title: Impact of Medicare changes in pharmacy reimbursement on patient care: two case reports.
abstract: OBJECTIVE
  Two case reports illustrate the impact of changes in pharmacy reimbursement associated with the Medicare Prescription Drug Improvement and Modernization Act (MMA) on patient care.
  
  
  CONCLUSIONS
  The Medicare Part D benefit is complex and difficult for patients to understand. A patient's personal financial situation and quality of life issues may enter into decisions about enrolling in Part D and the use of drug therapy. Local coverage decisions by the Centers for Medicare and Medicaid Services can limit access to drug therapy and raise ethical dilemmas.
  
  
  CONCLUSIONS
  Changes in pharmacy reimbursement associated with MMA has the potential to markedly impact patient care and outcomes.
authors.affiliation: The Ohio State University Hospitals, Columbus, Ohio 43210, USA. jerry.siegel@osumc.edu
authors.forename: Jerry
authors.initials: J
authors.lastname: Siegel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000191:economics; D003408:Cresols / Q000191:economics; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics; D007342:Insurance Benefits / Q000191:economics / Q000379:methods / Q000639:trends*; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000639:trends*; D006278:Medicare; D005791:Patient Care / Q000191:economics / Q000379:methods / Q000639:trends*; D010665:Phenylpropanolamine / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends*; D000068737:Tolterodine Tartrate
chemical_list: D001559:Benzhydryl Compounds; D003408:Cresols; D016756:Immunoglobulins, Intravenous; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate