May 6, 2010    Volume 1, Issue 10

People with Medicare who hit the coverage gap or “doughnut hole” in the Medicare drug benefit next year will receive a 50 percent discount at the pharmacy—without having to send in receipts or request a refund—according to draft guidance implementing the recently passed health reform law.

The guidelines from the Centers for Medicare and Medicaid Services (CMS) also state that the insurance companies offering Part D plans will inform pharmacies through their electronic claims systems when consumers are eligible for the discount, although the discounts will come from drug manufacturers.

State pharmaceutical assistance programs (SPAP) that provide coverage through the doughnut hole will also benefit from the discounts, while consumers enrolled in these programs will continue to pay the copays charged by their SPAP. Consumers enrolled in Part D plans offered by their employers, which often provide coverage through the doughnut hole, will not be eligible for the discount, according to CMS’s proposed guidance. The guidance is open for public comment until May 14, 2010.

Read the CMS draft guidance.       

Under current law, the Medicare Part D coverage gap, or “doughnut hole,” is projected to double
in size by 2021, exposing seniors to drastically increased liability for the costs of their
medications. This characteristic of the coverage gap makes it exceedingly expensive to correct –
Congress must dedicate significant resources simply to keep the gap from becoming larger every
year; reversing the momentum takes an even greater commitment of funds. The House of
Representatives has proposed to provide additional protection to seniors from the cost of
prescription drugs by closing the doughnut hole completely, though the high cost requires this
closure to be phased- in over time. According to a recent analysis by the National Committee to
Preserve Social Security and Medicare, the provisions to close the coverage gap in the House’s
America’s Affordable Health Choices Act (H.R. 3200) would close the gap by 2023. The
financial protection afforded by the bill becomes progressively stronger beginning in 2011,
providing increasing relief to seniors experiencing the coverage gap throughout the phase-out
period.
 from: National Committee to Preserve Social Security and Medicare

1. FAST FACT

Proposed health reform legislation from the House of Representatives will completely eliminate the Part D doughnut hole in 14 years, but would provide more immediate assistance to people using high-cost specialty drugs by progressively narrowing the coverage gap. (Avalere Health, Avalere Analysis of Proposed Elimination of Coverage Gap, June 2009)
  from Medicarerights.org

Article: Medical schools in the era of managed care: An interview with Arnold Relman

Article from:

Academe

Article date:

November 1, 1999

Author:

Anonymous

More results for:

Arnold Reiman

| Copyright informationCopyright American Association of University Professors Nov/Dec 1999. Provided by ProQuest LLC. (Hide copyright information)

RPOBABLY NO ONE IN THE UNITED STATES knows as much about the current situation in American medicine as Arnold Reiman, professor emeritus of medicine and social medicine at Harvard Medical School and editor-In-chief emeritus of the New En,dand Journal of Medicine. At the AAUP conference, “Academic Values in the Transformation of American Medicine,” held in Boston in May, Relman described the impact of the corporatization of the health-care system on the medical profession and on the cost and quality Of care. When Academe interviewed Relman at the Harvard Medical School in July, we asked him to talk about the ways in which those changes are affecting medical education as well. Reiman: Medical …

Anonymous Anonymous

Asclepios
Your Weekly Medicare Consumer Advocacy Update
An End to the Wait
May 21, 2009 • Volume 9, Issue 20

The Senate Finance Committee, which is writing legislation designed to extend affordable health care coverage to all Americans, has put forward four options to deal with the two-year delay in Medicare coverage for people with disabilities.

Option One shortens the waiting period to 12 months.

Option Two phases out the waiting period in six-month increments, with total elimination by April 2011.

Option Three has a slower phase-out, ending the waiting period in July 2015.

Option Four maintains the waiting period for people with access to private insurance (not including COBRA coverage from a former employer) and phases it out for everyone else.

The Medicare Rights Center believes that the sooner we completely end the waiting period for all people with disabilities, the better. Option Two achieves that goal.

(more…)

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