Press Release: 5/19/18
Drug Coverage for All
Medication is often expensive. Sometimes, drug prices may be due to legitimate reasons such as innovative advances in medical technology, bioengineering, and targeted therapy. However, drug prices are also influenced by question practices such as slightly modifying or re-packaging drugs such that these medications lose their generic status and their prices skyrocket to brand-name levels. Regardless, patients will not be consoled by any reason when their bank accounts are wiped clean by high the cost of treatment.
However, Medicare is the first government-sponsored insurance that has tried to fight escalating drug costs, and is doing so through the four tiers of drug coverage in the Medicare Prescription Drug Plan, otherwise known as Medicare Part D. Each tier of Medicare Part D is outlined and explained below:
However, Medicare is the first government-sponsored insurance that has tried to fight escalating drug costs, and is doing so through the four tiers of drug coverage in the Medicare Prescription Drug Plan, otherwise known as Medicare Part D. Each tier of Medicare Part D is outlined and explained below:
- Phase 1 (Deductible): Medicare Part D has a deductible monthly premium and tiered copays for prescribed drugs. Private insurance companies can charge for a full deductible , a partial deductible, or no deductible, and enrollees will pay for drugs out-of-pocket until the deductible is met and the insurance plan enters its initial coverage phase.
- Phase 2 (Initial Coverage): Medication copays are determined based on a drug formulary, a list of mostly generic drugs with some brand name ones as well, covered by Medicare Part D. These drugs are divided into separate tiers with specific copays, which individuals will pay until they hit the initial coverage limit.
- Phase 3 (Coverage Gap): Here, individuals will pay for 35% of the cost of brand name drugs and 44% of the cost of generic drugs until total out-of-pocket costs reach $5,000. Expenses that count towards the the $5,000 coverage gap include deductibles, co-insurance, co-payments, and direct drug-related expenses.
- Phase 4 (Catastrophic Stage): Here, insurance plans will pay for 95% of the cost of formulary medications for the remainder of the year.
Aside from Medicare Part D, commercial drug coverage, split into fee-for-service coverage and capitated drug coverage, also helps individuals pay for medications. In spite of these efforts, drug prices in the United States remain much higher than in other countries around the world. While consumer outcry by US consumers and global price transparency has led to decreases in domestic drug prices, efforts must still be made to ensure drug coverage for all in the United States.