- Center on Health Equity and Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Paul Billings Discusses the Financial Burden of Prescription Drug Costs in Medicare
Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.
Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.
Transcript
How does the financial burden of high prescription drug costs among the Medicare population differ from the non-Medicare population?
So, Medicare’s prescription drug benefit is designed differently than many private health plans, and what we see is that patients hit what is known as the donut hole, where their costs go up dramatically through their plan year, and that leads to patients having to face much higher costs when they show up at the pharmacy counter.
We had an experience with a patient that was used to paying $42 for each prescription, and she showed up and it was $175. It was quite a shock to her and she couldn’t afford it. So, patients experience these high costs and all of a sudden it can impact their ability to afford medication, and if they can’t afford their medication, it can lead to a wide range of additional health burdens. People with chronic obstructive pulmonary disease can end up hospitalized when they’ve had an exacerbation, rather than maintaining good health or managing their disease by being able to adhere to their medications.
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Gene and Cell Therapies Hold Potential—but How Can Payers Manage Their Costs?
April 18th 2024Presenters at the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting discussed the current promise and future potential of gene and cell therapies, as well as payer management strategies for these costly treatments.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Commonwealth Fund Report Details Pervasive Racial and Ethnic Disparities in US Health Care, Outcomes
April 18th 2024Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.
Read More
The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
Read More
