You’re probably carrying a dormant version of the virus that causes shingles right now. These private plans must cover all commercially available vaccines needed to prevent illness, except for those that Part B covers. Medicare Part B covers some other vaccines as free preventive care, such as flu and pneumonia vaccinesĪ prescription drug plan, such as Medicare Part D bought as an add-on to original Medicare or that is part of a Medicare Advantage plan that provides drug coverage, will pay for the shingles vaccine. Medicare’s Part A and Part B don’t cover shingles vaccinations, even though the Centers for Disease Control and Prevention (CDC) recommends that everyone age 50 and older get the vaccine. The investigators acknowledged that they did not "know the number of beneficiaries enrolled in each plan or the generalizability of our findings to other drug classes."Īs for future research, Elliot said, it would be interesting to see how the authors' findings could be changed by President Trump's efforts at price reductions for prescription pharmaceuticals.En español | Yes, if you have prescription drug coverage. Medicare PDPs covered a median of 25 of those prescriptions. Using Walmart's 2017 generic drug discount program list, the investigators selected 27 generic medications used to manage common cardiovascular conditions. The investigators reviewed 2,155 Medicare PDPs, of which 28.9% were standalone PDPs and 71.1% were Medicare Advantage plans. The implication is that that insurers are profiting by "paying less than the patient's copayment to settle the claim with the pharmacy, and pocketing the difference," she commented to MedPage Today, as "the availability of these drugs for $4 at Walmart is implicitly used here as an upper bound on what PBMs must be paying to settle these claims - if a patient off the street can fill the script for $4 at Walmart, a big PBM with all their negotiating leverage probably isn't paying more than $4." hospitalizations, ER visits), because they cover those costs as well," agreed Karen Van Nuys, PhD, of the University of Southern California's Center for Health Policy and Economics in Los Angeles, who was not involved in the study. "We generally think of plans as having stronger incentives to care about the non-pharmacy implications of patient adherence (e.g. The consistently higher cost sharing in the Medicare Advantage plans was "counterintuitive" compared with plans that solely cover pharmaceutical services, the investigators noted. "Never assume that, just because a particular drug is on the $4-per-month formulary, that your patient will not have to pay more out-of-pocket money to obtain this medication," William Elliot, MD, PhD, chief of pharmacology at Pacific Northwest University of Health Sciences in Washington, commented to MedPage Today on the analysis, in which he was not involved. In other tiers, 95.6% of the drugs' out-of-pocket cost surpassed Walmart's price under Medicare Advantage and 48.9% under standalone PDPs ( P<0.001). Even for tier 1 preferred generics and select care tiers in which cost sharing is supposed to be low or nonexistent, the median proportion over that $4 out-of-pocket threshold was 19.9% for Medicare Advantage plans and 1.9% for standalone Medicare prescription drug plans (PDPs).
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