Public Programs

Patient Access to Medications Through Public Programs

Government programs, such as Medicare, Medicaid, and the Department of Veterans Affairs, help Americans gain access to the medicines they need.

Affordable Care Act

The biopharmaceutical industry’s top priority is to provide patients with access to high quality medicines. For more on the Affordable Care Act, click here.

Medicare

Medicare is the government program that insures many of the nation’s retirees and disabled individuals. Outpatient prescription medicines are generally covered by Medicare Part D, which began providing prescription drug benefits in 2006. Part D is administered by private plans using a competitive bidding system which achieves savings and preserves incentives for continued innovation in biopharmaceutical research and development. Enjoying high satisfaction rates from beneficiaries (90% in 2012 ), Part D provides comprehensive, affordable access to medicines, and helps keep seniors healthier. Further, total Part D costs are on track to be $346 billion (or 45 percent) less than original projections, and average monthly premiums for 2013 are about $30 in 2013, less than half the original estimates. Learn more about this successful government program in our Medicare Part D section.  

Injected or infused vaccines and medicines that are administered or purchased by physicians are generally covered by Medicare Part B, which equates to the medical benefit provided by commercial insurance plans. Beyond certain medicines, Part B primarily provides coverage for physician and outpatient hospital services.

When a beneficiary receives prescription medicines during the course of a hospital or other inpatient stay, these medicines are covered by Medicare Part A.

Finally, some Medicare beneficiaries choose to enroll in Part C, or the program featuring private plans providing Medicare’s Part A and Part B services. Most Part C plans also provide the Part D prescription drug benefit.

Medicaid

Medicaid is a jointly run and financed by the States and the federal-government that provides access to healthcare for many low-income Americans, including children and their parents, pregnant women, and persons who qualify on the basis of disability. Millions more may qualify for Medicaid beginning in 2014, when states have additional tools to expand coverage. Medicaid is also the primary source of funding for long-term care services and provides additional benefits to the lowest income Medicare beneficiaries.

Each state administers its own Medicaid program within broad federal guidelines. While it is optional for states to offer prescription drug coverage through Medicaid, every state currently provides some form of coverage for medicines.  Learn more at Medicaid.gov

Veteran’s Affairs

The U.S. Department of Veterans Affairs (VA) serves a special population: veterans with service-related disabilities and, in some cases, their families. VA provides a variety of health services, including some prescription medicines, chiefly provided through federal facilities. Learn more at va.gov

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