Medicare part d where do we stand where are we going
Advertisement
This presentation is the property of its rightful owner.
1 / 34

MEDICARE PART D Where Do We Stand? Where Are We Going? PowerPoint PPT Presentation

MEDICARE PART D Where Do We Stand? Where Are We Going?. Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation Medicare Policy Project - www.kff.org/medicare Families USA Health Action 2007 Washington, D.C. 25 January 2007. Exhibit 1. Overview.

Related searches for MEDICARE PART D Where Do We Stand? Where Are We Going?

Download Presentation

MEDICARE PART D Where Do We Stand? Where Are We Going?

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Medicare part d where do we stand where are we going

MEDICARE PART D Where Do We Stand?Where Are We Going?

Juliette Cubanski, Ph.D.

The Henry J. Kaiser Family Foundation

Medicare Policy Project - www.kff.org/medicare

Families USA

Health Action 2007

Washington, D.C.

25 January 2007


Overview

Exhibit 1

Overview

  • Part D Plan Landscape and Enrollment

    • Private plan availability is higher in 2007 than 2006, and there continues to be wide variation in coverage and benefit design

    • The majority of beneficiaries now have drug coverage, but around 10% (~4 million) are not enrolled

  • Views and Experiences of Beneficiaries and Providers

    • Most enrollees say they are satisfied with their Part D plans so far, but many are still vulnerable to high out-of-pocket costs

    • Pharmacists and physicians have played a key role in helping beneficiaries navigate their Part D plans

  • Unanswered Questions and Issues to Monitor


Part d the medicare drug benefit

Exhibit 2

Part D - The Medicare Drug Benefit

  • Drug benefit is offered exclusively through private organizations, not traditional Medicare

    • 2 types:

      • Stand-alone prescription drug plans (PDPs) that supplement traditional fee-for-service Medicare

      • Medicare-Advantage prescription drug (MA-PD) plans – integrated medical and drug benefits – primarily HMOs, PPOs

    • Plans can change from year to year – add, drop, modify

  • New approach to delivering a Medicare benefit

    • Take-up is voluntary, not automatic

    • Standard benefit available, but plans can vary

    • Coverage and cost depends on plan chosen

  • Additional subsidies (“extra help”) available to people with low incomes, but subject to income and asset test

    • “Dual eligibles” no longer have drug coverage through Medicaid


Changes in plan options from 2006 to 2007

Exhibit 3

Changes in Plan Options from 2006 to 2007

  • Plan participation

    • Mostly the same organizations but far more plan options

      • PDPs: 1,429 in 2006 to 1,875 in 2007

      • MA plans: 3,195 in 2006 to 3,971 in 2007

  • Monthly premiums

    • Lowest increasing from $1.87 to $9.50

    • Highest increasing from $104.89 to $135.70

  • Benefit design and formularies

    • Minor changes in many plan offerings, along with major changes in some others

    • According to CMS, at least a 13% increase in number of drugs covered


Medicare part d where do we stand

Exhibit 4

45-50 drug plans (2 states)

51-55 drug plans (26 states)

56-60 drug plans (18 states)

61-66 drug plans (5 states)

Beneficiaries in Most States Had a Choice of At Least 50 PDPs in 2007

1,875 Stand-alone PDPs Offered Nationwide

53

51

57

53

53

53

53

51

57

61

54

53

57

56

54

66

53

53

53

56

61

54

56

54

66

53

56

54

55

55

DC

53

53

51

57

45

57

59

58

53

57

53

57

56

53

60

58

46


Medicare part d where do we stand

Exhibit 5

Most Beneficiaries Had Access to One or More Medicare Advantage Plans in 2007

3,971 MA Plans Offered Nationwide

Polk County: 20 MA-PD Plans (+ 53 PDPs and 2 SNPs)

San Diego County: 24 MA-PD Plans (+ 55 PDPs and 2 SNPs)

Miami/Dade County: 43 MA-PD Plans (+ 57 PDPs and 19 SNPs)


