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Healthcare Reform Law Expectations and Format

by Daniyal

Each and every country that aims for stability and growth in the health sector is governed by stringent reforms. The healthcare reform is a combination of various laws and legislations that have been enacted and joined to form the law. This is with due regard to the ever increasing need to enjoin new policies observed in the healthcare sector. The Medical Part D coverage gap falls in the center between the set out prior coverage limit, and the threshold set out to deal with catastrophes (Department of Health and Health Services, 2010). This is part of the Medicare Part D initiative, which was created and established by the US federal government. This translates to the responsibility being solely on the beneficiary of a Medicare plan in the event that he or she exits the previous prescription plan. The beneficiary would be required by law to shoulder and cater for expenses of the prescription that he, or she requires. This stipulated law only changes offering reprieve to the client when he or she reaches the point that requires the catastrophic threshold. This paper will analyze the healthcare reform law. This is with the sole purpose of trying to decipher how the law affects the Medicare Part D coverage gap. It will conclude on the overall meaning of the reception of the law, and its overall impact to the patients.   

The doughnut hole is a stressing period for many patients taking prescription medication. This is because of the impact felt when they have to shoulder the overall cost of the prescribed medicines. In many observable situations, many of the patients fall from their drug regiments at this point. The healthcare reform law of 2010 aimed to create existing avenues that aimed to address the coverage period. This is with due consideration to the gap being reduced and eventually eradicated. According to set projections, the federal government through the set law aims to ensure that the gap is sufficiently eradicated by the year 2020. This is the law that is appreciated and dealt with in line with its set stipulations (Keenan, 2007).  

Healthcare Reform Law Expectations and Format

Creating Discounts

Many patients consume generic and brand name drugs. As a result of this salient feature, the law recognizes this as an indication of the most commonly used brands. These brands deal with varied ailments and illnesses that have been prescribed to patients by many healthcare providers. As the gap range is experienced, many of the patients suffer because they cannot access their prescribed generic brands. The law, at this point, aims to cushion and reduce the overall effects of this change. This is through the offer and creation of discounts for the brand and generic drugs required by the patients. The gradual support will eventually translate to the phasing out of the 100 % commitment required by the patients experiencing the hole. The process was observed when it was rolled out in 2011. The agreement signed by the government and manufacturing companies presented a reprieve of 50 % to the patients. This reduction will be consistent with the set plans that will be eventually eradicated by 2020. This is one of the set out steps that aims to eradicate totally the demands experienced by the patient. This is especially when they are experiencing the coverage gap (Riley, Levy & Montgomery, 2009).

Reduced Out of Pocket Amounts

The law stipulates that the period between 2014 and 2019 will be observed by many changes in the amount of money required out of the patient’s pockets. This means that an enrollee will enjoy drastic cuts and reductions in the enrollee’s catastrophic coverage. There are many enrollees’ who have considerably high prescription drug expenses. As a result of this fact, the out of the pocket reduction will suit them significantly. Their overall expenses will be halved in this period making the drugs highly affordable. The process will be replicated in coming years ensuring that stability is attained by reducing out of the pocket cost for the patients. Economically, the reduction of out of the pocket costs for the 3 million Medicare Part D enrollees will boast the economic fortunes of the region. This is because the finances will be channeled into other sectors of the economy.

Prescription Drug Coverage

As a result of the reduction experienced in prescription drug coverage, the adherence and subscription to this cover is highly attractive. Many people who previously had issues with this coverage because of its high costs especially during the coverage period can enjoy the changes observed. This is in line with the benefits accrued when the overall costs will be drastically reduced shelving and eventually eradicating the gap (Riley, Levy & Montgomery, 2009). Many pharmaceutical companies are faced with the constant struggle to ensure that they are in line with the new law. This is with the overall aim of ensuring that they meet the demands of the law, attracting and retaining as many clients as possible.

Overall Changes in Perception

Agents contributed drastically in the overall cost of Part D plans. The Centres for Medicare and Medicaid services are constantly required to compensate agents. This created heightened churning for all the parties involved. The application of the new law dictates that agents deserve compensation based on the created laws. This means that agents and their overall practices will have to be in line with the law. The aspect of renewed compensation puts into practice imposed limits and renewed levels of compensation for all the parties involved. This means that the agents will have a renewed sense of about how Part D is viewed and understood. Generally, the agents will benefit exponentially from the legislation and its provisions. This is because the overall issue of doughnut hole will be off the table.  

Cash Refund for the Year 2010

Part D beneficiaries that are experiencing the coverage gap will have their overall financial burdens reduced. This is through the creation and provision of a $250 rebate for their prescription expenses. This is through the concentration of the related brand name prescriptions that are effected in the year 2010. This does not mean that the recipients are not liable for 100% of their prescription medication expenses at this period. The reverse is true, because as the law takes effect they are still responsible for their prescriptions. The rebate translates to the reimbursement of $250 towards their medications in line with the selected brand names. This rebate is applied in 2010, and after that it is totally discontinued.  

Protection from Pharmaceutical Companies

In many instances, the pharmaceutical companies have been observed to collect in a lot of capital from the people. This is through gross over charging of the prescription drugs that the patients need. The pharmaceutical companies record high profits from the amounts of money that they charge their clients. The closure of the gap will act as a reminder and an effective control gauge for the pharmaceutical companies. This means that the corporations will now have to stick to the strict requisites set in line with the offering and selling prescription medication (Shrank, Choudhry & Agnew, 2010). The discounts and reduced prices allocated to the clients will showcase and highlight the attained price reduction. This will offer some reprieve to clients who suffer from the high prices set.

Social Support and Improved Healthcare

The eradication of the gap will drastically revamp the healthcare sector. This is through the stringent application of factors that will ensure affordable healthcare for all. The reform law adopted will create sustainable and long term avenues to ensure that all that is required to stabilize the industry is attained. This means that the healthcare sector will have the ability to speak, act and conduct all its activities in one voice. This is the voice that encourages and expects all its members to adhere to the set laws at all times. 


In retrospect, the healthcare law has considerably improved patient treatment. This is through the provision of improved healthcare for all the concerned parties. The Medicare Part D coverage gap is a situation that had rendered many patients hopeless with the medical provisions. This is because the provisions required them to commit and shoulder their own expenses once they reached the gap period. Despite the fact that the law is relevantly new, it is clear that it is on the right path in relation to the set practices and structures. Many patients can now enjoy the reprieve that comes with the realization that they can attain decent healthcare as a direct result of the adoption of the law. This is one of the most popular reasons why Obama scored some credit in the healthcare sector. In many instances, patients have been recorded to suffer immensely during this gap (Keenan, 2007). Many of them had reduced or totally ignored their prescriptions as a result of the law. This drastically affected their coping mechanisms with varied diseases and disorders. The eventual closure or eradication of the gap is a clear sign that the healthcare sector is interested in protecting citizens. This is through the provision of enhanced economic aspects that would eventually enable the government to care and protect their citizens.

  • Department of Health and Human Services. (2010). Prescription drug cost relief to more than 750,000 Medicare beneficiaries. Retrieved from http://www.hhs.gov/news/
  • Keenan, T. A. (2007). Prescription drugs and Medicare Part D: A report on access, satisfaction, and cost. Washington, DC: Therapy Management Programs.
  • Riley, G. F., Levy, J. M., & Montgomery, M. A. (2009). Adverse selection in the Medicare prescription drug programs. Health Affairs 28(6), 1826–1837.
  • Shrank, W. H., Choudhry, N. K., & Agnew-Blais, J. (2010). State generic substitution laws can lower drug outlays under Medicaid. Health Affairs 29(7), 1383–1390.

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