Biomedical subjects

Daniel A Lace

Publications and source records attributed to Daniel A Lace.

2 recordsLinked to original sources

PubMed2006

Medicare Part D: exceptions and appeals process.

Once enrolled in a Medicare Part D prescription plan, the focus changes to access to medically necessary medications through the prescription plan. In many situations, this will involve the exceptions and appeals process. Each Medicare plan has its own drug formulary and differentiates itself through various parameters within those formularies. The federal government has rules in place for what may or may not be covered in a formulary, and has specified parameters for an exceptions and appeals process. It is the responsibility of the patient, along with his or her physician, to learn about and take advantage of mechanisms built into the system to ensure access to medically necessary medications. As physician reimbursement moves to an outcome-based through pay-for-performance system, physicians will have a financial incentive for assuring that their patients receive the necessary medications.

Gatekeeping↗

PubMed2006

The competitive acquisition program for drugs and biologicals.

Unlike the Medicare Part D program, which has a significant number of participating plans, the new Competitive Acquisition Program (CAP), which was to have started on Jan. 1, 2006, along with Medicare Part D, did not because, in part, of a lack of interest. As a result, the program was delayed until July 1, 2006. This new program separates the physician from the purchase and billing of medications provided in the physician's office. Under CAP, physicians sign with a specialty pharmacy provider that will deliver the medications to the physicians as ordered and then bill Medicare directly. This will alleviate some physician administrative responsibilities. Although it is unlikely that high-volume Medicare Part B medication providers, such as oncologists, will use a CAP provider, it is likely that busy primary care physicians and other specialists not usually involved in providing medications in their offices now may start to take advantage of this valuable service.

Medicare↗