Standard medicare prescription drug benefit 2007

Exhibit 6

Standard Medicare Prescription Drug Benefit, 2007

Beneficiary Out-of-Pocket Spending

Plan Pays 15%; Medicare Pays 80%

Enrollee Pays 5%

$5,451 in Total Drug Costs($3,850 out of pocket)

$3,051 Coverage Gap (“Doughnut Hole”)

Enrollee Pays 100%

$2,400 in Total Drug Costs

Enrollee Pays 25%

Plan Pays 75%

$265 Deductible

$328 Average Annual Premium

NOTE: Annual premium amount based on $27.35 national average monthly beneficiary premium (CMS, August 2006). Amounts for premium, coverage gap, and catastrophic coverage threshold rounded to nearest dollar.

SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit, updated with Part D benefit parameters for 2007 (from CMS, OACT, May 22, 2006).


Medicare part d where do we stand

Exhibit 7

The “Standard” Drug Benefit Design is Not the Typical Part D Plan Offering in 2007

Percent of plans:

Generic Only

No Coverage

Brand and Generic

Standard

Enhanced

$250

Partial(<$250)

$0

Actuarially Equivalent

Coverage in the Gap

Benefit Design

Deductible Amount

SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007

Offerings; November 2006.


Part d and the doughnut hole

Exhibit 8

Part D and the “Doughnut Hole”

  • Of 22.5 million Part D enrollees in 2006:

    • 9 millionreceived low-income subsidy and face no gap in coverage

    • Less than 1 millionenrolled in plans with full gap coverage

    • An estimated 11 million Part D enrollees had no coveragein the doughnut hole in 2006

      • Of that total, 4 million Part D enrollees were estimated to have spending in the doughnut hole

      • 2 million were estimated to reach catastrophic coverage level

  • Between 2006 and 2007, the number of PDPs that cover brand-name drugs in the doughnut hole decreased slightly

    • From 33 PDPs in 2006 to 27 PDPs in 2007

  • In 11 states there are no plans available with full coverage of brands and generics in the gap


Average monthly premiums are highest for pdps offering full gap coverage

Exhibit 9

$100

$93.46

$90

$80

$70

$60

$51.11

$50

$40

$30.17

$30

$20

$10

$0

No Coverage

Generics

Only

Generics and

Brands

Average Monthly Premiums Are Highest for PDPs Offering Full Gap Coverage

Number of PDPs in 2007:

1,337

511

27

SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings; November 2006.


Hhs estimates 90 of medicare beneficiaries have drug coverage

Exhibit 10

HHS Estimates 90% of Medicare Beneficiaries Have Drug Coverage

No Creditable Coverage

Stand-Alone PDP

Other Creditable Coverage1

Total in Part D Plans: 22.5 Million

(53%)

Dual Eligibles in PDPs

Creditable Employer/Union Coverage2

Medicare Advantage Drug Plan3

Total Number of Beneficiaries = 43 Million

NOTES: Numbers do not sum to 100% due to rounding. 1 Includes coverage from Veterans Administration, Indian Health Service, employer plans without retiree subsidies, and employer plans for active workers. 2 Includes employer/union, FEHB, and TRICARE coverage. 3 Approximately 0.5 million dual eligibles are enrolled in Medicare Advantage drug plans and are reported in this category. SOURCE: HHS, June 14, 2006. Data as of June 11, 2006.


Medicare part d where do we stand

Exhibit 11

Enrollment in Medicare Drug Plans Is Concentrated in a Few Organizations

Top 10 Parent Organizations:

5.7

million

UnitedHealth

Humana

4.4

million

Wellpoint

1.2 million

WellCare Health Plans

1.0 million

3 organizations have 50% of total Part D enrollmentof 22.5 million

Member Health

1.0 million

Kaiser Permanente

0.8 million

Coventry Health Care

0.7 million

Universal American Financial Corporation

0.5 million

All other parent organizations (n=216) have fewer than 400,000 PDP and/or MA-PD enrollees

0.4 million

Health Net

Medco Health Solutions

0.4 million

SOURCE: CMS Medicare Drug Coverage Enrollment Data, July 26, 2006.


