CMS Thinks Medicare Part D Needs An Overhaul

Published October 20th, 2015 by USA Rx
Fact Checked by
Chris Riley

CMS Thinks Medicare Part D Needs An OverhaulThe Centers for Medicare and Medicaid Services, or CMS, is currently planning out a revamping of Medicare Part D, the part which covers prescription medication costs and which got its start in 2006. Considering its youth, it’s understandable that there are more than a few kinks in the system, kinks which add up to $200 billion or more in mishandled funds. Thus, it’s equally understandable that CMS wants to get rid of these kinks as fast as it can.

Part D suffers from a number of issues, many of which come from the involvement of private insurance companies. There’s no such thing as a “standard” Part D plan, for instance, since each insurance company offers its own set of custom plans which can categorize different drugs into different tiers so long as the overall benefits meet a few basic and often vague standards.

Medicare is also unable to directly negotiate Part D drug prices. Technically speaking, there is a mechanism for negotiation in place, but it involves going through the private company, winning an appeal, and also getting full approval from congress. As such, it’s effectively impossible outside of a few very public cases. Other government agencies in charge of medical benefits, such as the Department of Veterans Affairs, pay somewhere between 40-56 percent less than Part D, saving an estimated $50 billion per year at the very least.

At the same time, while the government is paying out large subsidies to keep costs reasonable for Part D policy holders, the budget for oversight and management isn’t nearly up to its task. This lack of oversight means there’s plenty of room for mismanagement, mistakes, and outright fraud.

The CMS is looking to change at least some of this with the Part D Enhanced MTM Model. While the Center still doesn’t have the budget to solve all its problems, it’s at least offering greater flexibility and financial incentives to participating plans.

At the same time, the Affordable Care Act is attempting to shore up the infamous Part D “donut hole” where medication coverage simply stops for a few thousand dollars, but there remains a period during which many seniors have to pay full price for overpriced drugs. Fortunately, there is a way to get some relief during this period: the USA Rx pharmacy discount card. Our card isn’t a form of insurance and it works with any plan you may happen to have. With just a name and an email address, we can get you discounts of up to 75 percent on brand name and generic medication, and unlike Plan D our discounts don’t end at any arbitrary limit.

If you’d like to know more, try our email at [email protected] or else call us at 888-277-3911.

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