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Standard Medicare Prescription Drug Benefit, 2013. CATASTROPHIC COVERAGE. Catastrophic Coverage Limit = $6,955 in Estimated Total Drug Costs. Enrollee pays 5%. Plan pays 15 %; Medicare pays 80%. Brand-name drugs Enrollee pays 47.5%; Plan pays 2.5% 50% manufacturer discount

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standard medicare prescription drug benefit 2013
Standard Medicare Prescription Drug Benefit, 2013

CATASTROPHIC COVERAGE

CatastrophicCoverage Limit = $6,955 in

Estimated Total Drug Costs

Enrolleepays 5%

Plan pays 15%; Medicare pays 80%

Brand-name drugsEnrollee pays 47.5%; Plan pays 2.5%50% manufacturer discount

Generic drugs

Enrollee pays 79%; Plan pays 21%

COVERAGE

GAP

Initial Coverage Limit = $2,970 in Total Drug Costs

Enrollee pays 25%

INITIAL

COVERAGE

PERIOD

Plan pays 75%

Deductible = $325

DEDUCTIBLE

NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,734 for LIS enrollees), which corresponds to True Out-of-Pocket (TrOOP) spending of $4,750 (the amount used to determine when an enrollee reaches the catastrophic coverage threshold.SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit for 2013 (standard benefit parameter update from Centers for Medicare & Medicaid Services, 2012). Amounts rounded to nearest dollar.

distribution of medicare part d stand alone prescription drug plans by benchmark status 2006 2013
Distribution of Medicare Part D Stand-Alone Prescription Drug Plans, by Benchmark Status, 2006-2013

NOTE: Excludes PDPs in the territories. *Under a Medicare demonstration, de minimis plans were eligible to retain LIS beneficiaries despite exceeding the benchmark premium by $2 in 2007 and $1 in 2008. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS PDP Landscape Source Files, 2006-2013.

weighted average monthly premiums for medicare part d stand alone prescription drug plans 2006 2013
Weighted Average Monthly Premiums for Medicare Part D Stand-Alone Prescription Drug Plans, 2006-2013

2012-2013: 2% increase

2006-2013: 49% increase

NOTE: Average premiums are weighted by enrollment in each year (March for 2013). Excludes Part D plans in the territories.

SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation.

slide4
Premiums in Medicare Part D Stand-Alone Prescription Drug Plans with Highest 2013 Enrollment, 2006-2013

NOTE: 1Average premiums are weighted by enrollment in each region for each year. 2Humana Walmart-Preferred PDP was not offered before 2011. 3First Heath Part D Value Plus PDP was not offered before 2012.

SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape Source Files for the Kaiser Family Foundation.

weighted average premium for medicare part d basic stand alone pdps by region 2013
Weighted Average Premium for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013

Less than $30(9 regions)

$30 to <$32(7 regions)

$32 to <$34(9 regions)

$34 or higher(9 regions)

$33.23ME, NH

$33.65OR, WA

$29.56 CT, MA, RI, VT

$33.24IA, MN, MT, NE, ND, SD, WY

$34.59

$41.50

$32.11

$34.12NJ

$38.83 ID, UT

$35.09PA, WV

$28.47

$32.22

$23.13

$38.84DE, DC, MD

$34.21IN, KY

$28.82

$25.53

$32.18

$31.81

$27.66

$30.64

$32.48AL, TN

$35.09

$32.34

$30.65

$28.53

$20.67

$32.13

$31.44

$34.56

$31.85

$30.61

$24.67FL

$31.96HI

2013 National Monthly Average Premium for Basic PDPs = $31.98

NOTE: PDP is stand-alone prescription drug plan. Average premiums are weighted by enrollment.

SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File for the Kaiser Family Foundation.

slide6
Range of Monthly Premiums for National and Near-National Medicare Part D Basic Stand-Alone PDPs, 2013

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File for the Kaiser Family Foundation.

minimum and maximum monthly premiums for medicare part d basic stand alone pdps by region 2013
Minimum and Maximum Monthly Premiums for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013

Delaware, Maryland, DC

Hawaii

Florida

Texas

Georgia

New York

California

Illinois

PDP Region #

PDP Regions, Sorted from Lowest to Highest Maximum Monthly Premium

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File and Plan Crosswalk for the Kaiser Family Foundation.

weighted average monthly premiums for stand alone pdps by type of benefit package 2013
Weighted Average Monthly Premiums for Stand-Alone PDPs, by Type of Benefit Package, 2013

Type of benefit package

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation.

share of enrollment in medicare part d plans by level of gap coverage 2006 and 2013
Share of Enrollment in Medicare Part D Plans, By Level of Gap Coverage, 2006 and 2013

In 2013, the coverage gap is partially filled by a 50% price discount plus 2.5% plan coverage for brand-name drugs and 21% coverage of generic drug costs, as required by the ACA

Level of gap coverage in 2006:

