Exhibit 1 NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,734 for LIS enrollees), which.

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Exhibit 1 NOTE: Excludes plans in the territories. Total for 2014 includes 168 plans under CMS sanction and closed to new enrollees as of October 2013.
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Presentation transcript:

Exhibit 1 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. Standard Medicare Prescription Drug Benefit, 2013 Deductible = $325 Initial Coverage Limit = $2,970 in Total Drug Costs Plan pays 75% Plan pays 15%; Medicare pays 80% Enrollee pays 5% Enrollee pays 25% Catastrophic Coverage Limit = $6,955 in Estimated Total Drug Costs Brand-name drugs Enrollee pays 47.5%; Plan pays 2.5% 50% manufacturer discount Generic drugs Enrollee pays 79%; Plan pays 21% INITIAL COVERAGE PERIOD COVERAGE GAP CATASTROPHIC COVERAGE DEDUCTIBLE

Exhibit 2 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 SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS PDP Landscape Source Files, Distribution of Medicare Part D Stand-Alone Prescription Drug Plans, by Benchmark Status,

Exhibit : 49% increase : 2% 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. Weighted Average Monthly Premiums for Medicare Part D Stand-Alone Prescription Drug Plans,

Exhibit 4 Name of PDP 2013 Enrollment (of 18.0 million) Weighted Average Monthly Premium 1 % Change Number % of Total AARP MedicareRx Preferred3,851, %$26.31$39.85$ %+54% SilverScript Basic3,022, %$30.94$30.75$ % Humana Walmart-Preferred 2 1,755,0079.7%--$15.10$ %-- Humana Enhanced1,313,7017.3%$14.73$39.58$ %+197% Cigna Medicare Rx Plan One684,5433.8%$35.05$31.09$ %+2% First Health Part D Premier676,3343.8%$24.98$32.56$ %+30% First Health Part D Value Plus 3 644,9203.6%--$25.43$ %-- NOTE: 1 Average premiums are weighted by enrollment in each region for each year. 2 Humana Walmart-Preferred PDP was not offered before First Heath Part D Value Plus PDP was not offered before SOURCE: Georgetown/NORC analysis of CMS PDP Landscape Source Files for the Kaiser Family Foundation. Premiums in Medicare Part D Stand-Alone Prescription Drug Plans with Highest 2013 Enrollment,

Exhibit National Monthly Average Premium for Basic PDPs = $31.98 Less than $30 (9 regions) $30 to <$32 (7 regions) $32 to <$34 (9 regions) $34 or higher (9 regions) $28.82 $32.13 $31.81 $33.65 OR, WA $27.66 $23.13 $33.24 IA, MN, MT, NE, ND, SD, WY $25.53 $30.61 $28.53 $20.67 $32.18 $31.44 $32.22 $34.59 $34.21 IN, KY $32.11 $30.65 $31.85 $30.64 $34.56 $34.12 NJ $31.96 HI $32.34 $35.09 $29.56 CT, MA, RI, VT $33.23 ME, NH $28.47 $32.48 AL, TN $38.84 DE, DC, MD $35.09 PA, WV $38.83 ID, UT $41.50 $24.67 FL 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. Weighted Average Premium for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013

Exhibit 6 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File for the Kaiser Family Foundation. Range of Monthly Premiums for National and Near- National Medicare Part D Basic Stand-Alone PDPs, 2013

Exhibit 7 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. Minimum and Maximum Monthly Premiums for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013 PDP Regions, Sorted from Lowest to Highest Maximum Monthly Premium Delaware, Maryland, DC Hawaii Texas GeorgiaIllinois PDP Region # New YorkCalifornia Florida

Exhibit 8 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. Weighted Average Monthly Premiums for Stand-Alone PDPs, by Type of Benefit Package, 2013

Exhibit 9 PDPsMA-PD plans 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: 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, , for the Kaiser Family Foundation. Share of Enrollment in Medicare Part D Plans, By Level of Gap Coverage, 2006 and 2013

Exhibit 10 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. Weighted Average Monthly Premiums for Medicare Part D Stand-Alone PDPs, by Level of Gap Coverage, 2013

Exhibit 11 Share of Medicare Part D Stand-Alone Prescription Drug Plans, By Deductible Amount, NOTE: Estimates may not sum to total due to rounding and are unweighted. SOURCE: Georgetown/NORC analysis of CMS PDP landscape source files, , for the Kaiser Family Foundation. Standard deductible amount: $250 $265$275 $295 $310 $320$325

Exhibit 12 FORMULARY TIER PART D PLAN TYPE PART D COST SHARING EMPLOYER PLANS Generic PDP $5 $7 $5$2 $10 MA-PD $5 $6 $5 Preferred brand PDP $28 $30$37$42 $41$40 $29 MA-PD $26.70$29$30 $39$40$42$45 Non- preferred brand PDP $55$60$71.50$74.75$76.50$78$92$85 $52 MA-PD $55$60 $79$80$84$90 Specialty PDP 25%30% 33%30% 29%26% 32% MA-PD 25% 33% 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, Cost Sharing for Medicare Part D Plans, , and Employer-Sponsored Plans, 2013

