Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Term Paper Example

? Medicare Prescription Drug, Improvement, and Modernization Act of 2003: Medicare Part D: al Affiliation: Medicare Prescription Drug, Improvement, and Modernization Act of 2003: Medicare Part D Introduction The Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003 and in particular Medicare part D policy addresses the issue of prescription drug plans. The policy was meant to address the problem of prescription resulting from the new and expensive drugs prescribed to many US patients who were beneficiaries of Medicare. The MMA policy defines the type of drugs covered in part D according to Hoadley, Hargrave, Cubanski and Neuman (2008). It also covers the issue of payment for the drugs in relation to what is covered in Medicaid and Medicare. The drugs covered in part D are those verified by the Food and Drug Administration, need a prescription for making payments as required in by Medicaid related regulations. Products such as insulin and its supplies as well as drugs with smoking cessation are catered for under part D. Drugs with an optional Medicaid payment are excluded from part D by the MMA. Part D was aimed at providing protection to the patients from catastrophic cost of drugs through the prescription of drugs at affordable costs. This was in consideration of the mental health patients because their overall drug prescription was likely to be high due to their need for psychotropic medication. Mentally ill patients also frequently suffered from chronic medical situations hence they were greatly in need of pharmacotherapy. This policy is vital because those patients with mental problems are not able to differentiate which drug is important for their health; with the doctor’s prescription they are able to take their medication properly. Those affected by the problem and the way they are affected The problem of drugs prescription to patients which is addressed by part D affects almost everyone in the United States. For instance the drug beneficiaries suffer from large costs and inability to differentiate the best drugs from the new upcoming drugs. For instance, patients are required to pay around 250USD which is deductible in addition to twenty five percent of annual drug costs amounting to $2,250 according to The Congress of the United States (2004). Drug beneficiaries are also expected to pay from $2,251 to $ 3,600 annually which is too expensive. The general public also suffers from bearing additional costs such as taxes. The United States government on the other hand as it had to partially fund the implementation of part D (i) which addresses this problem. The drug prescription problem addressed in part D affects all the US citizens especially the senior ones who are under Medicaid benefits and those with mental illness among others. This is because the types of drugs used by this category of people tend to be very expensive. The patients feel oppressed because they are not able to get the right treatment due to their inability to raise enough cash to cater for their health needs. This is oppression because the unhealthy individuals are not in a position to look for cash in order to purchase the right drugs. The mentally ill individuals are the mostly affected by this problem particularly because of their inability to think properly and more so because their drugs are expensive. Their suffering is also heightened by the fact that there rights are likely to be violated intentionally as they are unable to express themselves properly. The problem addressed in part D of the MMA policy affects the practice of pharmacy as suggested by Hoadley, Hargrave, Cubanski and Neuman (2010). This is so going by the fact that it takes longer time to go for prescription drugs due to the costs involved. In many cases, the patient takes long to be convinced to buy the drug. The pharmacists also find a problem with the frequently changing habits when it comes to buying of drugs which is likely to cause them losses at times. With the establishment of part D, pharmacies will have a better opportunity to handle their clients. The problem addressed in part D also affects the general public in that they are to ensure the wellbeing of the sick individuals. For instance the burden of buying such expensive drugs is passed to them especially for those suffering from mental illness. The public is also affected through the increased tax payment to cater for the buying of expensive drugs. The nation at large also suffers from this problem because despite the difficult situation, it has to provide medication to its less wealthy citizens at a considerable price. Magnitude of the Problem Around forty four percent of patients who are dually eligible were unable to access medication before part D plan was implemented as noted by Hoadley (2006). Medicare beneficiaries could only receive their benefits by passing through health care insurance plans. The problem of drug prescription gave the government the burden of negotiating with the drug producing companies for discounts. This caused the government to establish a formula in the administration of drugs. Many mentally ill patients had a problem in accessing psychiatric