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Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act, or MMA) substantially expanded the federal Medicare program by creating the prescription drug benefit known as Part D. In FY 2013, Medicare Part D covered 39 million people. The federal government spent $59 billion net of premiums on Part D in that year; after accounting for certain payments from states under the program, the net federal cost was $50 billion, which represented 10% of net federal spending for Medicare. A combination of broader trends in the prescription drug market and lower-than-expected enrollment in Part D has contributed to much lower spending for the program than projected when the MMA became law in 2003. This report examines the federal budgetary cost and competitive design of Medicare Part D and compares Medicare Part D and Medicaid Fee for Service. Figures and tables. This is a print on demand report.
The Code of Federal Regulations is a codification of the general and permanent rules published in the Federal Register by the Executive departments and agencies of the United States Federal Government. This print ISBN is the official U.S. Federal Government edition. 42 CFR Parts 414-429 covers the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. This volume covers rules, procedures and regulations pertaining to payment for Part B Medical and other health services, services by physicians, ambulatory surgical services, health maintenance organizations, hospice care, competitive medical plans, healthcare prepayment plans, medicare contracting, medicare advantage program, and more. Other products pertaining to this topic include the following: Federal Register, V. 76, No. 228, Monday, November 28, 2011, Medicare Program: Payment Policies Under the Physician Fee Schedule and Other Revisions To Part B for CY 2012 can be found at this link: https://bookstore.gpo.gov/products/sku/069-001-00196-0 Health United States 2013 With Special Feature on Prescription Drugs can be found at this link: https://bookstore.gpo.gov/products/sku/017-022-01621-4 Keywords: Medicare conditions for payment; medicare shared savings program; national coverage determinations and local medicare , coverage determiniations; health insurance; voluntary medicare prescription drug benefit; Medicare Advantage Program, Prospective Payment System for Hospital Outpatient Services; outpatient services; prescription drugs; medicare savings; medicare payments; Medicare; MEDICARE; Medicare hospice covera≥ Medicare prescription drug covera≥ Medicare Part B Health covera≥ Medicare Part B Heatlh Covera≥ HMO; HMOs; medical plans; Medical plans; competitive medical plans; ambulance surgery; ambulance surgical services; Medicare program integrity; Medicare prescription drug benefit; Medicare Shared Savings Program; Medicare Program; MEDICARE Program; MEDICARE program; Medicare physician care covera≥ Medicare physician office visit covera≥ Medicare outpatient service covera≥ 42 CFR Parts 414 to 429; 42 CFR Parts 414-429; 42 CFR Parts 414-429; cfr 42 parts 414 to 429; cfr 42 parts 414-429; Medicare Benefits; Medicare benefits; medicare benefits; medicare health benefits; Medicare entitlement health benefits; senior health care; health care for older Americans; Federal Medicare program;