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International Common Wealth fund, The English Health Care System, 2019). A2A. Coverage of MedicationsIn Great Britain the NHS provides coverage for both inpatient and outpatient prescriptionmedications for all persons’ residing in the country and patients’ are charged a copay for each outpatient medication prescription, with medications prescribed at a NHS hospital being 100% free. Medication charges in the country are set nationally by the Department of Health in order tomanage the overall costs of medications (International Common Wealth fund, The English Health Care System, 2019).
ORGANIZATIONAL SYSTEMS TASK 37Some people in GB are exempt from paying any prescription medication copays; including all children age 15 or younger, children age 16-18 and in school fulltime; people age 60 or older, and people of low income (including the unemployed), and receive their medications100% free of charge. In 2015, 89.7% of all prescriptions dispensed in GB were provided free of charge (International Common Wealth Fund, The English Health Care System, 2019). In comparison to the GB prescription medication system, the coverage for prescription medications in the USA is quite complex and includes several options. In 2015, approximately 67.2% of US residents’ obtained their healthcare coverage from private voluntary heath insurance plans, with 55.7% obtained through employer based health insurance plans, and 14.6% obtained through direct coverage. Additional US residents’ were covered through a variety of public healthcare programs (International Common Wealth Fund, The US Healthcare System, 2019).In regards to prescription medication coverage in the USA, the ACA mandates that health insurance plans through the individual insurance exchanges, and through the small group insurance markets, cover 10 essential categories of health benefits, one of which includes prescription medication coverage. However, specific prescription medication healthcare coverageunder this mandate varies by state. Although prescription medications are now required to be covered by health insurance plans in the USA, these plans can and do vary greatly and include copays and deductibles of varying amounts as part of their cost sharing measures, some of whichcan be quite high in cost overall (International Common Wealth Fund, The US Healthcare System, 2019).Prescription medication coverage varies greatly under the many federally funded healthcare programs in the USA. Medicare, which is the countries healthcare program for people
ORGANIZATIONAL SYSTEMS TASK 38age 65 and older and for disabled people, for example, is divided into different “parts” for services provided. Medicare part B provides coverage for a limited number of outpatient prescription medications, and Medicare part C allows for the optional coverage of prescription drug benefits. Medicare part D, implemented in 2006, is the program’s specific prescription drug benefit and includes additional premiums, deductibles and copays for program participants, which are based on the individual’s qualifying benefit coverage category. Enrollment in the