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RN group expands as viable managed market target

Medicare & Reimbursement Advisor Weekly, September 4, 2009

New rebate program highlights Medicare D reform

The three major nurses’ organizations in the country have come together to form the largest RN union and professional association in U.S. history. For more informa- tion, visit www.healthleadersmedia.com/content/238318/topic/WS_HLM2_HR/Three-Nurse-Groups-Merge-to-Create-Super-Union.html.

Rebates: Part D reform

Congress’s health reform bill (HR 3200) would:

• Create a new rebate program that under various circumstances would require pharmaceutical manufacturers to pay the federal government the difference between the statutory rebate under Medicaid and the rebates paid to Medicare’s prescription drug plans. Specifically, this policy would apply to covered drugs dispensed to full-benefit dual-eligible individuals, which are beneficiaries who are enrolled in both Medicare and Medicaid.
• Phase out the doughnut hole by extending the benefit’s initial coverage limit and lowering the catastrophic threshold at specified rates. This would result in elimination of the doughnut hole by 2022.
• Apply to covered drugs dispensed to full-benefit dual-eligible individuals for beneficiaries who are enrolled in both Medicare and Medicaid. Since the statutory rebate provided under Medicaid is usually larger than those negotiated by the plans providing the Medicare drug benefit, the provision would reduce federal spending.

Medicare beneficiaries would see their Part D prescription drug benefits rise by 5% in 2011, according to the Congressional Budget Office.

However, beneficiary spending on prescription drugs—apart from those premiums—on average would fall.

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