PDPs

MA-PD plans

Level of additional gap coverage in 2013:

Little/no additional gap coverage

Mostly generics

Brands & generics

NOTE: Estimates include Part D enrollees receiving low-income subsidies, but who receive coverage for costs in the gap regardless of whether their plan offers it. SOURCE: Georgetown/NORC analysis of CMS Part D landscape and enrollment files, 2006-2013, for the Kaiser Family Foundation.

slide10
Weighted Average Monthly Premiums for Medicare Part D Stand-Alone PDPs, by Level of Gap Coverage, 2013

In 2013, the coverage gap is partially filled by a 50% price discount plus 2.5% plan coverage for brand-name drugs and 21% coverage of generic drug costs, as required by the ACA

Level of additional gap coverage in 2013

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation.

share of medicare part d stand alone prescription drug plans by deductible amount 2006 2013
Share of Medicare Part D Stand-Alone Prescription Drug Plans, By Deductible Amount, 2006-2013

NOTE: Estimates may not sum to total due to rounding and are unweighted.

SOURCE: Georgetown/NORC analysis of CMS PDP landscape source files, 2006-2013, for the Kaiser Family Foundation.

cost sharing for medicare part d plans 2006 2013 and employer sponsored plans 2013
Cost Sharing for Medicare Part D Plans, 2006-2013, and Employer-Sponsored Plans, 2013

NOTES Part D cost-sharing amounts are medians; employer plan cost-sharing amounts are means. Part D plan estimates weighted by enrollment in each year; analysis excludes generic/brand plans, plans with coinsurance for regular tiers, and plans with flat copayments for specialty tiers.SOURCE: Georgetown/NORC analysis of data from CMS for MedPAC and the Kaiser Family Foundation; data on employer plans from Kaiser/HRET Employer Health Benefits Survey, 2013.

slide13
Share of Enrollment in Medicare Part D Plans with Specialty Tiers, by Specialty Tier Coinsurance Rate, 2009-2013

PDPs

MA-PD plans

Coinsurance rates:

NOTE: Estimates weighted by enrollment in each year. Analysis of MA-PD plans excludes Special Needs Plans.SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation.

slide14
Share of Medicare Part D Stand-Alone PDP Enrollees with Coverage of Top Ten Brand-Name Drugs, by Formulary Tier, 2013

NOTE: PDP is stand-alone prescription drug plan. Analysis is weighted by enrollment. Preferred brand includes plans using standard benefit without tiers. Non-preferred brand includes plans using specialty tiers. SOURCE: NORC/Social & Scientific Systems analysis of data from CMS.

slide15
Share of Covered Drugs with Utilization Management (UM) Restrictions Across All Medicare Part D Stand-Alone PDPs, 2007-2013

NOTE: PDP is stand-alone prescription drug plan. Calculations are share of listed chemical entities, weighted by enrollment in each year.SOURCE: NORC/Social & Scientific Systems analysis of data from CMS.

slide16
Share of Medicare Part D Stand-Alone PDP Enrollees Facing UM Restrictions for Top Ten Brand-Name Drugs, 2013

NOTE: PDP is stand-alone prescription drug plan. UM is utilization management. Presence of UM restrictions is measured as a share of plans with the drug listed on formulary.SOURCE: NORC/Social & Scientific Systems analysis of data from CMS.

slide17
Distribution of Monthly Part D Premiums for Low-Income Subsidy PDP Enrollees Paying Premiums, 2006-2013

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape and Enrollment files for the Kaiser Family Foundation.

number of low income subsidy pdp enrollees paying monthly premiums 2006 2013
Number of Low-Income Subsidy PDP Enrollees Paying Monthly Premiums, 2006-2013

NOTE: PDP is stand-alone prescription drug plan.

SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape and Enrollment files for the Kaiser Family Foundation.

share of medicare part d stand alone pdps and pdp enrollees by plan star ratings 2013
Share of Medicare Part D Stand-Alone PDPs and PDP Enrollees, by Plan Star Ratings, 2013

4 or more stars

NOTE: PDP is stand-alone prescription drug plan. Unrated plans are excluded from percentages.SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Ratings, 2013.

top 10 firms offering medicare part d plans ranked by 2013 enrollment
Top 10 Firms Offering Medicare Part D Plans Ranked by 2013 Enrollment

NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, 2006-2013.

top 10 medicare part d plans ranked by 2013 enrollment
Top 10 Medicare Part D Plans Ranked by 2013 Enrollment

NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, 2006-2013.

top 5 medicare part d stand alone pdps ranked by 2013 lis enrollment and non lis enrollment
Top 5 Medicare Part D Stand-Alone PDPs, Ranked by 2013 LIS Enrollment and Non-LIS Enrollment

NOTE: LIS is low-income subsidy. Excludes employer group plans and plans in the territories.

SOURCE: Georgetown/NORC analysis of CMS PDP Landscape and Enrollment Files, 2013, for the Kaiser Family Foundation.