MedPAC Commission suggests bold overhaul
MedPAC Commission suggests bold overhaul
Pharmacy home delivery co-pays reduced. The TRICARE Management Activity recently announced that co-payments for some medications provided through the TRICARE Pharmacy Home Delivery are being reduced to zero. As of Oct. 1, 2011, Home Delivery beneficiaries can fill generic prescriptions at no cost to themselves.Generic formulary drugs purchased through Home Delivery currently cost $3 for a 90-day supply, but as of Oct. 1 the co-payment drops to zero.Other changes to the TRICARE pharmacy co-payments that will go into effect Oct. 1 include:
- Generic formulary drugs purchased at retail pharmacies will go from $3 to $5.
- Brand name formulary drugs from retail pharmacies will go from $9 to $12.
- Non-formulary medications will go from $22 to $25 in both retail and Home Delivery.
Brand name formulary drugs purchased through Home Delivery will have the same $9 co-payment. Co-payments for prescriptions filled through Home Delivery cover a 90-day supply, but only a 30-day supply when purchased at a retail pharmacy.Military, their families and retirees are increasingly using Home Delivery to get their maintenance medications conveniently delivered through U.S. mail – saving TRICARE about $30 million in 2010. Use of Home Delivery has grown in 2011 by nearly 10 percent over 2010. More than 1 million prescriptions per month are filled through the service.For more information about TRICARE pharmacy, the new co-payment rates and Home Delivery, visit www.tricare.mil/pharmacy. Commission releases "doc fix" proposal. An influential commission, established by Congress, has released a bold plan to overhaul Medicare’s physician payment formula.The Medicare Payment Advisory Commission (MedPAC) was established in 1997 to analyze access to care, cost and quality of care, and other key issues affecting Medicare. MedPAC advises Congress on payments to health plans participating in the Medicare Advantage program and providers in Medicare’s traditional fee-for-service programs.Finding a permanent solution to the annual cuts in reimbursement rates for physicians who treat Medicare patients has proven to be next to impossible. Because payment rates in the TRICARE program are tied to Medicare rates, this affects many military beneficiaries. Each year, Congress implements short-term patches that merely make the problem worse. Physicians now face a nearly 30 percent drop in reimbursement rates on 1 January when the current patch expires. By Congressional Budget Office (CBO) estimations, it would cost about $300 billion to replace the current formula.In accordance with what AUSA has been saying for some time, MedPAC Chairman Glenn Hackbarth said that the payment cuts could prompt doctors to withdraw from the program.Under the MedPAC idea, Congress could replace the formula for $200 billion over a decade. The $100 billion difference from CBO’s estimate would be achieved by cutting payments to specialists, instead of following CBO’s assumption that reimbursement rates would remain the same for all physicians. Specialists’ payments would be trimmed by 6 percent a year for three years; then they would be frozen. Reimbursements to primary care doctors would remain flat.MedPAC said that the plan would be paid for with $235 billion in payment cuts across health care sectors. They identified $75 billion in cuts from the pharmaceutical industry; $49 billion from skilled nursing facilities, home health care and other "post-acute" care; $33 billion from beneficiaries; $26 billion from hospitals; $21 billion from labs; $14 billion from wheelchairs, hospital beds and other medical equipment; and $12 billion from Medicare’s private health plans.Also, don’t think MedPAC’s plan is a foregone conclusion. The Commission will decide at their October meeting whether or not to present the plan to Congress.Groups that would be affected by the policy changes/cuts will most certainly come out swinging against the plan.There is also the Joint Deficit Reduction Committee whose work is ongoing. They have to come up with $1.2 trillion in cuts by late November. They could very easily adopt MedPAC’s identified cuts as part of their own plan.In any event, Congress needs to come up with something more permanent than the short term patches we have been dealing with for several years.