Page 32 - Management Theory 2023-2024 Edition

www.pharmacyexam.com Krisman

4. The MMA will also create a national competitive bidding program for drugs and durable medical
equipment starting in 2007.

5. This law also includes provisions that affect state Medicaid programs, under a new provision, and will
create tax-free health savings accounts and increase the availability of generic medications to Medicaid
recipients.

6. This law will also add the Medicare Part D prescription drug benefit program in 2006 and enable
beneficiaries to enroll in national or regionally-based insurance plans that cover prescription drugs.

Medicare Approved Prescription Drug Discount Card Program

To provide Medicare beneficiaries, especially those without prescription coverage, with discount on their
prescription medications, MMA establishes a Medicare approved drug discount card program.

All Medicare beneficiaries entitled to or enrolled in Medicare Part A and/or Part B, would be eligible for the
Medicare-approved discount card (without any income limit).

The program will operate for the 18 month period beginning in June 2004, continuing through the end of 2005,
to provide “interim relief” from prescription drug costs to uninsured Medicare beneficiaries before the Medicare
Part D prescription drug coverage program begins in 2006.

The actual savings may vary; however the cardholder may save up to 10 to 25% on prescription medications
dispensed through community and mail order pharmacies. The Medicare approved discount cards will have a
Medicare-approved seal. Just as Medicare-approved discount cards are voluntary for beneficiaries; they are also
voluntary for pharmacies. Individual, chain, and mail order pharmacies have been signing contracts and making
business decisions about which discount cards they will and will not accept in their stores.
There are several criteria that card sponsors (i.e. HMOs, PBMs, etc.) had to meet before they could be approved
by The Center of Medicare and Medicaid Service (CMS).

1. Drug card sponsors must have at least three years of experience in negotiating discounts with
manufacturers and pharmacies and adjudicating claims, and must operate a program that serves at least
one million.

2. Drug card sponsors have to provide discounts on covered drugs to all their enrollees, but they can vary
discounts based on the type of enrollee or the pharmacy from which the covered drugs are obtained.
They can also vary discounts by disease stage.

3. Drug card sponsors must provide convenient access to pharmacies, which means that the retail
pharmacy network must be constructed so that 90% of beneficiaries in urban areas have access to a
retail pharmacy within 2 miles.

4. Drug card sponsors must implement the system to reduce medication errors and prevent adverse drug
reactions. Drug card sponsors must also provide enrollees with a card that complies with NCPDP
standards, maintains a grievance process to resolve disputes, and is precluded from marketing non-drug
products to Medicare beneficiaries.

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