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

Slides:

Advertisements

Similar presentations

Dual Eligible and Low-Income Medicare Beneficiaries and Part D Presentation to National Medicaid Congress by Andy Schneider, Senior Advisor June 5, 2006.

Advertisements

Part Ds Low-Income Benefits: Theory and Reality Marc Steinberg, Families USA Health Action 2006 January 26, 2006 ** Washington, DC

1 Filling the Holes in Part D: SPAPs to the Rescue? Marc Steinberg, Families USA Health Action 2005 * January 27,

Medicare Prescription Drug Discount Card Ranjani Varadarajan PYPC 7810.

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

The Medicare Drug Discount Card: A public-private partnership July 28, 2004 Grace-Marie Turner Galen Institute.

Reduction of Medicaid Expenditures from State Prescription Programs in Illinois and Wisconsin Donald S Shepard, PhD* Desiree Koh, * Cindy Thomas, PhD*

2006 Retiree MIP Overview October 2006 Rajiv Nundy & Kent Humphries HR Compensation Management.

The Evolving Role of States in the Medicare Drug Benefit Thomas M. Snedden, Director Pennsylvania PACE Program The Third National Medicare Congress October.

Supplementing PACE through Medicare Part D

Ideas for People Losing Illinois Cares Rx Benefits July 2011.

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.

Access Denied? The Medicare Part D Benzodiazepine Challenge and Maine’s Coverage Solution. Stacie Sparkman Medicare Prescription Drug Specialist Eastern.

MEDICARE: PAST, PRESENT AND FUTURE James G. Anderson, Ph.D. Department of Sociology & Anthropology.

MEDICARE: PAST, PRESENT AND F UTURE James G. Anderson, Ph.D. Department of Sociology & Anthropology.

Deciphering Medicare Part D Susan Miller, Patient Education Douglas A. Magenheim, MD, MBA, FACP.

© 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.

Medicare Prescription Drug Coverage. What’s Different About Prescription Drug Information? One size does not fit all, more than ever before Distinct messages.

Medicare Modernization Act, Part D Prescription Drug Benefit Presentation for County Program Administrators September 1, 2005.

Rutgers Center for State Health Policy June 28, 2005 Presentation to the Academy Health Kimberley Fox, Senior Policy Analyst Rutgers Center for State Health.

Agenda Trends in the Senior Market Part D Benefits & Guidelines

MEDICARE PRESCRIPTION DRUG BENEFIT Presented by Juliette Cubanski, Ph.D. Principal Policy Analyst Medicare Policy Project The Henry J. Kaiser Family Foundation.

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

Medicare in Minnesota 2012 Your Medicare: Making the Best Possible Decisions October 2011 Presented by Stephanie Minor Senior LinkAge Line® Program Consultant.

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

Medicare Prescription Drug Benefit: Part D Health & Disability Advocates Stephanie Altman, J.D Ext

1 Medicare Prescription Drug Improvement and Modernization Act & Beneficiaries With Mental Illnesses Presentation to NAMI Convention June 19, 2005 Andrew.

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.

MEDICARE PART D Are We Ready? Are We Ready?. Medicare Part D Overview Medicare Part A and B covers individuals Age 65 and older Age 65 and older Those.

Medicare Update Presented by Tricia Neuman, Sc.D. Vice President, Henry J. Kaiser Family Foundation for Grantmakers in Health November 4, 2004.

What Difference Will It Make for People with Disabilities? Michael Dalto Maryland Department of Disabilities December 8,

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

STAY INFORMED! WHAT YOU NEED TO KNOW ABOUT HEALTH CARE REFORM May 2012.

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

NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare prior to SOURCE: Centers.

Introduction to Medicare and Medi-Cal for Seniors.

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

 The Impact of the Medicare Prescription Drug Legislation on Pharmaceutical Revenues Presented By: Jack Rodgers PricewaterhouseCoopers February 27,

THE COMMONWEALTH FUND The 2009 Congressional Health Reform Bills: Insurance Coverage Sara R. Collins, Ph.D., Vice President Rachel Nuzum, M.P.H., Senior.

Medicare Part D Symposium Thursday, September 1, 2005 Sacramento, CA Cathy Senderling Senior Legislative Advocate, CWDA.

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

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.

1. 2 Governor Doyle’s Health Care Vision  Every Wisconsin resident has a right to health care.  State government must do what it can to ensure that.

