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La inscripción abierta de Medicare finaliza el 7 de diciembre: Comparar opciones de cobertura podría ahorrarle dinero

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(Family Features) Si está inscrito en Medicare, es importante recordar que la Inscripción Abierta de Medicare es hasta el 7 de diciembre de cada año. Es el momento para que las personas con Medicare comparen sus opciones de cobertura médica y de medicamentos recetados para el próximo año.

Es importante comparar sus opciones porque los planes pueden cambiar cada año; incluso su elección actual puede estar cambiando. Sus necesidades de salud también pueden cambiar. Al comparar todas sus opciones, podría ahorrar dinero, encontrar una opción de cobertura que se adapte mejor a sus necesidades, o ambas cosas.

Cómo comparar opciones de cobertura médica y de medicamentos recetados
La fuente oficial de información sobre Medicare y la Inscripción Abierta es Es.Medicare.gov. Es posible que vea información de inscripción de varias compañías de seguros y otras fuentes. Comience en Es.Medicare.gov para obtener información imparcial y encontrar el tipo de cobertura que mejor se adapte a sus necesidades.

Comparar opciones de cobertura médica y de medicamentos recetados es fácil en Es.Medicare.gov. Puede ingresar la lista de medicamentos que está tomando y realizar una comparación en paralelo de la cobertura del plan, los costos y el nivel de calidad. Si está satisfecho con su elección actual, no tiene que hacer nada. Si elige una nueva opción para 2024, podrá inscribirse allí mismo.

Antes de inscribirse en un plan, considere lo siguiente:

  • Verifique si sus proveedores de atención médica están en la red de un plan.
  • Verifique si sus recetas médicas están incluidas en el formulario de un plan y si el plan trabaja con su farmacia.
  • Consulte el número de estrellas de su plan en Es.Medicare.gov para ver su desempeño en calidad, servicio al cliente y más.
  • Recuerde que es posible que las primas mensuales bajas no siempre sean el mejor valor general para sus necesidades específicas.
  • Revise los costos totales estimados de un plan para usted, incluya el deducible y otros costos de bolsillo.
  • Verifique si los planes Medicare Advantage ofrecen beneficios adicionales, como cobertura de visión, audición o dental, si necesita estos servicios.
  • Recuerde que es posible que necesite una autorización previa para algunos servicios de los planes Medicare Advantage.

Ahorro en costos de vacunas, insulina y medicamentos
Las mejoras al programa de Medicare ofrecen ahorros y un mejor acceso a tratamientos asequibles gracias a la Ley de Reducción de la Inflación.

  • Insulina: Si tiene Medicare y usa insulina, no pagará más de $35 por el suministro mensual de cada insulina cubierta. Esto incluye a las personas que tienen cobertura de medicamentos de Medicare Parte D y todas las insulinas cubiertas por la Parte B.
  • Vacunas: Las personas con cobertura de medicamentos de Medicare no pagarán nada de su bolsillo por las vacunas para adultos, incluida la vacuna contra el herpes zóster, recomendadas por el Comité Asesor sobre Prácticas de Inmunización de los Centros para el Control y la Prevención de Enfermedades.
  • Ahorros en costos de medicamentos: En 2024, las personas inscritas en la Parte D que tienen costos de medicamentos verán un alivio en estos gastos. Cuando lleguen a cierta cantidad de pagos directos de bolsillo (lo que llamamos la fase catastrófica), ya no tendrán costos compartidos ni copagos en las farmacias.  

Medicare puede ayudar
Para comparar opciones y encontrar la mejor cobertura que se ajuste a sus necesidades:

  • Visite Es.Medicare.gov y realice comparaciones de costos y cobertura en paralelo.
  • Llame al 1-800-MEDICARE. La ayuda está disponible las 24 horas del día, incluidos los fines de semana.
  • Acceda a asesoramiento personalizado sobre seguros médicos en su comunidad sin costo, disponible en su Programa Estatal de Asistencia sobre Seguros Médicos (State Health Insurance Assistance Program, SHIP por sus siglas en inglés). Visite shiphelp.org (enlace en inglés) o llame al 1-800-MEDICARE para conocer las ubicaciones cercanas a usted.

