negotiating with the physician practices and drug manufactuerers to establish prescription drug costs at a much lower rate. Prescirption costs are typically always covered in Germany. Individuals may have to pay a fixed out of pocket amount depending on the price of the prescription drug. However, children and teenagers under 18 do not have to pay those additional costs. (PubMed, 2015). The Medicaid program in the United States offers prescirption drug coverage with little to no copay to its individuals. Medicare is prohibited to negotiate with drug manufacturers to decrease the costs of prescription drug prices. Private health insurance companies have various copays on medications depending upon the tier in which the medication is covered under. For example, tier one mostly consists of generic brand medications with a copay of $10.00. Tier two and three increase in copay costs depending on the brand of medication. There are various non-formulary medications
that may not be covered under specific prescription plans and will cause the consumer to pay more for the medication. A2b. Referral to see a Specialist A refferral to see a specialist is not a requirement in Germany, however, the doctor will typically provide the patient with a written refferal for a sepcialist to exempt the patient from co-pay costs. The patient is responsible for the co-pay costs with the specialist if they fail to obtain a written refferal from the physician. In contrast to Germany, the United States requires a written order for refferal to any specialist from the primary care physician. When this guideline is not properly carried out, then the patients insurance plan can potentially not pay for the services provided to the patient.
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- Spring '16
- Universal health care