Failures of medicare part d delivery and recommendations for improvement.
نویسندگان
چکیده
mularies and benefits to include a full range of treatment options then in use by prescription drug plans. Mandates imposed by the MMA included a requirement that Part D was to provide the most clinically appropriate medications at the lowest achievable cost for all Part D beneficiaries. The MMA also required CMS to acknowledge the specific needs of individuals who were already stabilized with specific drug regimens (e.g., enrollees with HIV infection and AIDS, mental illness, and other cognitive disorders). CMS was also obligated to identify patients who were eligible for prescription drug benefits under both Medicare and Medicaid, the socalled “dual eligible” population. These dual eligibles were (and continue to be) at increased risk for reduced access to appropriate pharmaceutical care. Dual eligibles were automatically enrolled in Part D prescription drug programs by CMS on a random basis. Neither the dual eligibles themselves nor the prescription plans selected to administer their Part D benefits were informed of the impact that the randomly selected plan and its formulary could have on each patient’s pre-existing drug coverage, continuing drug treatment options, and state of health. In this article, we examine the barriers to prescription drug access that have arisen under the Medicare Part D prescription drug program since its implementation in 2006. In our view, PBMs play a key role in both the decreased level of pharmaceutical access and excessive costs under Part D.
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ورودعنوان ژورنال:
- P & T : a peer-reviewed journal for formulary management
دوره 33 3 شماره
صفحات -
تاریخ انتشار 2008