Variation in costs for 2007 among the 10 pdps with the highest enrollment

Exhibit 12

Variation in Costs for 2007 Among the 10 PDPs with the Highest Enrollment

Note: *Marketed as Pacificare Saver in 2006. Monthly premium amount is weighted average across all regions where plan is offered.SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings; November 2006.


Variation in 2007 cost sharing in top 10 pdps for top 10 brand name drugs

Exhibit 13

Variation in 2007 Cost Sharing in Top 10 PDPs for Top 10 Brand-Name Drugs

Note: *indicates drugs covered by all 10 PDPs with highest 2006 enrollment.

SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007

Offerings; November 2006.


Choice matters even for healthy seniors

Exhibit 14

Choice Matters – Even for Healthy Seniors

ESTHER

CAROLYN

Carolyn, age 60, on

SSDI and is about to go

on Medicare. She has

rheumatoid arthritis and

other chronic conditions

and takes 8 medications.

Esther is 67 and

lives in Bethesda.

She takes only one

drug, Fosamax,

for osteoporosis.

  • The difference between her most and least expensive plan option is roughly $700 for either PDP or MA-PD

  • The difference between her most and least expensive plan option is at least $3,000 – greater for PDPs

Esther would pay between $577 and $1,309 per year in a PDP, and between $300 and $970 in an MA-PD plan, including premiums, depending on the plan she chooses.

Carolyn would pay between $4,423 and $11,522 per year in a PDP, and between $4,608 and $7,973 in an MA-PD plan, including premiums, depending on the plan she chooses.


Medicare part d where do we stand

Exhibit 15

Only a third of surveyed seniors say there are important differences among Part D Plans

ASKED OF SENIORS ONLY: Would you say there are important differences among the Medicare drug plans now available, or do you think they are all basically the same?

Important differences

They are basically the same

Don’t know/ Refused

SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Part d plan enrollment decisions in 2006

Exhibit 16

Part D Plan Enrollment Decisions in 2006

  • Contrary to conventional wisdom, beneficiaries did not report conducting extensive research before choosing a Medicare drug plan

  • Many relied on “trusted sources” including pharmacists, family members, and friends

  • Most beneficiaries did not use resources provided by Medicare to help choose a plan

    • Only 10% of beneficiaries said they or a family member used Medicare.gov

  • Name recognition and prior experience with the company were key factors for many in selecting a Part D plan, possibly “trumping” other considerations


Medicare part d where do we stand

Exhibit 17

Trends in Seniors’ Impressions of Drug Benefit

AMONG SENIORS:

Given what you know about it, in general, do you have a favorable or unfavorable impression of the new Medicare drug benefit?

*Question prior to Apr-05 referred to “new Medicare prescription drug law”.

Note: The increase in the percent saying “favorable” is statistically significant between Jun-06 and Nov-06.

SOURCE: Kaiser Family Foundation surveys.


Medicare part d where do we stand

Exhibit 18

Many Part D Plan Enrollees Say They Are Satisfied and Saving Money

AMONG SENIORS WHO SAY THEY ARE ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN:

Compared to what you paid for prescriptions last year, are you now saving money, paying more or paying about the same overall?

All in all, have your experiences using your new Medicare drug plan been:

Somewhat positive

Very positive

Saving money

Paying more

Somewhat negative

Paying about the same

Don’t know

Very negative

Don’t know/ refused

SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Medicare part d where do we stand

Exhibit 19

Yet Many Seniors Report Problems Related to Getting Prescriptions Under Their Part D Plan

AMONG SENIORS WHO SAY THEY ARE ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN:

Yes, had a MAJOR problem

Yes, had a MINOR problem

Have you had administrative problems, such as problems getting enrollment cards, problems with premium payments, or billing mistakes associated with your Medicare plan, or not?

12%

Have you had any problems getting your Rx drugs, such as drugs not being covered by your plan or being unable to afford the cost of drugs under your plan, or not?

