Prescription Drugs and Medicare

Nursing Leadership Health Policy

Health Policy Change

The health policy change encompasses Medicare Part D. Medicare D. is also referred to as the Medicare prescription drug benefit. It is part of the Medicare program that is purposed to bankroll the cost of prescription drugs together with coverage payments for prescription drugs for Medicare recipients (Centers for Medicare & Medicaid Services, 2016). The proposed policy change with respect to Medicare Part D is the reduction and lessening of generic drug copayments to zero. In particular, this alteration will be a form of encouragement for the use of generic drugs amongst Medicare enrollees that are poorer by all in all eradicating their costs for generic drugs. Majority of the members of Medicare Part D that are categorized as having low income give out minimal compensation or nil for Part D prescription drugs. In the past year, with respect to generics, the costs varied between $1.20 and $2.95 whereas for brands, the costs varied from $3.60 to $7.40. It is imperative to note that health care plans are not able to place levels or rank medications of most of the members in Medicare Part D similar to how it is undertaken in other kinds of health care plans in the Affordable Care Act or commercial markets. The implication of this is that it causes members to move in the direction of treatment options that have more value or impact for their money (Schultz, 2016). Here comes in the change.

By eradicating copayments for generic drugs as well as some sought after brand drugs, it implies that Medicare plans will be able to make certain that those who enroll spend federal funds in a sensible and prudent manner while gaining accessibility to cost-effective health care. Several Medicare members that have low income, that would feel the deemed minimal $2.95 copayment to be a financial encumbrance, would largely benefit by not having to pay anything at all for obtaining their generic and cost-effective brands of prescribed medication. In turn, this will give rise to augmented adherence to medication by the members. Taking this into consideration, the small group of Medicare members of low income that would opt to go on utilizing brand medications that are not preferred, would have to give out greater payments for such treatments that are less cost-effective (Schultz, 2016).

From my own perspective, adequate safeguard have been put in place for such Medicare members for the reason that there will be an already set up exemption procedure if it turns out that a less costly medication is not clinically suitable for a Medicare Part D member. Decreased federal spending and higher financial accountability for Medicare Part D members would be beneficial in getting rid of those generic copayments.

Exact Wordings

Concerns: Issues linked to admissibility for and payment of subsidies for assistance with premium and cost-sharing amounts for Part D eligible individuals with lower income and resources.

A bill to amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries.

"Under current law, the Centers for Medicare & Medicaid Services Plans must explain in its exceptions criteria the cost-sharing scheme that will be applied. Allowing plans the flexibility to determine which level of cost-sharing will apply is consistent with section 1860D-2(b)(2) of the Act, which permits a plan to establish tiers to manage its covered Part D benefits so long as the co-payments associated with the plan's tiers meet the actuarial equivalence standard in section 1860D-2(b)(2)(A)(ii) of the Act" (Centers for Medicare & Medicaid Services, 2016).

Plan for Implementation

There is a sequential plan to be followed for the implementation of the amendment in order for it to be signed into law. The first phase takes into account the introduction of the bill in the House of Representatives. It is imperative for the bill to be passed in the House. Subsequently, the bill will be moved to the Senate. In this phase, the bill will be taken into consideration by a committee, which is encompassed in the Senate Health, Education, Labor, and Pensions Committee. The committee activity will consist of holding hearings regarding the issues on the health policy change and on this particular bill proposal. The bill will be developed much further and any other recommended changes shall be handed out to the full chamber. Once this is done, the bill proposal is taken by the conference committee to the House and Senate for approval. Once such approvals are ratified, the bill will be signed into law (Congress.gov, 2016).