medications due to lack of prescriptions owing to high costs of drugs. As this problem has been squarely addressed by the enactment of the policy, many patients are unable to access some medications prescribed to them by the doctor. Hence, several deaths and suffering of many patients has occurred as a direct result of the policy’s enactment. The Loser and Gainers in addressing the problem Gainers Due to part D of the regulation, many individuals benefit either directly or indirectly. For instance the patients themselves benefit from the subsidized drug costs. In part D there is a reform law which offers a new-income which is related to premiums for the beneficiaries covered. Through this policy senior citizens are able to get a financial boost for any expenses incurred during medication. The general public will benefit in that drug prescription will reduce the amount of tax they pay in buying such drugs. They will also have their relatives treated in a at a cheaper cost and in a better way. The standard benefit in part D with its deductions and the coverage gap is a good for the beneficiaries of the policy according to Summer, Nemore and Finberg (2008). Those enrolled in the drug prescription coverage benefit also from a reduced spending on non-drug medication. They may also attain an better therapy for various diseases including chronic illnesses. Losers The pharmacists are likely to lose under this policy compared to what they initially used to earn. This is because they are not able to overcharge patients due since the prescription involves the use of computer technology. The drug companies may also loose since the government is no longer involved in negotiation of costs. Instead the government may urge patients to withdraw from using certain pharmaceutical products.. Causes of the Problem and its Consequences The Causes The problem of high cost of drugs is caused by the lack of standard policies in as far as medication is concerned. It also results from the enactment of inappropriate legislative procedures that delayed the implementation of this part of the policy. Lack of accountability and transparency by the congress also led to the problem as they could not handle some of the matters facing the health industry. Another related problem is the government’s failure to implement improved drug prescription cover and make it affordable to nationals. The Consequences The problem of costly medication and lack of prescription drugs in some cases resulted in the adoption of part D of the MMA. Due to the enactment of this section, a lot of patients benefit from drug subsidies as they spend much less in seeking better health. It has also resulted to the government being withdrawn from making negations with the drug producing companies as it never solved the problem. According to Safran, Strollo, and Guterman (2010) Prescription drug coverage has been put in place to cater for those with chronic conditions such as mental illness. Since the introduction of the part D of the MMA policy, patient care in the United States has increased. Typical, more affordable, premiums on health insurance have also been introduced as a result of the introduction of the policy. The federal government provides care to patients through Medicare as periodical contributions enable this mission to be achieved. Various Perspectives of the Problem There are different perspectives from various individuals regarding medical care in the United States. For instance some people have argued that part D of the MMA policy is a voluntary program and thus does not give much help to patients. Others have argued that regulations related to Medicare prohibit beneficiaries from gaining original Medicare benefits (Summer, Nemore and Finberg, 2007). Some individuals have also argued that due to the cost sharing aspect in the program of Medicare, there will be a rise in the use of health care provided by the Medigap policies to the beneficiaries of Medicare. It has been perceived by many that the system provided in part D decreases the financial risk of the plan without decreasing related incentives. References: Hoadley, J. (2006). Medicare's New Adventure: The Part D Drug Benefit. New York, NY: The Common Wealth Fund. Hoadley, J. Hargrave, E. Cubanski, J.& Neuman, T. (2008). The Medicare Part D Coverage Gap: Costs and Consequences in 2007. California: The Henry J. Kaiser Family Foundation. Hoadley, J. Hargrave, E. Cubanski, J.& Neuman, T. (2010). PArt D PLan Availability in 2011 and Key Changes Since 2006. California: The Henry J. Kaiser Family Foundation. Safran, D.G. Strollo, M.K. & Guterman, S. (2010). "Prescription Coverage, Use and Spending Before and After Part D Implementation: A National Longitudinal Panel Study, " Journal of General Internal Medicine. 2010 25(1): 10-17. Summer, L. Nemore, P. & Finberg, J. (2007).Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries. New York, NY: The Commonwealth Fund. Summer,L. Nemore, P. & Finberg, J.(2008). Medicare Part D: How Do Vulnerable Beneficiaries Fare?. New York, NY: The Commonwealth Fund. The Congress of the United States. (2004). A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit. Washington, D. C.: Congressional Budget Office. Read More