12%

Have had either type of problem

23%

SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Medicare part d where do we stand

Exhibit 20

Minor Problems Reported

Major Problems Reported

Problems Filling Prescriptions by Number of Prescriptions and by Income

AMONG SENIORS WHO HAVE USED THEIR MEDICARE DRUG PLAN:

Percent who report having problems related to getting prescriptions by the number of prescriptions taken daily…

Percent who report having problems related to getting prescriptions by 2005 income…

41%

46%

33%

34%

27%

≤ 3 Rx

daily

4 or 5

Rx daily

≥ 6 Rx

daily

Income ≤ 20K

Income > 20K

SOURCE: Kaiser Family Foundation Health Poll Report Survey (conducted June 8-18, 2006)


Medicare part d where do we stand

Exhibit 21

Most Pharmacists Say Benefit Works Well for Their Customers

How well would you say the new Medicare drug benefit works for your customers in each of the following areas…

Very well

Somewhat well

Not too well

Not well at all

Lowering their out-of-pocket costs

3%

Getting them access to the prescription drugs they need

4%

SOURCE: Kaiser Family Foundation National Survey of Pharmacists (conducted April 21-June 27, 2006)


Medicare part d where do we stand

Exhibit 22

Yet nearly one in five pharmacists say most of their Medicare customers have had problems with their drug plan

To the best of your knowledge, have any of your Medicare customers experienced problems getting their prescriptions filled since joining a new Medicare drug plan?

IF YES: Would you say most, some or just a few of your customers who joined Medicare drug plans have had problems filling prescriptions?

Most

Some

None

Just a few

SOURCE: Kaiser Family Foundation National Survey of Pharmacists (conducted April 21-June 27, 2006)


Medicare part d where do we stand

Exhibit 23

Specific Problems Reported by Pharmacists

Percent of pharmacists who say any of their customers have experienced the following specific problems filling prescriptions since joining a Medicare drug plan…

Left the pharmacy without their prescription because the drug wasn’t on their plan’s formulary

Had problems getting enrollment cards or letters of enrollment after signing up for a plan

Had to pay out-of-pocket for their prescription because pharmacist couldn’t verify their enrollment

Left the pharmacy without their prescription because they couldn’t afford the copayment

SOURCE: Kaiser Family Foundation National Survey of Pharmacists (conducted April 21-June 27, 2006)


Medicare part d where do we stand

Exhibit 24

About half of surveyed doctors say the Medicare drug benefit works well for their patients

Among the 78% of doctors who say at least a few of their patients are enrolled in Medicare drug plans: How well would you say the new Medicare drug benefit works for your patients in each of the following areas…

Very well

Somewhat well

Not too well

Not well at all

Don’t know/ Refused

Lowering their out-of-pocket costs

Getting them access to the prescription drugs they need

SOURCE: Kaiser Family Foundation National Survey of Physicians (conducted April 25-July 8, 2006)


Medicare part d where do we stand

Exhibit 25

Yet most doctors say at least some of their Medicare patients experienced problems in their drug plan

Among the 78% of doctors who say at least a few of their patients are enrolled in Medicare drug plans…

To the best of your knowledge, have any of your Medicare patients experienced problems getting their prescriptions filled since joining a new Medicare drug plan, or not?

Would you say that most, some, or just a few of your patients who joined Medicare drug plans have had problems filling prescriptions?

Most

No

Yes

Some

Don’t know/ Refused

Just a few

SOURCE: Kaiser Family Foundation National Survey of Physicians (conducted April 25-July 8, 2006)


Medicare part d where do we stand

Exhibit 26

Seniors, Pharmacists, and Doctors Agree: Medicare Drug Benefit is Too Complicated

Percent who agree or disagree that the Medicare prescription drug benefit is too complicated

Agree

Disagree

Don’t know/Refused

Ages 65 and over

Pharmacists

Doctors

SOURCES: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006); Kaiser Family Foundation National Survey of Pharmacists (conducted April 21-June 27, 2006); Kaiser Family Foundation National Survey of Physicians (conducted April 25-July 8, 2006)


Medicare part d where do we stand

Exhibit 27

Support for Limiting Plan Choice

ASKED OF SENIORS ONLY:

Which statement better reflects your opinion?

