Medicare Catastrophic Prescription Drug Benefits Act of 1987

Summary

Medicare Catastrophic Prescription Drug Benefits Act of 1987 - Amends title XVIII (Medicare) of the Social Security Act to cover catastrophic expenses for outpatient prescription drugs and insulin (outpatient drugs) under part B (Supplementary Medical Insurance) of the Medicare program. Establishes an annual $400 deductible for outpatient drugs. Covers all costs in excess of such deductible provided the cost for each drug does not exceed payment limits based on the average cost for each drug. Authorizes the Secretary of Health and Human Services to deny payment for outpatient drugs which are prescribed or dispensed with excessive frequency or in excessive quantities. Authorizes a pharmacy to enter into an agreement with the Secretary to accept payment under part B of the Medicare program on an assigned basis for outpatient drugs furnished to part B enrollees. Sets forth the obligations of participating pharmacies, including the requirements that they: (1) charge Medicare beneficiaries no more for drugs than they charge the general public; (2) keep patient records for all outpatient drugs dispensed to such beneficiaries; (3) assist beneficiaries in determining whether or not their expenses have exceeded the annual deductible; and (4) offer to counsel each of their beneficiaries on the appropriate use of such drugs and the availability of therapeutically equivalent outpatient drugs. Requires the Secretary to provide each participating pharmacy with: (1) a distinctive emblem indicating its status as such; and (2) information on the payment limits established for outpatient drugs. Increases the monthly Medicare part B premium to cover Medicare payments for outpatient drugs. Requires Medicare carriers which make determinations or payments with respect to outpatient drugs to offer to receive requests from participating pharmacies for payments for such drugs through electronic communications and respond to requests by such pharmacies as to whether or not an individual has paid the deductible for such drugs. Directs the Secretary to: (1) take this Act's amendments into account in estimating the adjusted average per capita cost used in computing payments to be made to health maintenance organizations; and (2) require such organizations to adjust their agreements with Medicare beneficiaries in consideration of such amendments.

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1 official file

• Introduced in House

  summary · EN · 20 May 1987

  Open at official source

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