Magazine article Drug Topics

Rx Outpatient Benefit for Medicare under Review Again

Magazine article Drug Topics

Rx Outpatient Benefit for Medicare under Review Again

Article excerpt

The cash-and-carry market for I prescription drugs could be going the way of the mortar and pestle. The Clinton Administration is committed to making sure every American is covered by health insurance, and it is widely expected to propose that the basic benefits package include coverage for Rx drugs.

In addition, the Administration is considered likely to suggest an outpatient Rx insurance plan under Medicare, which will remain separate for some time. If the Medicare benefit is enacted, that would eliminate the largest single source of cash customers for most pharmacies and result in one billion Medicare Rx claims being filed each year.

"Such volume would be best handled by electronic on-line systems in pharmacies for drug utilization review and claims payment purposes," Bruce C. Vladeck, administrator of the Health Care Financing Administration, told Congress last month. "Such a system would require sufficient lead time to accommodate the procurement process for system development."

Over 600 million claims/year: Medicare already handles about 660 million claims annually, with more than 88% of those filed by hospitals and 62% of those from physicians processed electronically. "While complex, an electronic drug claims processing system seems much more accessible now than five years ago, when we were working on the Medicare catastrophic drug benefit," Vladeck testified to the House Ways & Means Committee's subcommittee on health.

Since that benefit was scuttled in 1989 before it was implemented because of concerns about Rx costs and who should pay for them, subcommittee chairman Rep. …

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