Medicare Savings Due to Prescription Drug Coverage for Near-poor Elders Christine Bishop, Ph.D. 1 Andrew Ryan, M.A. 1 Daniel Gilden, M.S. 2 Cindy Parks.

Exhibit ES-1. The Percentage of Young Adults Uninsured Declined over 2010–2012, While Rates Rose in Other Age Groups Note: Totals may not equal sum of.

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.

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicare Modernization Act of 2003: Implications for Low-Income People and State.

Avalere Health LLC | The intersection of business strategy and public policy The Medicare Modernization Act: The Impact on States and Low-Income Beneficiaries.

Figure 1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Dual Eligibles: The Basics Barbara Lyons, Ph.D. Director, Kaiser Commission on.

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

1 Medicare Reform: Implications for Pharmaceutical Manufacturers G. Lawrence Atkins, PhD Schering-Plough Corporation January 14, 2004.

Medicaid Lecture 15A Medicaid Established in 1965 along with Medicare Medicaid is a federal and state program that helps low income and disabled individuals.

Karissa A. Laur Director, Prescription Assistance Programs Coordinating Patient Assistance Programs with Medicare Part D: A Manufacturer’s Perspective.

Overview of the New Medicare-Endorsed Prescription Drug Discount Card Program The Intersection of Business Strategy and Public Policy The Health Strategies.

National Conference of State Legislatures National Medicaid Congress June 5, 2006 State Pharmaceutical Assistance Programs, Medicaid & Part D: 2006 State.

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

State Responses to Medicare Part D Presented by: Kimberley Fox, Senior Policy Analyst, Institute for Health Policy Academy Health Annual Research Meeting.

Exhibit 1. More Adults Who Visited the Marketplaces Found It Easy to Compare Benefits and Costs of Plans; Few Found It Easy to Compare Plans by Providers.

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

2018 Medicare Prescription Drug Benefit

Director, Pennsylvania PACE Program National Medicare Congress

Medicare Rx Drug Benefit

Presented by Tricia Neuman, Sc.D.

Medicare Part D Implementation Issues: Key Decisions for States

SeniorCare Prescription drug coverage for Wisconsin residents age 65+

Presentation transcript:

1 State Perspectives on Medicare Part D: Lessons from Pharmacy Plus Programs Cindy Parks Thomas Donald Shepard Christine E. Bishop Daniel M. Gilden Brandeis University Schneider Institute for Health Policy and Jen Associates, Inc. Academy Health Annual Research Meeting June 27, 2006

2 Lessons from Wisconsin SeniorCare Response to Medicare Part D

3 Background Pharmacy Plus Medicaid Waivers: Expanded pharmacy coverage for low-income seniors –Most eliminated after Part D Study based on Brandeis/CMS evaluation of Pharmacy Plus Programs in Illinois and Wisconsin and RWJ HCFO Grant # –Program design and outcomes Case study of Wisconsin SeniorCare: Program maintained after Medicare Part D implemented –Interviews with state officials in 2005/2006 –Program data early 2006 –AARP Sellers Feinberg financial analysis

4 Wisconsin SeniorCare and Part D Benefits Income by FPL Wisconsin SC Enrollment fee $30, No asset test Medicare Part D 2006 std. benefit Income-based Premium + Asset test (Cost share Indexed) <100%No deductible Copay: $5generic/ $15 brand No premium No deductible/ no gap Copay $1/$3 to $5100 rx cost %No premium No deductible/ no gap Copay $2/$5 to $5100 rx cost %Sliding scale premium Deductible $50/no gap 15% coins to $5100 rx cost Standard Part D benefit: %Deductible $500 Copay: $5 generic/ $15 brand $420 premium Deductible $250 25% coins to $2250 Full pay (gap) $2250 to $5100 5% coins after $5100 (160% fpl) State only program: % FPL: $850 deductible, same copays.

