association of National Mental Health, Epilepsy Foundation, Cerebral Palsy and Paralyzed Veterans wanted amendments in the bill of the Medicare Part-D’ so they can get guarantee, for all those who were overcharged due to any reasons like copayments should reimburse and reimbursement is needed for pharmacists who have paid the beneficiaries payment of the medications cost, due to the problems with the ‘drug benefit’.
AARP is an advocacy organization who claims that they represent more than 35 million of people above age 50 are in the support of the Medicare Modernization Act of 2003 and the prescription drug bill. Their support is an important factor in the passage of the bill. AARP are in the view that Medicare Prescription and drug program is the basic and needed step to give access to people who are disable and senior citizens of the United stated for Medicare Prescription and drug program. They announced that the number of beneficiaries who enrolled themselves in this program encouraged them, and they will educate the people about this Act. .
US Senate
Although Central Government does not like to extend the dead line for enrollment of May 15, however a change in the fiscal year budget resolution was approved by the United States Senate On March 15, 2006 and it gives power to the Health and Human Services Secretary Michael O. Leavitt, that he may extend the deadline for enrollment .
- Bush Republicans and Administration
The United States Central Government and the legislator from Republicans expresses their view that all the implementation problem with ‘Medicare Part D’ should not be fixed with legislation but they should be fixed with the management tools.
Implementation and Adoption
Final rule published from the United States Secretary of Human and health Services on January 28, 2005, that will translated the ‘Medicare Modernization Act of 2003’ and ‘Medicare Part D’ into authoritarian language with the explanation of almost all of the provisions.
Implementation problems
Problem in the implementation starts from the very first month. Due to administrative problem, pharmacists announced, that they are not able to know about the beneficiaries’ drug plan as the system is not able to found the enrolled beneficiaries. Pharmacists also announced that due to delay in payments they are faced to the situations of losing money which is a big problem for them. Therefore the ‘Association of community Pharmacists’ is trying their level best that the congress pass the bill as early as possible, which will force the health plans to pay bill within two weeks under ‘Medicare Part D’ for medication.
The second problem faced by the administration in the ‘Medicare Part-D’ implementation is that of there are dual eligible beneficiaries in their automatic enrolment. In this regard many states will have to pay the cost of drugs for beneficiaries who come fit in the eligibility criteria for both Medicaid and Medicare who faces problem in the ‘Medicare Part D’. The Bush administration in this regard made it clear that it up to February 15, 2006, they will that will fix this problem by giving emergency coverage to all dual eligible; however, still some states are not happy with this decision and they have asked the Bush Administration that the dead line of February 15, 2006 may be extended. The Federal Government has however, made it clear that it will not extend the dead line any further.
For the smooth running of the ‘Drug benefits’, health plans the government has now agreed to extend the deadline for a month. Critics said that due to the increase in number of plans of the ‘Medicare Part D drug benefits’, the beneficiaries are confused in choosing the most feasible plan for them. In this regard Secretary of Human and Health Services Michael O. Leavitt and Administrator of Centers for Medicare and Medicaid Services have made it clear that with passage of time the market forces by self; will delete the less popular plans and thus the number of the total plans will be reduced and then the beneficiaries will not have any confusion an choosing the most appropriate plan for them. They further said that the Medicare and Medicaid Service want to increase in near future its monitoring health plans’ call center, and their processing speed for enrollment of application. They are also going to design some performance measures indicators to have track of its monitoring health plans’ call center, and their processing speed for enrollment of application and whey they are completed then this data will be available to public. The yearly spending on drugs is in the range of $2,250 and $5,100, they said that the government have made a plan of sending letters to alert the beneficiaries that they are near to the level of doughnut hole and hence they will get the time to shift to another plan so they avoid the unwanted situation.
Generally speaking, those beneficiaries who are enrolled under ‘Medicare Prescription Drug Plan’ can switch to another plan in only under few circumstances and it is the specific time every year they can change their plan which is from 15 November to 31 December. Other than this time frame they are not allowed to change their ‘Medicare Prescription Drug Plan’. It is due to the fact that the enrollment is for the complete calendar year. However in certain cases, like if a person enters or moves to nursing home, then the beneficiaries can change his plan other than those mentioned above. Furthermore, in this case if the beneficiary is entitled for both Medicaid and Medicare then he/she can switch to plan of his choice any time he/she wishes to. .
Evaluation and Monitoring
Secretary Leavitt announced that so for on March 23, 2006, in the drug benefit program 27 million people have enrolled themselves. CMS also reported that if by April 30, 2006, beneficiaries did not enroll themselves then they will enroll 1.2 million beneficiaries automatically. However the Central Government Administration target is to enroll about 30 million beneficiaries in the ‘drug benefit program’. However, advocacy groups are in the view that as the beneficiaries who were previously enrolled, have already had ‘drug benefit program’, therefore the statics are not correct. Time is needed to evaluate the outcome of the statics as ‘Medicare Part D’ has started its function from January 1, 2006.
Expected outcome
Drug benefits bill is not new and it is in effect as part of the law from 40 years, but still advocates and policy observers are in the view that in drug benefit of Medicare there is prescription problem. People were very hopeful when they came to know about the new version of the drug benefits, as in the previous versions of drug benefits bill there were problems and they don’t like it; however, before the new bill become a law it became a political issue. As benefits in this bill were only true private plans and the bill was designed in such a way that it didn’t integrate medical care with pharmaceuticals. As a matter of fact majority of the beneficiaries are of the type of chronic illness which makes the bill less affective.
Another problem which the beneficiaries face is that they don’t know what the most appropriate plan is for them and how to get benefits from traditional Medicare. Coverage of traditional Medicare is Medigap, Medical care, retiree coverage or Medicaid which includes Medicare benefits and also it now cover the drug coverage. The low income people who are part of this plan get the highest help from it while the others get moderate assistance. Still there is huge information needed to work out on the program when it is finished, and as the matter becomes politicized so there will be problems to continue any further progress on this matter .
Conclusion
References
Clinton, H. R. (2005). Introduction to Medicare Part D: Prescription Drug Coverage Under Medicare.
Fincham, J. E. (2007). The Medicare Part D Drug Program: Making the Most of the Benefit. Burlington: Jones & Bartlett Learning.
Luong, J. R. (2010). Medicare Part D Prescription Drug Coverage: Federal Oversight of Reported Price Concessions Data. Darby (PA): DIANE Publishing.
United States. Congress. Senate. Special Committee on Aging. (2007). Medicare Part D: is it working for low-income seniors? Washington: U.S. G.P.O.
Walberg, M. P. (2009). A Patient-perspective Approach to Medicare Part D Prescription Drug Plan Costs. Michigan: ProQuest.
