All beneficiaries are eligible for the new Medicare benefit, but it is voluntary. Beneficiaries choosing coverage through Medicare are encouraged to enroll when first eligible to keep premiums affordable. The benefit is integrated into the Medicare program to ensure it s availability to all beneficiaries, and because it makes the most clinical sense.
Access is guaranteed in every region of the country.
The MOD Act is the only bill introduced to date to provide fully-defined complete coverage of all medically necessary prescription drugs. After a deductible is met, there are no limits or caps on the benefit, and no gaps in coverage. Inclusion of a deductible encourages appropriate utilization, and holds down program costs and beneficiary premiums. Coinsurance is graduated, or ramped-up to provide the most assistance to the beneficiaries with the most need. Used currently in the private sector, PBMs negotiate drug prices with manufacturers, process pharmacy claims, ensure appropriate drug use, administer disease prevention and management programs, and track health and economic outcomes.