Cost Sharing Under Part D: Impact on Beneficiaries with the Standard Benefit Bruce Stuart, PhD Director, Peter Lamy Center on Drug Therapy and Aging.

Slides:

Advertisements

Similar presentations

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 The Transition of Dual Eligibles to Medicare Drug Coverage: Implications for Beneficiaries.

Advertisements

Challenges of Serving Low-income Medicare Beneficiaries: Impact of Cost Sharing Cindy Parks Thomas Brandeis University Schneider Institute for Health Policy.

Cost Offsets from Recommended Medications for Medicare Beneficiaries with Diabetes AcademyHealth June 9, 2008 Bruce Stuart,* Linda Simoni-Wastila,* Lirong.

Supplementing PACE through Medicare Part D

Pharmaceutical Assistance Contract for the Elderly (PACE) Program began July 1, 1984 PACE Needs Enhancement Tier (PACENET) Program began January 1, 1997.

Medicare Part D and HIV/AIDS: What a Clinician May Want to Know Laura Cheever, M.D., ScM Deputy Director, Chief Medical Officer HIV/AIDS Bureau Health.

THE AIDS INSTITUTE The AIDS Institute HEALTH REFORM AND ADAP Emily McCloskey, Public Policy Associate Carl Schmid, Deputy Executive Director AIDS Drug.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health? Get Educated, Get Enrolled An.

Medicare and the New Prescription Drug Benefit Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser.

Figure 1. Average Out-of-Pocket Health Care Spending, for All Medicare Beneficiaries Age 65 and Up * Projected costs assume an annual 5.1% inflation rate.

1 State Perspectives on Medicare Part D: Lessons from Pharmacy Plus Programs Cindy Parks Thomas Donald Shepard Christine E. Bishop Daniel M. Gilden Brandeis.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health?

Patient Advocacy. Access, Affordability, and understanding treatment costs.

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Roy Trudel, CMSO National Eligibility Workers Association 07/12/05.

1 Maryland SPAP Premium Subsidies to MedicareRx Plans National Association of Comprehensive Health Insurance Plans October 16, 2008 Richard Popper Executive.

(c) 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy.

HEALTH IN COLORADO GOVERNOR HICKENLOOPER’S VISION.

Slide -1 Medicare Prescription Drug Benefit Denise S. Stanley, Pharm.D. Atlanta Regional Office Centers for Medicare & Medicaid Services March 17, 2006.

1 What is Medicare? Medicare is a government program developed for the nation’s aged to provide financial benefits for health related occurrences. Typically,

Diagnosis-Based Risk Adjustment for Medicare Prescription Drug Plan Payments John Robst Melvin Ingber Jesse Levy Centers for Medicare & Medicaid Services.

N ATIONAL M ULTIPLE S CLEROSIS S OCIETY The Affordability of the Medicare Drug Benefit Session 1.02 Third Annual National Medicare Congress Susan Sanabria.

Medicare, Medicaid, and Health Care Reform Todd Gilmer, PhD Professor of Health Policy and Economics Department of Family and Preventive Medicine 1.

Gaps in Drug Benefits: Impact on Utilization and Spending for Drugs Used by Medicare Beneficiaries with Serious Mental Illness Linda Simoni-Wastila, PhD.

Overview of the Maryland Primary Adult Care (PAC) Program Rhode Island Policy Makers Breakfast November 17, 2010 Stacey Davis Deputy Director of Planning.

Medicare and Patient Assistance Sean M. Dougherty Senior Director Medicare Strategy & Patient Assistance Programs Government, Public Policy And Managed.

The New Medicare Prescription Drug Benefit: An Overview Prepared by: Michelle Kitchman, M.H.S. Kaiser Family Foundation For the: California Senate Health.

THE COMMONWEALTH FUND Medicare Part D: What Are The Concerns? Stuart Guterman Director, Program on Medicare’s Future The Commonwealth Fund Association.

11/8/051 Medicare Prescription Drug Benefits Employee Workshop November 2005.

Return to Tutorials Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009 Medicare 101:

Avalere Health LLC | The intersection of business strategy and public policy The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries.

Finance Team National Hispanic Medical Association Leadership Fellowship 2003 Jose Castro MD Elsa Escalera MD Inginia Genao MD Advisor: Charles Brecher.

