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Friday, February 18, 2011

From Doughnuts to Workers Compensation Dollars

The failure to provide complete subsidies for prescription-drug coverage will indirectly continue to have an adverse financial impact on soaring workers' compensation costs. The Affordable Care Act (ACA) enacted in March 2010 has attempted but not completely removed the so-called "doughnut hole."


The aging workforce continues to increase as a result of both the economic downturn, as well a a dramatically increased retirement age. Furthermore, the increase in the denial rate of occupational conditions, some caused by latent disease, has increased to the number of beneficiaries on the Medicare system. Medicare continues to seek reimbursement through the Medicare Secondary Payer Act of conditional secondary payments to potential workers' compensation beneficiaries.


Those who elect Part D coverage, after the yearly deductible ($310) , are entitled to contribution from the Federal program for up to 25% of additional medical costs. Once they enter "the gap" in coverage ($2,840 to $4,550), the beneficiary is responsible for 100% of prescription costs. 


William H. Shrank, MD, M.S.H.S and Niteesh K. Choudhry, M.D., Ph.D., point out in their recent article in the New England Journal Of Medicine, that the present "doughnut hole system" results in seniors not taking prescribed medication because of the inability to pay dor drugs. The failure to deliver prescription care to seniors will ultimately result in an unhealthier workforce that the workers' compensation system will have the potential indirect responsibility to pay for. The cascading and progressive complications of underlying disease will have systemic negative health consequences for the aging workforce, and ultimately their employers, and their workers' compensation insurance coverage.
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