United States prescription drug benefit for the elderly and disabled
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Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs.[1] Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Under the program, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government. Part D plans typically pay most of the cost for prescriptions filled by their enrollees.[2] However, plans are later reimbursed for much of this cost through rebates paid by manufacturers and pharmacies.[3]
Part D enrollees cover a portion of their own drug expenses by paying cost-sharing. The amount of cost-sharing an enrollee pays depends on the retail cost of the filled drug, the rules of their plan, and whether they are eligible for additional Federal income-based subsidies. Prior to 2010, enrollees were required to pay 100% of their retail drug costs during the coverage gap phase, commonly referred to as the "doughnut hole.” Subsequent legislation, including the Affordable Care Act, “closed” the doughnut hole from the perspective of beneficiaries, largely through the creation of a manufacturer discount program.[4]
In 2019, about three-quarters of Medicare enrollees obtained drug coverage through Part D.[5] Program expenditures were $102 billion, which accounted for 12% of Medicare spending.[6] Through the Part D program, Medicare finances more than one-third of retail prescription drug spending in the United States.[7]
^Kirchhoff, Suzanne M. (August 13, 2018). Medicare Part D Prescription Drug Benefit(PDF). Washington, DC: Congressional Research Service. Retrieved 29 August 2018.
^A Data Book: Health Care Spending and the Medicare Program(PDF). Medicare Payment Advisory Commission. 2020. p. 168.
^Report to the Congress: Medicare Payment Policy(PDF). Medicare Payment Advisory Commission. 2020. p. 430.
^Closing the Coverage Gap — Medicare Prescription Drugs Are Becoming More Affordable(PDF). Centers for Medicare & Medicaid Services. 2014.
^"Medicare—CBO's Baseline as of March 6, 2020" (PDF). CBO.gov. March 6, 2020. Retrieved July 9, 2021.
^Report to the Congress: Medicare Payment Policy(PDF). Medicare Payment Advisory Commission. 2021. p. 411.
^"Retail Sales for Prescription Drugs Filled at Pharmacies by Payer". Kaiser Family Foundation. 2020. Retrieved July 9, 2021.
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penalties. In 2017, CMS fined UnitedHealthcare after discovering issues in MedicarePartD leading to delays or denials in a 2016 audit. The New Jersey Department...
Congress created MedicarePartD with the Medicare Prescription Drug, Improvement, and Modernization Act, which prevented Medicare, the country's largest...
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on 15 June 2021. Retrieved 14 June 2021. "What MedicarePartD drug plans cover". US Centers for Medicare & Medicaid Services. Archived from the original...
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plans, labor unions, government agencies, and individuals served by MedicarePartD Prescription Drug Plans. Medco was a member of the S&P 500 and ranked...
Medicare, or join or change plans within the Medicare Advantage and MedicarePartD Prescription Drug programs for the coming calendar year. Individuals...
profits at the expense of traditional Medicare. MedicarePartD provides a private insurance option to allow Medicare beneficiaries to purchase subsidized...
long-term care insurance, annuities, and Medicare products, including plans for Medicare Advantage and MedicarePartD prescription drug coverage. The company's...
The Medicare for All Act (abbreviated M4A), also known as the Expanded and Improved Medicare for All Act or United States National Health Care Act, is...
Waltham, Massachusetts improperly altered prescription drug claims to MedicarePartD and the Massachusetts Medicaid program that resulted in higher reimbursement...
least part of the cost (typically limiting the number of doses covered per month), many providers, including those operating under MedicarePartD, do not...
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