- Posted February 1, 2014 by
Medicare Part D Might See Changes
People who rely on Medicare might soon have to worry about how to pay for some prescription drug costs. While this is an occurrence for a lot of people who have a considerable number of prescriptions to have filled on a regular basis, an end is usually in sight when the coverage gap closes.
A new rule has been proposed by the Centers for Medicare and Medicaid Services that would significantly change Medicare Part D coverage. As it stands now, "substantially all" prescription medications are covered. There are some that are exempt, such as fertility medications. If the new law goes into effect, specific drugs in each category of the formulary might be removed from coverage.
For people who aren't on these drugs, the changes might seem insignificant. It is important to remember that different medications have different compositions. This means that a lot of these drugs aren't interchangeable because they may have different effects. By reducing the number of available drugs in each class, the CMS is essentially saying that people will have to live with medications that might be ineffective if they don't want to pay for those drugs out-of-pocket.
One example of how the availability of drugs will be limited under the new proposal deals with mental health medications. Under the current formulary, there are 23 generic and 7 brand name medications available. If the new proposal goes into effect, this number will be reduced to 9 generic drugs that can be used to care for beneficiaries with mental health concerns. This will make it much more difficult for budget-minded Medicare beneficiaries who are suffering from a mental illness to get adequate pharmaceutical treatment. In 2011, Medicare beneficiaries who received income-based financial assistance accounted for 83% of the total number of antipsychotic prescriptions filled by Medicare Part D.
Reducing the number of prescription drugs available on the Medicare Part D formulary might seem like a good way to manage costs. The truth here is that more emphasis needs to be placed on helping patients learn how to manage chronic illnesses effectively instead of simply cutting off the medications they need.
Many of the elderly who are Medicare beneficiaries are barely surviving now on the limited income they have available. If they are expected to pay out-of-pocket for the drugs currently covered, they may have to make the choice between those life-saving medications and other life necessities.