What is it? – Healthcare economist


If you participate in Medicare, how much will you pay for insulin? The answer is in the picture below (via MedPAC’s payment basis)

Looks messy? Well, it does. The beneficiary of Part D of the medical insurance has a deductible, followed by the standard coverage stage, where 25% of the cost is shared, and then the coverage where the beneficiary pays 25% of the cost (the manufacturer bears 70% of the cost of the branded drug in this coverage %), and then the catastrophic phase, where the beneficiary pays 5%. Wouldn’t it be easier if there is a simple co-payment like many business plans?

This is what CMS has been trying in its Part D advanced savings model. This model includes fixed co-payments for certain enhanced Part D plans. CMS write:

The voluntary model tested the impact of providing beneficiaries with more enhanced Part D replacement plan options that could provide lower insulin out-of-pocket costs. CMS is testing changes to the manufacturer’s underwriting gap discount plan (“discount plan”) to allow Part D sponsors to provide Part D benefit designs through eligible enhanced alternative plans, including predictable deductibles, initial coverage Scope and cover the gap stage by providing supplementary benefits that apply after the manufacturer provides discounted prices for the various insulins included in the model.

As stated by the former CMS administrator Simma Velma Health affairs Blog:

MS’s Part D Advanced Savings Model aims to reduce prescription drug costs by providing Medicare patients with a Part D plan that provides beneficiaries with a wide range of insulin supplies that are used by beneficiaries at a stable, affordable, and predictable price of no more than $35 for 30 days …Beneficiaries who do not qualify for the low-income subsidy (LIS) currently pay 5% of the negotiated price when they reach the catastrophic stage, which in most cases should be less than $35. Part D sponsors can provide co-payments of less than US$35 and still maintain the flexibility and choice of all prescriptions.

Sharon Jhawar, chief pharmacy officer of SCAN Health Program, believes that the elderly savings model is working, should become permanent, and should be extended to other diabetes drugs and drugs used to treat other common chronic diseases. Previous research has shown that Cost is an obstacle to drug compliance, She wrote:

Let’s speed up the timeline to make the model permanent and use the expected cost savings (US$250 million per year) Advancing other health plans for Medicare beneficiaries with diabetes… However, diabetes is only the fifth most common chronic disease among Medicare beneficiaries. People with other chronic diseases such as heart disease, neurological disease or autoimmune disease will face the same financial challenges as diabetes medication. With a successful template to manage costs, we have a unique opportunity to reduce prescription costs across the board.

For more information, please read CMS Advanced Savings Plan Fact Sheet And visit their website.



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