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- PD means medicines or prescription drugs in medical terms
- Prescription drugs are a major part of medical care and health costs in the US
- Combined with other letters PD represents a prescription insurance option
- MA-PD describes Medicare Advantage plans that offer prescription coverage
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In medical terminology, PD is a symbol for prescription drugs. The designation appears in many standard names and labels. Prescription drugs are an important part of modern medical care both inpatient hospitalization and outpatient care. Higher prices come along with the advances and increased effectiveness of prescription medicines.
Comparison shopping can help consumers find the best values in private prescription drug insurance. Click here to compare free quotes now!
US Prescription Prices are High
Drug prices in the US are higher than in comparable advanced nations. Many US residents struggle with the financial consequences of prescriptions and drug prices. Comparison shopping can focus on the consumer’s expected needs and preferences when selecting this important financial protection.
PD in Obamacare
The Affordable Care Act reformed the health insurance industry and made it favor the consumer in important new ways. One of the fundamental changes was the individual mandate that required every eligible person to get coverage.
The law requires universal acceptance by insurers so that applicants with pre-existing conditions could get insurance. Pre-existing conditions include conditions managed by prescription drugs.
Essential Prescription Drug Benefits
Obamacare put prescription benefits into qualified health insurance plans with no lifetime cap or limit on the amount. Obamacare did not cap prices pharmaceutical companies can charge for their products. In 2015, national prescription drug costs exceeded $450 billion. In 2016 the costs rose as prices increased as well as the number of prescriptions per patient.
- Obamacare requires insurance coverage of prescription drugs but does not affect the discretion of sellers to increase prices in response to a higher demand or a desire for higher profits.
- Obamacare incorporated important minimum essential coverage into every policy; called essential health benefits, these requirements included prescription drug coverage in every qualified policy.
- Grandfathered major medical plans do not need to meet the requirement, but most do. Using carve-outs, they placed these benefits under the control of managed care specialists that administer prescription drug programs. The addition of a second insurer gave the plan a pieced-together appearance, but it was a successful model.
- The idea behind the prescription drug carve-outs was to improve efficiency by relying upon specialists in prescription drug benefits administration.
- In the US, Medicaid and the CHIP offer similar coverage in the form of low or no cost prescription drugs for those with limited ability to pay. For other residents, they must pay retail prices or get insurance coverage that can reduce the costs to small copays and infrequent coinsurance payments.
Politics and Missed Opportunity
The politics of GOP resistance and Democratic Party support for health insurance created gaps in the scope of Obamacare such as price regulation or increased bargaining power for Medicare. The gaps in Obamacare, like Social Security and Medicare in the past, require careful study and legislative action.
Instead of serving the people’s best interest in the health care systems upon which they rely, we have had years of stalemate and undercutting the benefits of the Affordable Care Act. This represents a lost opportunity for healthcare reform.
PD Carve-Outs
In the years before passage of the Affordable Care Act, many employers and plan sponsors used a technique called a carve-out for prescription drug benefits. Before Obamacare, prescription drug benefits were optional, and plans could provide them or not as they chose.
Obamacare made prescription drug coverage an essential health benefit. Consumers can use comparison shopping on individual and family plans as well as menus and options within employer-sponsored coverage.
PD and Medicare
Medicare has four major parts, and they comprise a complete health care system for older Americans and those limited by severe conditions. The Congress enacted prescription drug benefits as Medicare Part D. It can be a stand-alone prescription drug plan for subscribers to Original Medicare.
It can also work with Medicare Advantage plans that do not have prescription benefits. It cannot work with Medicare Advantage-PD plans. The below-listed items describe Medicare prescription drug options.
- Original Medicare plus Medicare Part D – Prescription Drugs
- Medicare Advantage with Prescription Drug Benefits- MA-PD
PD and Medicaid
Medicaid is qualified health insurance under the Affordable Care Act. State Medicaid agencies provide the essential health benefits including Medicaid prescription drug coverage. Medicaid offers prescription drug benefits to its users that require them.
Most state Medicare agencies contract with managed care organizations to deliver insurance services for medical care.
Most of these managed care organizations, in turn, used prescription drug carve-outs to administer the prescription drug benefits.
PD and Mental Health
Unforeseen at the time of the passage of the Affordable Care Act, the current opioid epidemic has stretched state and local resources. The Affordable Care Act requires insurers to cover mental health as any other type of disease or illness.
The essential mental health benefits included diagnosis and treatment for drug and alcohol addictions. Qualified health insurance is an important weapon in the arsenal against drug abuse and the terrible toll it has wreaked upon US communities and families.
Costs of Prescription Coverage
Qualified Obamacare plans and private prescription insurance plans require deductibles, copays, and coinsurance to get benefits. Some plans set separate deductibles for prescription drug coverage. The Centers for Medicare and Medicaid set maximum limits on deductibles for Medicare prescription coverage.
In 2017, no plan can charge more than $400 in deductible expenses before releasing benefits to subscribers. Prescription plan costs typically include the below-listed items.
- Copays – These small per-service payments reduce insurer costs and help regulate subscriber demands.
- Coinsurance – These substantial percentage charges help pay for the drug; they represent an agreed percentage of consumer payment.
- Deductibles – These are payments that the consumer must make to trigger insurance benefits.
- Outside expenditures – Prescription plans typically do not cover drugs outside of the formulary or above restrictions on quantities. Subscriber have appeal rights to get preferred drugs or additional quantities.
No Cost Drugs
In some countries, health policies address the need for prescription drugs by reducing or eliminating the costs of pharmaceuticals. In neighboring Canada, Ontario Province legislated rules requiring free prescription drugs for older Canadians and for young residents.
PD Means Prescription Drugs and Prescription Benefits
In Medicare, Medicaid, and Obamacare, PD has important meanings and contributions to public health. In medical terms, prescription drugs are vital to regular medical care. Regarding access to medical care, prescription drug insurance relieves financial burdens caused by high prices for drugs in the US.
Generic drugs provide lower prices and savings in Obamacare plan formularies. Comparison shopping is an ideal way to rate private prescription drug insurance.
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[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]
- https://www.healthcare.gov/using-marketplace-coverage/prescription-medications/
- https://obamacarefacts.com/obamacare-individual-mandate/
- https://www.healthcare.gov/using-marketplace-coverage/common-questions/
- https://obamacarefacts.com/covered-benefits/
- https://obamacarefacts.com/2015/12/05/senate-passes-bill-to-repeal-obamacare-and-defund-planned-parenthood/
- https://obamacarefacts.com/obamacare-employer-mandate/
- https://www.medicare.gov/part-d/coverage/part-d-coverage.html
- https://www.medicaid.gov/medicaid/prescription-drugs/
- https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- https://www.medicare.gov/part-d/costs/deductible/drug-plan-deductibles.html
- https://obamacarefacts.com/2015/11/10/we-need-a-public-health-plan-like-canada-story/
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