5 Wisconsin SeniorCare: A Better Benefit than Part D for Most Source: Wisconsin Department of Health and Family Services, 2006 Out-of-pocket Costs for Wisconsin SeniorCare Versus Standard Part D

6 Wisconsin Challenge CMS recommended to states: –Eliminate Pharmacy Plus programs –Convert to SPAP so out of pocket costs would contribute to catastrophic Wi. SeniorCare member analysis 2004 –<135%FPL and full subsidy would be better off in Part D –<150% FPL and partial subsidy better off in SeniorCare –All others better off in SeniorCare (estimated 94%)

7 Wisconsin Choices for Pharmacy Assistance Maintain SeniorCare waiver through June 2007 Convert SeniorCare to state program for Medicare Part D wraparound Convert SeniorCare to state pharmacy assistance program and allow choice Eliminate all state pharmacy assistance for low-income seniors

8 Important Factors Very popular program since 2002 –Legislative –Public support –Wisconsin aging network well established Medicaid matching costs Other revenue sources State costs Differences in member out-of-pocket spending

9 Qualifying for the Low-income Subsidy Estimates of how many income-eligible seniors would qualify for LIS: –Congressional Budget Office 2003: 88% –Congressional Budget Office July 2004: 45% –CMS 2005: 57% –Wisconsin SeniorCare estimate 2005: 20% based on: Percent in Medicaid meeting asset test; Wisconsin DHFS survey Actual percent qualifying: 18-19%

10 Estimated Cost to Wisconsin for Wraparound Coverage for SeniorCare Members Source: Wisconsin Department of Health and Family Services and Sellers Feinberg, 2006 Donut Hole: $72 million Total = $137.3 million dollars cost to State to wrap around program

11 Estimated Savings to Federal Government for Extending SeniorCare With Medicare Part D Fiscal Year ($ in millions)SeniorCareMedicare Part D Drug and Out-of- Pocket Costs  Pharmacy Billed Amount (Retail Price)$204.4  Less SeniorCare Discount Price Savings (AWP & MAC) 36.8  Less Other Participant Insurance Payments 1.3  Less Senior Out-of-Pocket Costs$55.2$137.3 Subtotal - Costs$111.1$67.1 Program Funding  Federal Funds$41.5$67.1  State Funds38.2  Manufacturer Rebates31.2 Subtotal - Funding$110.9$67.1 Source: Wisconsin Department of Health and Family Services and Sellers Feinberg, 2006

12 Enrollment Process into Wisconsin SeniorCare versus Part D SeniorCare now creditable coverage RFP for wraparound coverage: no plans responded Assist in outreach 2800 members were autoenrolled to Part D and had to be disenrolled 85% re-enrollment rates in SeniorCare Still about 1000 members who qualify for LIS Plan also wraps around Part D –Uncovered classes and –SeniorCare covered drugs

13 Wisconsin State Part D Market 844,272 Medicare beneficiaries –294,740 <200% FPL 107,200 dual eligibles 187,542 income eligible for SC waiver –32% of processed LIS applications approved Market –Least expensive PDP: $11/month (average $36) –80% have no coverage in gap –64% have no deductible (35% of low cost plans) Source: Kaiser Family Foundation, 2006

14 Wisconsin SeniorCare Enrollment Estimates

15 Enrollment in SeniorCare Increased After Jan 2006 Source: Wisconsin Department of Health and Family Services, 2006

16 Number of SeniorCare Prescriptions per Member Before and After January JulyAug Sept Oct Nov Dec Jan FebMar <160% FPL 160 to 200% FPL 200 to 240% FPL >240% FPL Average number of prescriptions per member per week Source: Wisconsin Department of Health and Family Services, 2006

17 Average Cost per Prescription for SeniorCare Before and After January 2006 Source: Wisconsin Department of Health and Family Services, 2006

18 Some Design Lessons for States for Part D Wraparound Coverage Differences in cost sharing matter: –Higher copays decrease rx use –Higher copays, tier differences, and utilization management increase generic use Gaps in coverage matter: –Cap at $1750 lowers spending by 30% –Deductible affects enrollment: sicker members enroll –Deductible affects spending: 17% lower spending during deductible period More generous coverage decreases the income effect of lower use for lower income members For the very poor (<100% of federal poverty), non- financial barriers also exist Formularies can result in very different use and expenditures

19 Lessons from Wisconsin State Response to Part D Useful approach to compare state program with Medicare Part D Members who may be better off in Medicare Part D stayed in SeniorCare –Popular familiar program –Considerable outreach –Inertia/ confusion regarding new program Transition enrollment problems –Erroneously autoenrolled into Part D Must have popular support: Full funding for SeniorCare for 2006 This is a unique state situation (waiver extension) but lesson for state programs