Congressional Budget Office: Options for Reducing Deficit
The health option (from the options listed in chapter 5 of the report) to implement is the increase in the premiums of Medicare Part B and Part D. The healthcare institution that this will primarily affect are pharmacies. Currently, in the Medicare market, enrollees pay a certain amount for their Medicare Part B and D benefits (2020 Medicare, 2020). Those with low-income pay a very affordable and standard premium whilst those with higher incomes pay an adjusted premium based on their higher income. By increasing the Medicare premium paid by the enrollees, Medicare spending can decrease significantly. The purposed plan has the patient pay as much as a 35% premium for Part B and Part D respectively. This is a major change from the current 25% premium for Part B and 25.5% premium for Part D (Options for, 2016). This affects pharmacies in general because of Medicare Part D in the pharmacy benefits program for the geriatric population.
Pharmacy Plans
By increasing the premiums, pharmacies will have to come up with a plan to earn the business of the patients. One of the big drawbacks to this particular option is that patients on fixed incomes will have to spend more on their prescription drug costs, and this can lead to patient non-compliance with their prescription medication due to the cost. “The latest government estimates say that total U.S. prescription drug spending will grow 60 percent from 2019 to 2027, to $576.7 billion from $360.3 billion. The fastest growth will come in the government Medicare program” (Rowland, 2019, para 22). One idea that retail pharmacies can implement can be prescription drug management. Meaning pharmacists can offer a comprehensive and free benefit where they manage each patient prescription long term so that the patient can be compliant with their medications. Since this benefit is offered by companies for a cost (Cigna, Aetna, Anthem, Etc.), doing it for free can be an enticing offer to earn the business of patients (Pavoola, 2019). This option also freezes the income-based premium cut-offs. This means that enrollees that meet the cut-offs will most likely stay in that category for the purposed amount of years (7 years). This can lock patients into a category where they pay increased premiums even if their income gets reduced in the coming years. Pharmacies can also mitigate this by offering plans to qualified individuals to help bridge the gap between their income and pharmacy costs.
Conclusion
These plans can bridge the gap more thoroughly by charging a fee to be enrolled in the plan, then pay for any gaps in coverage. Increasing the premiums creates a more competitive market and this in turn creates more choice in terms of options and benefits for the patient. With this purposed plan put into action, there are a lot of ways pharmacies can improve to help every patient overcome any changes implemented while preserving Medicare for future generations.
References
2020 Medicare Costs. (2020). Centers for Medicare and Medicaid Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-Medicare-Costs.pdf
Options for Reducing the Deficit 2017 to 2026. (2016). Retrieved from https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142- budgetoptions2.pdf
Pavoola, A. (2019). The top insurers all have PBMs: Here's Who They Are. Retrieved from https://www.beckershospitalreview.com/pharmacy/the-top-insurers-all-have-pbms-here- s-who-they-are.html
Rowland, C. (2019). Drug Industry Defense for High Prices: Blame Insurance Companies. Retrieved from https://www.washingtonpost.com/business/economy/drug-industry- defense-for-high-prices-blame-insurance-companies/2019/02/25/cc0151ce-35e7-11e9- a400-e481bf264fdc_story.html
The health option (from the options listed in chapter 5 of the report) to implement is the increase in the premiums of Medicare Part B and Part D. The healthcare institution that this will primarily affect are pharmacies. Currently, in the Medicare market, enrollees pay a certain amount for their Medicare Part B and D benefits (2020 Medicare, 2020). Those with low-income pay a very affordable and standard premium whilst those with higher incomes pay an adjusted premium based on their higher income. By increasing the Medicare premium paid by the enrollees, Medicare spending can decrease significantly. The purposed plan has the patient pay as much as a 35% premium for Part B and Part D respectively. This is a major change from the current 25% premium for Part B and 25.5% premium for Part D (Options for, 2016). This affects pharmacies in general because of Medicare Part D in the pharmacy benefits program for the geriatric population.
Pharmacy Plans
By increasing the premiums, pharmacies will have to come up with a plan to earn the business of the patients. One of the big drawbacks to this particular option is that patients on fixed incomes will have to spend more on their prescription drug costs, and this can lead to patient non-compliance with their prescription medication due to the cost. “The latest government estimates say that total U.S. prescription drug spending will grow 60 percent from 2019 to 2027, to $576.7 billion from $360.3 billion. The fastest growth will come in the government Medicare program” (Rowland, 2019, para 22). One idea that retail pharmacies can implement can be prescription drug management. Meaning pharmacists can offer a comprehensive and free benefit where they manage each patient prescription long term so that the patient can be compliant with their medications. Since this benefit is offered by companies for a cost (Cigna, Aetna, Anthem, Etc.), doing it for free can be an enticing offer to earn the business of patients (Pavoola, 2019). This option also freezes the income-based premium cut-offs. This means that enrollees that meet the cut-offs will most likely stay in that category for the purposed amount of years (7 years). This can lock patients into a category where they pay increased premiums even if their income gets reduced in the coming years. Pharmacies can also mitigate this by offering plans to qualified individuals to help bridge the gap between their income and pharmacy costs.
Conclusion
These plans can bridge the gap more thoroughly by charging a fee to be enrolled in the plan, then pay for any gaps in coverage. Increasing the premiums creates a more competitive market and this in turn creates more choice in terms of options and benefits for the patient. With this purposed plan put into action, there are a lot of ways pharmacies can improve to help every patient overcome any changes implemented while preserving Medicare for future generations.
References
2020 Medicare Costs. (2020). Centers for Medicare and Medicaid Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-Medicare-Costs.pdf
Options for Reducing the Deficit 2017 to 2026. (2016). Retrieved from https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142- budgetoptions2.pdf
Pavoola, A. (2019). The top insurers all have PBMs: Here's Who They Are. Retrieved from https://www.beckershospitalreview.com/pharmacy/the-top-insurers-all-have-pbms-here- s-who-they-are.html
Rowland, C. (2019). Drug Industry Defense for High Prices: Blame Insurance Companies. Retrieved from https://www.washingtonpost.com/business/economy/drug-industry- defense-for-high-prices-blame-insurance-companies/2019/02/25/cc0151ce-35e7-11e9- a400-e481bf264fdc_story.html