Strengthen Part D

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Close the Part D doughnut hole sooner

The Affordable Care Act took a historic step toward making prescription drugs more affordable by closing the Part D prescription drug coverage gap (or doughnut hole). Until 2010, […]

June 2nd, 2015|Categories: 50 Medicare Wishes, Increase Affordability, Strengthen Part D|

Require Part D plans to give the reason for a medication denial at the pharmacy counter

Knowing why a prescription drug is refused at the pharmacy counter is critical to helping beneficiaries determine their next steps—whether it is working with their physician to secure […]

Require Part D coverage determinations at the pharmacy counter

After being refused a prescribed medication at the pharmacy, a beneficiary must formally request coverage from their Part D plan before the appeals process can even begin. In […]

May 18th, 2015|Categories: 50 Medicare Wishes, Simplify Appeals, Strengthen Part D|

Allow appeals on the Part D specialty tier

When medically necessary, people with Part D have the right to request that their plan allow them to pay less for high-cost medications when a similar, lower-cost medicine […]

Add Part D to an integrated appeals process for Medicare-Medicaid managed care plans

In some states that are testing new care coordination models for dually eligible Medicare and Medicaid beneficiaries, the federal government is allowing the state and health plan to […]

May 16th, 2015|Categories: 50 Medicare Wishes, Simplify Appeals, Strengthen Part D|

Create a publicly-administered Part D benefit

The Medicare prescription drug program is operated solely by private health plans. Adding a public drug benefit to the Part D program would diminish confusion among beneficiaries who […]

Create Medicare Part E—a public supplement to Original Medicare with Part D benefits and a catastrophic cap

Medicare beneficiaries who opt for the flexibility and simplicity of Original Medicare should be protected from catastrophic costs by an out-of-pocket maximum and should benefit from an integrated […]

May 1st, 2015|Categories: 50 Medicare Wishes, Modernize Benefits, Strengthen Part D|

Restore Medicare prescription drug rebates

When the Medicare Part D drug benefit was created, the federal government lost important discounts from pharmaceutical makers for prescription drugs made available for low-income beneficiaries. At a […]

April 22nd, 2015|Categories: 50 Medicare Wishes, Increase Affordability, Strengthen Part D|

Allow Medicare to negotiate Part D prices—especially for high-cost, specialty drugs

Unlike state Medicaid programs and the Veteran’s Administration, Medicare is prohibited from negotiating the price of prescription drugs directly with pharmaceutical makers. This prohibition is becoming increasingly problematic […]

April 21st, 2015|Categories: 50 Medicare Wishes, Increase Affordability, Strengthen Part D|