Ian D. Spatz Merck & Co., Inc. January 14, 2004 Ian D. Spatz Merck & Co., Inc. January 14, 2004 Overview of the New Medicare Prescription Drug Law.

“For the vast majority of seniors, the new benefit is working.” -Mark McClellan, CMS, February 2006 "It's a disaster, Medicare Part D - D is unfortunately.

The Potential Impact of Health Care Reform on California: Consumer Affordability Dylan H. Roby, Ph.D. Assistant Professor of.

How Big a Problem is Obesity for the Medicare Program? AcademyHealth June 10, 2008 Bruce Stuart, Lirong Zhao, Jennifer Lloyd The Peter Lamy Center Drug.

1 Assessing the Medicare Prescription Drug Benefit Impact on Medicaid Vernon K. Smith, Ph.D. HEALTH MANGEMENT ASSOCIATES For Invitational Summit for State.

Exhibit 1 NOTES: LIS is Low-Income Subsidy. PDP is prescription drug plan. MA-PD is Medicare Advantage Prescription Drug Plan. Analysis includes non-LIS.

Prescription Drug Expenditures and Healthcare Burdens in the Medicaid Population G. Edward Miller, Jessica S. Banthin and Thomas M Selden AHRQ Conference.

1 Cost Sharing for Low-Income Beneficiaries and Supplementing Part D Examples from Pharmacy Plus Medicaid Demonstration Programs Summit for State Health.

Chapter 7: Medicare Part D Prescription Drug Coverage in Patients with Chronic Kidney Disease 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D.

Estimating the Cost of the Medicare Drug Benefit Philip Ellis Steve Lieberman Medicare Prescription Drug Congress February 27, 2004.

MEDICARE PART D July MEDICARE PART D: OVERVIEW Part D provides prescription drug coverage for Medicare beneficiaries. Prescription drug plans compete.

Avalere Health LLC | The intersection of business strategy and public policy The Impact of Enrollment in the Medicare Prescription Drug Benefit on Premiums.

Overview of the Medicare Drug Benefit Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser Family.

Introducing the Medicare Prescription Drug Benefit This is a presentation created by GeorgiaCares. This is not an official document. The official Medicare.

Retirement Health Care

Health Coverage Enrollment in Michigan

Medicare 101 Seminar The Senior Planning Center 648 Wilton RD

Welcome and Introductions

2016 Annual Data Report, Vol 1, CKD, Ch 7

Chapter 7: Prescription Drug Coverage in Patients with CKD

2018 Medicare Prescription Drug Benefit

Director, Pennsylvania PACE Program National Medicare Congress

Cost-Sharing Provisions by State and Program, 2003 (Part 1)

MMA, Private Plans, and Competition: Commercial Health Plan Response to MMA November 1, 2005 David F. Ogden, F.S.A. Milliman, Inc.

Health Coverage Enrollment in Michigan

Current Medicare benefits* New Public Plan in Exchange

Lindy Hinman Avalere Health LLC

Healthcare Reform and Medicare Part D

Medicare Part D: What Are The Concerns?

Current Medicare Benefits*

Income-related monthly adjustment amount Total monthly premium amount

G. Edward Miller, Jessica S. Banthin and Thomas M. Selden

Estimated Annual Premiums Under Different Scenarios, 2010

Medicare Rx Drug Benefit

Presented by Tricia Neuman, Sc.D.

Medicare Made Clear Neither “We Speak Medicare” nor the presenting agent is connected with the Federal Medicare Program.

DallasMMS.com Dallas Major Medical Services

Understanding Your Medicare Plan Options

Presentation transcript:

Cost Sharing Under Part D: Impact on Beneficiaries with the Standard Benefit Bruce Stuart, PhD Director, Peter Lamy Center on Drug Therapy and Aging University of Maryland Baltimore Invitational Summit for State Policy Makers Medicare Part D Implementation Issues Philadelphia, October 8, 2004

Why States Should be Concerned about Beneficiaries with the Standard Benefit Part D low income subsidies Full-benefit dual eligibles or <135% FPL and meets MMA asset tests (no premium, small copays) 136% -150% FPL and meets asset tests (phased out subsidy) Who won’t qualify for the subsidies… > 150% of the FPL (varies by household size) < 150% of FPL but fails to sign up or fails asset tests

Assessing the Impact of Gaps in the Part D Standard Benefit Given the cost sharing features of the standard benefit… What is the relationship between drug spending and the generosity of the Part D benefit? How persistent is drug spending over time? How will beneficiaries respond to benefit gaps in the face of persistent need for medication therapy?

