Page 31 - Management Theory 2023-2024 Edition

www.pharmacyexam.com Krisman

1. 75% of the first $2,250 spent
2. Nothing for the next $3,600 spent
3. 95% for drug bills over $5,850

The government would guarantee drug coverage in any region that does not have at least one stand-
alone drug plan and one private health plan. Employers that offer equivalent drug coverage for retirees
would receive tax-free subsidies.

Employers could also offer premium subsidies and cost-sharing assistance for retirees who enroll in
Medicare drug plans.

Lower-income seniors and disabled individuals will receive additional help in paying for prescription
drugs when the program starts in 2006:

1. People eligible for both Medicaid and Medicare will pay no premium or deductible and have no gap in
coverage. They will pay $1 per prescription for generics and $3 for brand names (copays are waived for
those in nursing homes).

2. People with incomes below about $13,000 ($17,600 for couples) in 2006 and assets of under $6,000
($9,000 for couples) will pay no premium or deductible and have no gaps in coverage. They will pay $2
for generics, $5 for brand names, and nothing above the catastrophic limit.

3. People with incomes between $13,000 and $14,400 ($17,600 and $19,500 for couples) in 2006 and
assets under $10,000 ($20,000 for couples) will pay premiums on a sliding scale, a $50 deductible and 15
percent of drug costs with no gaps in coverage. After spending $3,600 out-of-pocket in a year, co-pays
will be $2 for generics, and $5 for brand names.

4. In the interim, Medicare recipients could buy the prescription drug discount card that the Department
of Health and Human Services estimates will provide the savings of 10 to 25 percent off retail prices.
Beneficiaries with 2004 incomes below $12,569 ($26,862 for couples) would get the drug discount card
with a $600 per year benefit.

Medicare Modernization Act (MMA)

On December 8, 2003, President Bush signed the Medicare Prescription Drug, Improvement and Modernization
Act (known as Medicare Modernization Act, or “MMA” of 2003.)

MMA will make a voluntary prescription drug benefit available for the first time to more than 400 million
Medicare beneficiaries. In addition to offering the prescription benefit, the MMA is going to introduce the
following new regulations:

1. It will add new preventive medical benefits for seniors.

2. It will make a wealthier seniors pay a higher monthly Part B premium for physician services.

3. In the area of pharmacy, it will change the way that Medicare pays for covered outpatient Part B drugs
(i.e. immunosuppressants, oral cancer drugs, oral antiemetic drugs) and lower the reimbursement rates
for Medicare durable medical equipment (DME).

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