Williams K
National Pharmaceutical Council, Inc., Reston, Virginia 20191-5433, USA.
Clin Ther. 1998 Nov-Dec;20(6):1292-300. doi: 10.1016/s0149-2918(98)80123-9.
This paper briefly reviews the extent of current drug coverage for Medicare beneficiaries and describes the most important issues faced by aged beneficiaries who receive or seek drug coverage through a Medicare managed care plan. Changes in payment rates to these plans as a result of the Balanced Budget Act of 1997 may result in plans reducing or eliminating drug coverage. Under current law beneficiaries in these plans will have severely limited options for replacing drug coverage; as a result, many will not be able to obtain this coverage either through Medigap or previous retiree coverage. In the absence of any change in current law, one approach to addressing these issues is to refocus Medicare managed care plans on managing the total cost of caring for patients over time and across settings. Only through such an integrated approach will Medicare managed care plans have the tools to function within the new payment rates and realize the value of the pharmaceutical benefit to the plan and the patients.
本文简要回顾了医疗保险受益人目前的药物覆盖范围，并描述了通过医疗保险管理式医疗计划获得或寻求药物覆盖的老年受益人所面临的最重要问题。1997年《平衡预算法案》导致这些计划的支付费率发生变化，可能会使计划减少或取消药物覆盖。根据现行法律，这些计划中的受益人在替代药物覆盖方面的选择将受到严重限制；因此，许多人将无法通过补充医疗保险或以前的退休人员保险获得这种覆盖。在现行法律没有任何变化的情况下，解决这些问题的一种方法是将医疗保险管理式医疗计划的重点重新放在随着时间推移和跨环境管理照顾患者的总成本上。只有通过这种综合方法，医疗保险管理式医疗计划才能拥有在新的支付费率范围内运作的工具，并实现药物福利对计划和患者的价值。
