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This may involve prescribing activities, which include selecting and initiating medications for the treatment of a patient's diagnosed illnesses (as outlined in the CPA), discontinuing the use of prescription or over-the-counter medications, modifying a patient's drug therapy (e.g. changing the strength, frequency, route of drug administration ...
The Medicare Part D coverage gap (informally known as the Medicare donut hole) was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government.
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 as enacted in the US Statutes at Large; H.R. 1 on Congress.gov; Centers for Medicare & Medicaid Services (CMS) Medicare Modernization Act — includes PDF file of the actual text of the law. Medicare.gov — the official website for people with Medicare
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The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to "stretch scarce federal resources as far as possible ...
Over the following 35-years, third-party payment for prescription drugs became increasingly common. By the end of the century, less than one-third of drug spending was paid out-of-pocket. Despite the absence of a Medicare drug benefit, about 70% of Medicare enrollees obtained drug coverage through other means, often through an employer or Medicaid.
The history, design, and classification rules of the DRG system, as well as its application to patient discharge data and updating procedures, are presented in the CMS DRG Definitions Manual (Also known as the Medicare DRG Definitions Manual and the Grouper Manual). A new version generally appears every October. The 20.0 version appeared in 2002.
Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather being largely, or solely, being performed to increase the number of people due.