Vulnerable populations such as the elderly, people with disabilities, and racial minorities have unique health care needs that include complex chronic conditions, multiple chronic comorbidities, dependency, and lack of access to healthcare (Vanderbilt et al., 2013). Complex chronic conditions affecting people in these groups of the population require constant medications to enhance their wellbeing and longevity.
However, vulnerable populations often struggle to pay for the medications and some are forced to cut back on prescribed medications to save money, resulting in increased risk for disease entrenchment and suboptimal treatment outcomes (Freedman & Spillman, 2014). The proposed bill seeks to structure Medicare in such a way that it can utilize its buying power to negotiate with pharmaceutical firms for lower prices and hence ensure continuous drug coverage for vulnerable populations.
Although the health care law adds benefits to assist in making the Medicare prescription drug coverage more affordable upon reaching the Medicare Part D coverage gap, vulnerable populations have often fallen into what is commonly referred to as the “doughnut hole” due to failure to pay all the costs of their medicine as required by the law (Danzon, 2004).
Moreover, Gusmano and Allin (2011) proved that the current health care delivery systems in England and the US need improvement. Even though they tend to make healthcare services of good quality available to the diverse population, older persons and minorities have poor access to primary care in the US. The fact that access inequalities exist is underlined. It is claimed that even though the county tries to make forget about the racial differences, they are not ignored and affect the delivery of services negatively.
Under the current law, the coverage is 75% of the initial drug cost, which seems to be rather beneficial, but when the sum reaches $2,830, individuals become responsible for all costs. Here the coverage gap occurs, as the next coverage will be received only when the sum is almost $6,500 (Traynor, 2010). Thus, the necessity of the “donut hole” solution is undeniable.
Unfortunately, today one-third of the beneficiaries fall into the “donut hole”, which proves that the issue is to be solved as soon as possible. With the help of Part D, many people who suffer from chronic diseases and need constant treatment will pay very modest sums (Howard-Ruben, 2006). Part D coverage benefits the vulnerable population, as it will increase every year so that eventually people will always pay 25% of the cost, everything else will be paid by insurance and other private companies (Information pharmacists can use, 2013).
Those who are already on Medicare have an opportunity to change the program for Part B if they want, and others join it directly. The advantage of this coverage is that it has several drug plans that cover all services, and people can choose the one that will be the best for them depending on the drugs they need and their location. Moreover, some of them have mail order services so there is no necessity to go to the pharmacy.
Many old people and representatives of minorities have limited income and resources so they can receive Extra Help. This program provides premiums and coinsurance and can be got automatically or applied. People can also get assistance with drug coverage decisions if they visit the office, send an email, or just call (Your guide to Medicare n.d.).
Thus, it can be seen that the vulnerable population needs support and assistance even including the representatives who are applying for Medicare and Medicaid. With the help of Medicare Part D, they all will gain an opportunity to avoid or at least get out of the coverage gap. This program will use the money provided by insurance and private companies so that the individuals will pay only a quarter of the drug costs while those with limited income will also gain Extra Help.
References
Danzon, P.M. (2004). Closing the doughnut hole: No easy answers. Health Affairs, 23(2), 405-408.
Freedman, V.A., & Spillman, B.C. (2014). Disability and care needs among older Americans. Milbank Quarterly, 92(3), 509-541.
Gusmano, M., & Allin, S. (2011). Health care for older persons in England and the United States: A contrast of systems and values. Journal of Health Politics, Policies & Law, 36(1), 89-118.
Howard-Ruben, J. (2006). Unexpected “doughnut hole” raises concerns that patients will fail to fill needed prescriptions. ONS News, 21(2), 10-11.
Information pharmacists can use on closing the coverage gap. (2013). Web.
Traynor, K. (2010). Health reform law offers relief in Medicare part D coverage gap. American Journal of Health-System Pharmacy, 67(13), 1049-1049.
Vanderbilt, A.A., Isringhausen, K.T., Vanderwielen, L.M., Wright, M.S., Slascheva, L.B., & Modden, M.A. (2013). Health disparities among highly vulnerable populations in the United States: A call to action for medical and oral health care. Medical Education Online, 18(1), 1-3.
Your guide to Medicare prescription drug coverage. (n.d.). Web.