Statement B: Medicare should select a handful of plans that meet certain standards, so seniors have an easier time choosing

Statement A: Medicare should offer seniors dozens of plans so they can select their own

Don’t know/ Refused

SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Medicare part d where do we stand

Exhibit 28

Message to Congress About Medicare Part D

AMONG SENIORS:

Overall, what message would you send to policymakers in Washington regarding the new Medicare drug benefit?

Is not working well and should be repealed

Is working well and no real changes are needed

Is not working well and needs major changes

Could be improved with some minor changes

Note: “Don’t know/refused” responses not shown

SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Medicare part d where do we stand

Exhibit 29

Proposals to Change Medicare Part D

Percent of seniors who favor each of the following proposals:

Strongly favor

Somewhat favor

Allow government to negotiate with drug companies for lower prices

81%

76%

Waive the penalty for late enrollment

Spend more federal money to get rid of doughnut hole

68%

Allow seniors to get drug plan directly from Medicare

66%

Reduce the number of available drug plans

65%

Cut the program back because it is costing the government too much money

26%

25%

Keeping the program exactly as it is

Source: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)


Medicare part d where do we stand

Exhibit 30

Nationwide, 1 in 4 beneficiaries estimated to be eligible for Part D low-income subsidies are not receiving them

Beneficiaries Eligible for Low-Income Subsidies (LIS) = 13.2 million

3.1 million (24%)NOT receiving subsidy

7.5 million (57%)Full/partial dual eligibles and SSI recipients receiving subsidy

Total = 5.7 Million Non-Duals Eligible for LIS

2.0 million (15%) Eligible by SSA and receiving subsidy

0.5 million (4%)Eligible but estimated to have creditable coverage

0.1 million (1%) Anticipated facilitated enrollment

SOURCE: Testimony of Mark McClellan, CMS Administrator, June 14, 2006. Data from CMS, as of June 11, 2006, and updated LIS eligibility determinations from SSA, as of July 14, 2006.


Part d successes and challenges to date

Exhibit 31

Part D Successes and Challenges to Date

  • According to HHS, 90% of all Medicare beneficiaries now have “creditable” drug coverage – including over 23 million in Part D plans

  • Plan participation was greater than expected in 2006, and the market expanded in 2007

  • Initial implementation problems were overcome, and not repeated on a large scale in 2007

  • Most enrollees say they are satisfied with their plans so far

    HOWEVER…

  • Some beneficiaries still lack drug coverage and could face late enrollment penalty

  • Plans vary greatly in terms of coverage and benefit design

    • Unknown how well beneficiaries can choose a plan that meets their individual needs with so many choices

  • Difficulty getting “extra help” to those with low incomes

    • LIS participation lower than projected; outreach difficult

    • Asset test excludes many with low incomes

  • Even with drug coverage, many enrollees could face high costs

    • No coverage in the “doughnut hole”

    • High cost sharing for specialty drugs


Questions and unknowns about part d

Exhibit 32

Questions and Unknowns about Part D

  • Enrollment and Plan Participation

    • Which plans will stick around over time? What will happen to other sources of coverage, especially retiree plans? Do beneficiaries understand changes to their coverage? How do beneficiaries react?

  • Variations Across Drug Plans and Formularies

    • What are the implications of these variations for patients, especially those with chronic and/or rare conditions?

  • Experiences in the Doughnut Hole

    • How many people will be affected each year? What will their experiences be? Does utilization change?

  • Exceptions and Appeals Processes

    • How many enrollees are affected? How do these processes work for enrollees?

  • Outreach to the Unenrolled

    • What more can be done to get low-income subsides to those who are eligible but not receiving them? What happens to beneficiaries whose LIS status changes? How many beneficiaries will end up paying the late enrollment penalty?

  • Future Directions for Part D

    • How will the benefit and the program evolve over time? What are the prospects for possible reforms, such as drug price negotiation, simplification?


Thank you any questions

…thank you. Any questions?


  • Login