The problem affects private drug policies and Medicare Advantage plans that provide both medical and drug coverage and substitute for traditional government-run Medicare. It could leave plan members without coverage.
El problema abarca a la cobertura de medicamentos recetados (Medicare parte D) y a los beneficiarios que tienen planes médicos de Medicare Advantage.
Federal officials are hailing the introduction of services such as transportation to medical appointments, home-delivered meals and installation of wheelchair ramps as a way to keep beneficiaries healthy and avoid costly hospitalizations. But not many plans are offering the services in 2019.
Congress approved two bills last month that prohibit provisions keeping pharmacists from telling patients when they can save money by paying the cash price instead of the price negotiated by their insurance plan.
Federal officials are allowing the private insurance plans to use “step therapy” for drugs administered by doctors. In step therapy, patients must first use cheaper drugs to see if they work before receiving more expensive options.
Beneficiarios de Medicare pueden conseguir medicamentos más baratos si pagan en efectivo… pero por reglas mordaza el farmacéutico no puede decirlo.
Sometimes a drug plan’s copayment is higher than the cash price, and under a little-known federal rule, pharmacists have to tell Medicare beneficiaries that — but only if they ask.
Under new federal rules unveiled this week, these privately run alternatives to traditional Medicare might provide air conditioners, rides to medical appointments and home-delivered meals. In California, which has a high proportion of Medicare beneficiaries in private plans, a San Francisco-based nonprofit already offers similar services to disabled seniors and adults.
Los Centros para Servicios de Medicare y Medicaid ampliaron la forma en que definen los beneficios “relacionados directamente con la salud”, que las aseguradoras pueden incluir en sus pólizas.
Last month’s budget deal means Medicare beneficiaries are eligible for physical and occupational therapy indefinitely. Plus, prescription drug costs will fall for more seniors.