Opciones de Medicare
Hay dos formas principales de obtener cobertura de Medicare: Medicare Original y Medicare Advantage (planes aprobados por Medicare de empresas privadas). Existen diferencias entre los dos que es importante comprender al revisar sus opciones de cobertura.

  • Con Medicare Original usted obtiene atención médica a través de las Partes A y B de Medicare. Puede inscribirse en un plan de medicamentos separado para obtener la cobertura de medicamentos de Medicare (también llamada Parte D). Y puede visitar a cualquier médico que acepte Medicare en cualquier lugar de los EE. UU.
  • Medicare Advantage es una alternativa que generalmente combina su cobertura de salud y medicamentos en un solo plan. Algunos planes pueden ofrecer beneficios adicionales que Medicare Original no cubre, como ciertos servicios dentales, de visión y de audición. En muchos casos, solo puede utilizar médicos que estén en la red del plan.

Si es nuevo en Medicare o necesita revisar las formas en que puede obtener su cobertura de Medicare, visite Es.Medicare.gov y haga clic en “Comenzar con Medicare”.

Ayuda adicional con los costos de medicamentos recetados
Si tiene dificultades con los costos de los medicamentos recetados, Ayuda Adicional es un programa de Medicare que puede ayudarlo a pagar las primas, los deducibles, el coseguro y otros costos de su cobertura de medicamentos (Parte D). Si gana menos de $22,000 al año ($30,000 para parejas casadas), vale la pena presentar la solicitud. Visite  ssa.gov/es/medicare/part-d-extra-help o llame a la Administración del Seguro Social al 1-800-772-1213 para presentar la solicitud. El programa se ampliará para cubrir más costos de medicamentos para personas con recursos limitados en 2024. Las personas que califican para la Ayuda Adicional generalmente no pagarán más de $4.50 por cada medicamento genérico y $11.20 por cada medicamento de marca.

Información proporcionada por el Departamento de Salud y Servicios Humanos de los Estados Unidos

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SOURCE:
Centers for Medicare & Medicaid Services

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Clinical Trials Expand Patients’ Treatment Options

Clinical trials play a crucial role in developing effective treatments for chronic health conditions. They evaluate safety and efficacy, but low enrollment delays drug approvals, limiting patient options.

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Clinical Trials

(Family Features) For health conditions with no cure, effective treatments are the next best option. However, in order to make medical interventions including new drugs, devices, vaccines and lifestyle modifications available, they must undergo a thorough evaluation process to demonstrate their benefits.

Clinical trials are an important part of this process because they provide data for researchers on the effectiveness of various treatments and interventions. However, many myths about clinical trials deter people from enrolling. In fact, more than 70% of clinical trials are delayed at least one month due to unfulfilled enrollment, according to the “Journal of Medical Internet Research.”

Delays create barriers to the drug approval process and result in fewer available treatments for chronic conditions like Crohn’s disease and ulcerative colitis. The experts at the Crohn’s & Colitis Foundation offer these facts about the importance of clinical trials:

  1. More patients can benefit from clinical trials While hundreds of participants may take part in a trial, the results can lead to new care and treatment options for an entire patient community.
     
  2. Clinical trials lead to better and improved medications. For a new treatment to be approved, it needs to demonstrate a meaningful benefit to patients, such as improved outcomes, treating a wider range of symptoms, fewer side effects or more convenience for patients.
     
  3. They provide information. Clinical trials provide evidence of a treatment’s effectiveness and safety that can be used to guide patient care.
     
  4. Trials test safety and efficacy. Clinical trials are conducted in four phases. During the first phase, the main objective is to assess the safety of a new treatment. Experimental treatments only advance to the next stages if they pass certain safety and efficacy standards
    .
  5. They help prevent bias. In a randomized controlled trial, the effects of treatment with a new drug are compared with that of a control group – either a placebo (a treatment that looks identical to the new drug but contains no active medicine) or the current standard of care. Treatment assignments are “randomized,” which means neither the trial doctors nor the participants choose which treatment each participant will receive.

How Clinical Trials Work
Before a clinical trial begins, a research team develops a clinical trial protocol. This is the research plan that describes who can join the trial, which treatments the participants will receive, what questions the researchers will try to answer, how long the trial will last and how participant privacy and safety will be protected.