Coverage Gaps under the Part D Standard Benefit in 2006 Annual Drug Spending Months in Coverage Gap (assuming steady spending) % of Total Annual Drug Spending Paid Out of Pocket $1,000 3.0 44 $2,000 1.5 34 $3,000 4.0 50 $4,000 6.0 63 $5,000 7.2 70 $6,000 6.2 61 $7,000 5.3 53

Riding the Part D Rollercoaster Research shows that drug spending is highly persistent Beneficiaries hit with high cost sharing in one year are likely to be hit year after year Our study projected Rx spending to 2006-2008 for 3 groups of beneficiaries: Typical Part D enrollee (>150% FPL, without stable Rx coverage from an employer or a public program) with average drug spending Typical Part D enrollee with Rx spending above $2,250 Typical Part D enrollee with Rx spending above $5,100

Estimated Drug Spending (2006-2008) for Typical Enrollee with Average Spending in 2006 Year Mean Annual Total Prescription Drug Spending % Out-of-Pocket (OOP) Drug Spending 2006 $2,608 42% 2007 $2,880 46% 2008 $3,230

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending $250 deductible

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending $25% coinsurance

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending hits donut hole

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending $275 deductible

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending 25% coinsurance

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending hits donut hole

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending $300 deductible

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending 25% coinsurance

Estimated Quarterly OOP Drug Spending for Enrollee with Average Spending hits donut hole

Estimated Drug Spending (2006-2008) for Typical “High Spender” in 2006 (38% of enrollees with >$2,250 in 2006) Year Mean Annual Total Prescription Drug Spending % Out-of-Pocket (OOP) Drug Spending 2006 $5,534 65% 2007 $5,289 69% 2008 $5,562 67%

Estimated Quarterly OOP Drug Spending for Typical “High Spender” note change in scale

Estimated Quarterly OOP Drug Spending for Typical “High Spender” enters donut hole

Estimated Quarterly OOP Drug Spending for Typical “High Spender” passes catastrophic threshold

Estimated Quarterly OOP Drug Spending for Typical “High Spender” higher OOP spending due to rise in catastrophic threshold

Estimated Drug Spending (2006-2008) for Typical “Catastrophic Spender” in 2006 (14% of enrollees with >$5,100 in 2006) Year Mean Annual Total Prescription Drug Spending % Out-of-Pocket (OOP) Drug Spending 2006 $9,106 42% 2007 $7,663 53% 2008 $7,328 60%

Estimated Quarterly OOP Drug Spending for Typical “Catastrophic Spender” note change in scale

Estimated Quarterly OOP Drug Spending for Typical “Catastrophic Spender” enters donut hole

Estimated Quarterly OOP Drug Spending for Typical “Catastrophic Spender” passes catastrophic threshold

Estimated Quarterly OOP Drug Spending for Typical “Catastrophic Spender” higher OOP spending due to rise in catastrophic threshold

How Will Beneficiaries React to Multiple Benefit Gaps of Varying Duration? Research shows that beneficiaries will cut back on drug use Cut-backs are proportional to level of spending (higher spending = greater cutbacks) Beneficiaries with certain chronic conditions will cut back more

Estimated Impact of Drug Benefit Gaps on Drug Use by Beneficiaries with Selected Diseases (Impact relative to no gap and 25% coinsurance) Gap in months Average beneficiary Diabetes COPD Mental Illness 1 -2% -3% -4% 2 -6% -8% -9% 3 -12% -13% 4 -11% -16% -17% 5 -10% -14% -21% 6 -25% -26% 7 -20% -29% -30%

Implications for the States States need to consider the needs of vulnerable Medicare beneficiaries ineligible for subsidized prescription coverage under Part D. Risk factors are: Annual drug spending deep in the donut hole (e.g. >$4,000) Chronic illness (e.g., diabetes, COPD, mental disorders) Poor with modest assets Near poor (e.g., 150%-250% FPL)