Magazine article Drug Topics

Medicare Rx Benefit Part of New Democratic Plan

Magazine article Drug Topics

Medicare Rx Benefit Part of New Democratic Plan

Article excerpt

Several Democratic heavyweights have unveiled legislation that would allow consortia of retail pharmacies to bid against PBMs and insurers to administer a Medicare Rx drug benefit. Under the proposal, the secretary of HHS would enter into regional contracts with at least two private entities that would be reimbursed based on the number of seniors they enroll. The basic benefit calls for a 20% co-pay, $200 deductible, and coverage for $1,700 worth of expenditures a year. Out-of-pocket expenses above $3,000 annually would be entirely covered.

All winning bidders would have to provide convenient access to Rxs through retail pharmacies, said a summary of the bill provided by its chief sponsor, Sen. Edward M. Kennedy (Mass.). Other supporters include Sen. John D. Rockefeller IV (W.Va.) and Reps. Henry Waxman (Calif.), John Dingell (Mich.), and Fortney (Pete) Stark (Calif.) The benefit also must include an "adequate" formulary, an appeals process, on-line DUR, 24-hour counseling availability, and provider education, said Stark.

At press time, some of the legislative fine print was unavailable, so pharmacy associations did not immediately respond. Two pharmacy associations, APhA and NCPA, have said they will not support legislation that does not provide payments for R. …

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