Conducting clinical research relies on volunteer trial participants. Those interested in joining a clinical trial meet with clinical research professionals to discuss the trial, treatments, eligibility requirements and expectations.

Joining a Trial
If you are interested in participating in a clinical trial, do some research. Your doctor may not be aware of or proactively tell you about trials you may be eligible to join. If you find a clinical trial you may be interested in joining, discuss the trial with your doctor and other health care professionals on your research team.

Foundations supporting chronic conditions can be a good source of information. For example, you can learn more about trials affecting individuals with inflammatory bowel disease by exploring the Clinical Trials Community at crohnscolitisfoundation.org.

Photo courtesy of Shutterstock

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SOURCE:
Crohn’s & Colitis Foundation


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Why community pharmacies are closing – and what to do if your neighborhood location shutters

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Lucas A. Berenbrok, University of Pittsburgh; Michael Murphy, The Ohio State University, and Sophia Herbert, University of Pittsburgh

Neighborhood pharmacies are rapidly shuttering.

Not long ago, Walgreens, one of the nation’s biggest pharmacy chains, announced plans to close 1,200 stores over the next three years. That’s part of a larger trend that has seen nearly 7,000 pharmacy locations close since 2019, with more expected in the coming years.

Many community pharmacies are struggling to stay open due to an overburdened workforce, shrinking reimbursement rates for prescription drugs and limited opportunities to bill insurers for services beyond dispensing medications.

As trained pharmacists who advocate for and take care of patients in community settings, we’ve witnessed this decline firsthand. The loss of local pharmacies threatens individual and community access to medications, pharmacist expertise and essential public health resources.

The changing role of pharmacies

Community pharmacies – which include independently owned, corporate-chain and other retail pharmacies in neighborhood settings – have changed a lot over the past decades. What once were simple medication pickup points have evolved into hubs for health and wellness. Beyond dispensing prescriptions, pharmacists today provide vaccinations, testing and treatment for infectious diseases, access to hormonal birth control and other clinical services they’re empowered to provide by federal and state laws.

Given their importance, then, why have so many community pharmacies been closing?

There are many reasons, but the most important is reduced reimbursement for prescription drugs. Most community pharmacies operate under a business model centered on dispensing medications that relies on insurer reimbursements and cash payments from patients. Minor revenue comes from front-end sales of over-the-counter products and other items.

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However, pharmacy benefit managers – companies that manage prescription drug benefits for insurers and employers – have aggressively cut reimbursement rates in an effort to lower drug costs in recent years. As a result, pharmacists often have to dispense prescription drugs at very low margins or even at a loss. In some cases, pharmacists are forced to transfer prescriptions to other pharmacies willing to absorb the financial hit. Other times, pharmacists choose not to stock these drugs at all.

And it’s not just mom-and-pop operations feeling the pinch. Over the past four years, the three largest pharmacy chains have announced plans to close hundreds of stores nationwide. CVS kicked off the trend in 2021 by announcing plans to close 900 pharmacy locations. In late 2023, Rite Aid said that thousands of its stores would be at risk for closure due to bankruptcy. And late in 2024, Walgreens announced its plans to close 1,200 stores over the next three years.

To make matters worse, pharmacists, like many other health care providers, have been facing burnout due to high stress and the lasting effects of the COVID-19 pandemic. At the same time, pharmacy school enrollment has declined, worsening the workforce shortage just as an impending shortfall of primary care physicians looms.

Why pharmacy accessibility matters

The increasing closure of community pharmacies has far-reaching consequences for millions of Americans. That’s because neighborhood pharmacies are one of the most accessible health care locations in the country, with an estimated 90% of Americans living within 5 miles of one.

However, research shows that “pharmacy deserts” are more common in marginalized communities, where people need accessible health care the most. For example, people who live in pharmacy deserts are also more likely to have a disability that makes it hard or impossible to walk. Many of these areas are also classified as medically underserved areas or health professional shortage areas. As pharmacy closures accelerate, America’s health disparities could get even worse.

So if your neighborhood pharmacy closes, what should you do?

