Monthly Archives: April 2013

Subtitle D

Subtitle D is about Medicare Part D. Maybe they were being subtly ironic, but maybe they just didn’t notice. Who knows!

Section 3301 looks at the Medicare Coverage Gap Discount Program. This is the so called “Medicare Doughnut Hole” where after a certain point, participants were expected to pay 100% of drug costs, up to a catastrophic point. This section changes that to only 50%.

Section 3302 improves the determination of Medicare Part D’s low income benchmark premium. That’s pretty much what it does.

Section 3303 will allow a waiver of monthly premium for those people who are subsidy eligible, if the premium is de minimis, which is fancy Latin for trifling or minimal. It doesn’t actually say how much that it is though.

Section 3304 makes special rules for widows and widowers regarding eligibility for low-income assistance which basically extends the eligibility period for a year after their death.

Section 3305 improves information for subsidy eligible individuals reassigned to prescription drug plans. Specially formulary differences, and coverage determination.

Section 3306 increases funding and outreach for low-income programs.

Section 3307 improves formulary requirements for Medicare Part D, specifically requiring the inclusion of anticonvulsants, antidepressants, antineoplastic, antipsychotics, antiretroviral and immunosuppressants for treatment of transplant rejection. I wonder why there aren’t more pro-drugs. They seem so….negative.

Section 3308 reduces Part D subsidies for higher income individuals.

Section 3309 eliminates cost-sharing for dual eligible individuals (specifically here dual eligible for Medicaid and Medicare).

Section 3310 reduces wasteful dispensing of outpatient prescription
drugs in long-term care facilities. Or at least it tries to by allowing drugs to be prescribed in weekly or daily doses, rather than 30 days.

Section 3311 tries to improve Medicare prescription drug plans by creating a complaint system for problems with this plan.

Section 3312 creates uniform exceptions and appeals process for prescription drug plans including an Internet Website and a toll-free telephone number!

Section 3313 sets up another study! Of Prescription Drug plans!

Section 3314 allows for the inclusion of costs incurred by AIDS drug assistance programs and the Indian Health Service towards the annual out-of-pocket threshold.

Section 3315 was repealed and replaced. So no section 3315 for you!

 

 

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