Exhibit 13 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. Share of Enrollment in Medicare Part D Plans with Specialty Tiers, by Specialty Tier Coinsurance Rate, PDPs

Exhibit 14 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. Share of Medicare Part D Stand-Alone PDP Enrollees with Coverage of Top Ten Brand-Name Drugs, by Formulary Tier, 2013

Exhibit 15 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. Share of Covered Drugs with Utilization Management (UM) Restrictions Across All Medicare Part D Stand-Alone PDPs,

Exhibit 16 Top Brand- Name Drug % Enrollees with Drug Not Covered % Enrollees with Any UM % Enrollees with Prior Authorization % Enrollees with Step Therapy % Enrollees with Quantity Limits Nexium21%61%0% 57% Crestor26%83%0%9%82% Advair Diskus11%79%0%4%79% Namenda0%76%0% 76% Lantus13%30%0% 30% Spiriva0%78%0% 78% Cymbalta0%86%20%8%83% Zetia0%73%7%2%72% Celebrex22%74%40%26%73% Lyrica0%82%25%13%74% 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. Share of Medicare Part D Stand-Alone PDP Enrollees Facing UM Restrictions for Top Ten Brand-Name Drugs, 2013

Exhibit 17 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS PDP Landscape and Enrollment files for the Kaiser Family Foundation. Distribution of Monthly Part D Premiums for Low-Income Subsidy PDP Enrollees Paying Premiums, Of Total LIS Enrollees, Share Paying Premiums: %7%21%26%22%13%17%19% Number Paying Premiums: 488,400530,1001,718,8002,042,2001,731,0001,040,1001,433,9001,597,500 Average premiums:$9.20$12.69$6.87$11.10$9.95$14.71$12.45$11.82

Exhibit 18 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS PDP Landscape and Enrollment files for the Kaiser Family Foundation. Number of Low-Income Subsidy PDP Enrollees Paying Monthly Premiums,

Exhibit 19 NOTE: PDP is stand-alone prescription drug plan. Unrated plans are excluded from percentages. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Ratings, Share of Medicare Part D Stand-Alone PDPs and PDP Enrollees, by Plan Star Ratings, or more stars Total number of PDPs = 1,031Total enrollment = 17.9 million Distribution of PDPs by quality ratings: Distribution of PDP enrollees, by quality ratings:

Exhibit 20 Name of firm Change in Total Enrollment, Rank Enrollment (in millions) % of Total Part D in 2013 Rank UnitedHealth Group %1+38% Humana %2+19% CVS Caremark %11+920% Express Scripts %10+563% Aetna %12+530% CIGNA %17+675% Kaiser Permanente %6+44% Wellpoint %3-19% WellCare Health Plans %4+3% Envision %N/A TOTAL TOP 10 FIRMS28.2 mil79.9% TOTAL PART D35.3 mil100.0% NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, Top 10 Firms Offering Medicare Part D Plans Ranked by 2013 Enrollment

Exhibit 21 Name of Plan Change Rank Enrollment (in millions) % of Total Part D in 2013 Rank AARP MedicareRx Preferred PDP %1+21% SilverScript Basic PDP* %5+284% Express Scripts Medicare PDP (Employer)** %11+461% Humana Walmart-Preferred PDP %N/A Humana Enhanced PDP %3+37% SilverScript Group Calendar PDP (Employer) %N/A Humana Gold Plus HMO %14+113% Kaiser Permanente Senior Advantage HMO %7+16% Cigna Medicare Rx Plan One PDP %29+470% First Health Part D Premier PDP %18+157% NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, Top 10 Medicare Part D Plans Ranked by 2013 Enrollment

Exhibit 22 Top 5 Medicare Part D Stand-Alone PDPs, Ranked by 2013 LIS Enrollment and Non-LIS Enrollment Prescription Drug Plan Total LIS Enrollment Share of All LIS Enrollees Share LIS in Plan Number of Regions Where PDP is Benchmark Plan SilverScript Basic2,601, %86.0%30 Humana Walmart-Preferred Rx Plan926, %52.8%34 AARP MedicareRx Preferred737,0008.9%19.1%0 Cigna Medicare Rx Plan One592,0007.2%86.4%21 WellCare Classic436,0005.3%69.0%19 TOTAL FOR TOP 5 LIS PDPs 5,292, % Prescription Drug Plan Total Non- LIS Enrollment Share of All Non-LIS Enrollment Share Non- LIS in Plan Number of Regions Where PDP is Benchmark Plan AARP MedicareRx Preferred3,114, %80.9%0 Humana Enhanced1,134, %86.3%0 Humana Walmart-Preferred Rx Plan829,0008.5%47.2%34 First Health Part D-Value Plus617,0006.3%95.7%0 SilverScript Basic422,0004.3%14.0%30 TOTAL FOR TOP 5 NON-LIS PDPs6,116, % 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.