While convenience and location matter, you might want to consider other factors that can help you meet your health care needs. For example, some pharmacies have staff who speak your native language, independent pharmacy business owners may be active in your community, and many locations offer over-the-counter products like hormonal contraception, the overdose-reversal drug naloxone and hearing aids.

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You may also consider locations – especially corporate-owned pharmacies – that also offer urgent care or primary care services. In addition, most pharmacies offer vaccinations, and some offer test-and-treat services for infectious diseases, diabetes education and help with quitting smoking.

What to ask if your pharmacy closes

If your preferred pharmacy closes and you need to find another one, keep the following questions in mind:

What will happen to your old prescriptions? When a pharmacy closes, another pharmacy may buy its prescriptions. Ask your pharmacist if your prescriptions will be automatically transferred to a nearby pharmacy, and when this will occur.

What’s the staffing situation like at other pharmacies? This is an important factor in choosing a new pharmacy. What are the wait times? Can the team accommodate special situations like emergency refills or early refills before vacations? Does the pharmacist have a relationship with your primary care physician and your other prescribers?

Which pharmacies accept your insurance? A simple call to your insurer can help you understand where your prescriptions are covered at the lowest cost. And if you take a medication that’s not covered by insurance, or if you’re uninsured, you should ask if the pharmacy can help you by offering member pricing or manufacturer coupons and discounts.

What are your accessibility needs? Pharmacies often offer services to make your care more accessible and convenient. These may include medication packaging services, drive-thru windows and home delivery. And if you’re considering switching to a mail-order pharmacy, you should ask if it has a pharmacist to answer questions by phone or during telehealth visits.

Remember that it’s best to have all your prescriptions filled at the same pharmacy chain or location so that your pharmacist can perform a safety check with your complete medication list. Drug interactions can be dangerous.

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Community pharmacies have been staples of neighborhoods for more than a century. Unfortunately, current trends in pharmacy closures pose real threats to public health. We hope lawmakers address the underlying systemic issues so more Americans don’t lose access to their medications, health services and pharmacists.

Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of Pittsburgh; Michael Murphy, Assistant Professor of Pharmacy Practice and Science, The Ohio State University, and Sophia Herbert, Assistant Professor of Pharmacy, University of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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A How-To Guide for Participating in Clinical Trials

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(Family Features) Clinical trials help researchers studying chronic conditions answer important questions about the diseases and their treatment options. However, uncertainty about what to expect and a lack of knowledge about how to get started can prevent patients from joining a clinical trial.

Choosing to take part in a clinical trial means helping a study team figure out if a new method of diagnosis, treatment or prevention is effective. If you live with a chronic condition, such as Crohn’s disease or ulcerative colitis, and want to help find answers for others who share your experience, a clinical trial is an option to consider.

Once you identify a study that interests you, you’ll want to talk with the professionals involved in your ongoing treatment, a clinical research coordinator and your family to gather information necessary to determine whether the clinical trial is a good fit.

To find additional information about clinical trials and begin exploring trials in your area, visit crohnscolitisfoundation.org, and consider these steps for participating in a trial.

Clinical Trials

1. Talking with Your Doctor
Your gastroenterologist and other care providers can help determine whether a clinical trial is right for you and may be able to help point you toward recommended trials. It’s important to ask if or how your doctor will continue to be involved in your care if you participate in a trial.

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2. Finding a Study
If you need help beyond your care team in identifying clinical trial opportunities in your area, organizations dedicated to your condition can be a good resource. For example, the Crohn’s & Colitis Foundation offers an online Clinical Trial Finder for individuals with inflammatory bowel disease.

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3. Talking with the Research Coordinator
A clinical trial research coordinator can provide details specific to your circumstances and needs. You can discuss potential benefits and risks, why the trial is being conducted and who is involved in the health care team. You can talk about past treatments and how this study may differ from your previous experiences. Other questions you might ask include what your options are if the trial doesn’t work, any costs you might expect and what your personal commitment will be.

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4. Evaluating the Fit for You
Once you have the necessary information, you’ll be able to consider whether you’re ready to move forward with registering for the trial. You’ll want to weigh factors like your time commitment, travel distance and whether the trial will affect your personal or professional obligations.

Photos courtesy of Shutterstock

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SOURCE:
Crohn’s & Colitis Foundation


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