Medicare

Medicare

Community pharmacies provide cost-saving medication and pharmacy services to millions of Medicare Part B and D patients. Congress and the Centers for Medicare and Medicaid Services (CMS) are making changes to the program all the time. This section lists important changes that community pharmacists should know about and chronicles the NCPA Advocacy Centers efforts to ensure pharmacist can continue serving their patients and getting reimbursed appropriately for their services.


MEDICARE PART D PROGRAM

Part D is the government subsidized prescription drug program for senior citizens. The general requirement for eligibility is to be 65 years of age or older. While the government subsidizes the program, the individual prescription drug plans are run by private insurers. Part D beneficiaries also pay premiums, deductibles and co-pays for the drugs that they receive, just like private insurance. Independent community pharmacists are primary providers of the drugs that millions of senior citizens receive through the Part D program.

Rules and Regulations

Regulatory Comments

Oversight Reports


MEDICARE PART B PROGRAM

Part B is government-based outpatient health care program for senior citizens over the age of 65. When a senior citizen turns 65 and begins to receive Medicare his or her benefits are generally divided into two categories, inpatient and outpatient services. Part B is the payment system for outpatient products and services. Providers, such as independent community pharmacists, receive direct payments from the government for certain outpatient products and services provided to Part B beneficiaries. Within the Part B program, independent community pharmacists primarily provide diabetes supplies, inhalation, immunosuppressive medications, and vaccines.

Rules and Regulations

Regulatory Comments

Oversight Reports


FRAUD, WASTE AND ABUSE

NCPA strongly supports government efforts to eliminate fraud, waste and abuse within the health care system. NCPA's members work hard to contribute to an efficient, cost-saving health care marketplace. However, independent community pharmacists remained concerned that some of the efforts by government and private payors to reduce fraud, waste and abuse are overly broad, abusive and actually create waste, rather than generating savings. NCPA would like government and private payors to partner more with independent community pharmacists to fight fraud, waste and abuse, while preserving patient access to much needed health care products and services.

Rules and Regulations

Regulatory Comments

Oversight Reports

Testimony

Misc.

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