Medication cost sharing in low-income elders with chronic disease co-morbidities: Policy implication of PPACA provisions for dual eligibles and parallel systems at national health services

The implementation of the Patient Protection and Affordable Care Act (PPACA) is aimed at addressing patient safety, quality and insurance coverage for patients with co-morbidities in the United States. Chronic disease patients with both Medicare and Medicaid coverage, however, are further impacted, especially for prescription drug coverage. Additionally, the healthcare reform act entails specific provisions that only affect coverage benefits for low-income elders with chronic disease eligible for both Medicare and Medicaid insurance (dual eligibles). This paper will review the impacts on dual eligible beneficiaries prescription drug cost sharing, Part D plan optimisation and Medicare Advantage premiums. It will focus on the impacts of reducing the Part D doughnut hole and prescription drug cost sharing on patients having additional chronic disease co-morbidities, with reference to healthcare management theory of insurance. This paper will also analyse impacts that affect beneficiary quality of care and access. Dual eligible care for chronic disease patients will be summarised in the context of health insurance and management/economic theory. The PPACA provisions concerning dual eligibles Part D cost sharing align with the theory of demand for health insurance and health care. For dual eligibles with chronic disease, reduced medication cost sharing will increase medication adherence and reduce inpatient expenditures with reference to insurance theory.