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Medicare managed care: policy concerns

K Williams1

  • 1National Pharmaceutical Council, Inc., Reston, Virginia 20191-5433, USA.

Clinical Therapeutics
|January 23, 1999
PubMed
Summary
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Medicare managed care plans face challenges with drug coverage due to payment changes. Beneficiaries may lose access, necessitating integrated care management for sustained pharmaceutical benefits.

Area of Science:

  • Health Policy
  • Gerontology
  • Pharmaceutical Economics

Background:

  • Medicare beneficiaries face challenges with current drug coverage.
  • Changes from the Balanced Budget Act of 1997 impact Medicare managed care plans' drug coverage.
  • Aged beneficiaries are particularly vulnerable to reduced or eliminated drug coverage.

Purpose of the Study:

  • To review current drug coverage for Medicare beneficiaries.
  • To identify key issues for aged beneficiaries in Medicare managed care plans regarding drug coverage.
  • To explore potential solutions for maintaining pharmaceutical benefits.

Main Methods:

  • Review of current Medicare drug coverage policies.
  • Analysis of the impact of the Balanced Budget Act of 1997 on managed care plans.

Related Experiment Videos

  • Examination of beneficiary options for drug coverage replacement.

    • Main Results:

    • Payment rate changes may lead to reduced or eliminated drug coverage by managed care plans.
    • Beneficiaries have limited options to replace lost drug coverage through Medigap or retiree plans.
    • Current law restricts beneficiaries' ability to secure alternative drug coverage.

    Conclusions:

    • Managed care plans may need to reduce or eliminate drug coverage due to payment adjustments.
    • Beneficiaries face significant barriers in obtaining alternative drug coverage.
    • Refocusing on integrated care management is proposed to address these challenges within new payment structures.