Affordable Care Act and Pharmacy: Big Changes Ahead?
What changes to pharmacy practice will the Patient Protection and Affordable Care Act bring?
On June 28, 2012, the Supreme Court of the United States upheld most provisions of the Affordable Care Act (ACA) by a 5-4 vote. Basically, the law was supported by a majority of the justices on the basis of federal government's authority to increase taxes. This law and the resultant legal decision are likely to have the same impact on US law as did Social Security and Medicare and Medicaid legislations. The ACA, sometimes informally called "Obamacare," contains several mandates that overhaul healthcare and affect nearly every US citizen. The ACA is perhaps most simply viewed as the combination of 2 so-called "public laws" (PLs); PL 111-148, signed on March 23, 2010, and PL 111-152, signed on March 30, 2010.
The final law is more than 900 pages long and is arranged into 10 titles, which contain subtitles, which contain parts, which contain sections. To facilitate the reader's ability to learn more about the law, references to sections will be shown.
Medicare Part D became effective in 2006. Under the ACA, more benefits are provided under Medicare Part D, with implementation continuing through 2020. For example, pharmaceutical manufacturers must discount certain drugs for those who fall into a coverage gap because they are not quite eligible for low-income subsidies. Beginning in January 2011, beneficiaries received a 50% discount from manufacturers on prescription drugs while in the coverage gap. Patients receive the discounts at the point of sale, and pharmacies are not notified of the amount of discount. Patients wanting to know this discount amount may contact their Part D administrator.
More information concerning the discount program is available from the Centers for Medicare & Medicaid Services (CMS).
Question
What changes to pharmacy practice will the Patient Protection and Affordable Care Act bring?
|
|
Response from James L. Lindon, PharmD, PhD, JD Pharmacy Law Attorney, Lindon & Lindon, LLC, Cleveland, Ohio |
Introduction
On June 28, 2012, the Supreme Court of the United States upheld most provisions of the Affordable Care Act (ACA) by a 5-4 vote. Basically, the law was supported by a majority of the justices on the basis of federal government's authority to increase taxes. This law and the resultant legal decision are likely to have the same impact on US law as did Social Security and Medicare and Medicaid legislations. The ACA, sometimes informally called "Obamacare," contains several mandates that overhaul healthcare and affect nearly every US citizen. The ACA is perhaps most simply viewed as the combination of 2 so-called "public laws" (PLs); PL 111-148, signed on March 23, 2010, and PL 111-152, signed on March 30, 2010.
The final law is more than 900 pages long and is arranged into 10 titles, which contain subtitles, which contain parts, which contain sections. To facilitate the reader's ability to learn more about the law, references to sections will be shown.
Medicare Part D Coverage Gap (Section 3301)
Medicare Part D became effective in 2006. Under the ACA, more benefits are provided under Medicare Part D, with implementation continuing through 2020. For example, pharmaceutical manufacturers must discount certain drugs for those who fall into a coverage gap because they are not quite eligible for low-income subsidies. Beginning in January 2011, beneficiaries received a 50% discount from manufacturers on prescription drugs while in the coverage gap. Patients receive the discounts at the point of sale, and pharmacies are not notified of the amount of discount. Patients wanting to know this discount amount may contact their Part D administrator.
More information concerning the discount program is available from the Centers for Medicare & Medicaid Services (CMS).