Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5, 2007.

Slides:

Advertisements

Similar presentations

MEDICAID MANAGED CARE: OPPORTUNITIES AND IMPLICATIONS OF STATE EXPANSIONS FOR SPECIAL NEEDS PLANS James M. Verdier Mathematica Policy Research, Inc. National.

Advertisements

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

The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington,

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

Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation Medicare Policy Project - Families USA Health Action 2007 Washington,

Medicare Reform Exhibit 12 New benefit administered exclusively by private insurers New benefit administered exclusively by private insurers New income-related.

Medicare’s Role Medicare covers 47 million Medicare beneficiaries

Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors.

Medicare Part D How are Vulnerable Beneficiaries Faring? Laura Summer Health Policy Institute, Georgetown University With Support from The Commonwealth.

Illinois All Kids Program Illinois Department of Healthcare and Family Services Stephen E. Saunders, MD, MPH Child Health Services Research Meeting June.

Impact of the Medicare Rx Drug Legislation on Consumers Rx ______________________________ Willis B Helpin, M.D. 10 Betterhealth Lane Anytown, USA.

Medicare and Prescription Drugs: Issues for Employers and Consumers Robert D. Reischauer The Urban Institute National Health Policy Conference January.

Figure 1. Issues Related to Auto-Enrollment (Percent of Respondents Reporting How Often Issues Occur) N=641. Source: Georgetown University Health Policy.

Figure 1. CMS Estimates of Eligibility and Participation in the Medicare Part D Low-Income Subsidy Full/partial dual eligibles and SSI recipients automatically.

1 Medicare Part D Implementation North Dakotas Efforts.

Medicare Prescription Drug Discount Card Ranjani Varadarajan PYPC 7810.

Medicare Part D John A. Geib 10/3/05. Medicare Modernization Act (MMA) 2003 and How the MMA impacts California’s Medi-Cal Program Largest change in healthcare.

Supplementing PACE through Medicare Part D

State Specific Example: Texas The intersection of business strategy and public policy.

Health Coverage in Retirement Presentation at Citizens’ Health Care Working Group by Gerry Smolka, Senior Policy Advisor AARP Public Policy Institute July.

AREA AGENCY ON AGING AND DISABILITY STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP) 2012 Medicare 101.

© 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.

Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser Family Foundation for NASI Annual Conference.

Medicare Prescription Drug Coverage Extra Help with Medicare Prescription Drug Costs for Those Who Need it Most.

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.

Medicare Improvement for Patients and Providers Act of 2008 Preliminary Summary of Beneficiary and Plan Provisions July 14 th,

Joint Informational Hearing The Federal Medicare Prescription Drug Act: State Readiness, Implementation, and Consumer Issues Bonnie Burns, Training and.

Health Reform: What It Means to Our Community. Health Reform: Key Provisions o Provides coverage to 32 million uninsured people by o Changes insurance.

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

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?

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

What’s in the Mail? Overview of Medicare Prescription Drug Coverage Beneficiary Communications Employer Forum Conference Call October 13, 2005.

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

January National Medicare & You Training Program Amy Larrick, CMS NAACP April 27, 2006.

State Strategies: Expanding Prescription Drug Access Dee Mahan Families USA November 1, 2002.

Medicare Prescription Drug Plan Low Income Subsidy The Application Process Roy Trudel, CMSO National Eligibility Workers Call November 23, 2004.

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

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

Current Process for Enrolling Dual Eligibles Kenneth D. Nibali, Consultant on Social Security Former Associate Commissioner for Disability with the Social.

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.

Helping People Eligible for Extra Help What You Need to Know about LIS National Medicare Training Program Audio-conference Training September 26, 2007.

0 Beneficiary Choices in Medicare Part D and Plan Features in 2006 Supported by PhRMA September 13, 2006.

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

1 Medicare Part D: Cost Management Issues Jack Hoadley Research Professor Georgetown University Health Policy Institute National Academy of Social Insurance.

40,000 volunteers staffed more than 50,000 enrollment events across the country 90 percent of people with Medicare have drug coverage More than 80 percent.

How Health Reform Helps Missouri: Today and in the Future Brian Colby MO Health Advocacy Alliance.

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.

1 The Implications of Declining Retiree Health Insurance Courtney Monk and Alicia H. Munnell Center for Retirement Research at Boston College 11 th Annual.

"Helping Seniors Make Smart Decisions about their Drug Coverage Options" Hal Prink, FHFMA, Medicare Patient Advocate, Senior’s Voice for Healthcare Rights.

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

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.

Avalere Health LLC | The intersection of business strategy and public policy Enrollment in the Medicare Drug Benefit Medicare Congress Audioconference.

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.

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

Health Reform: What It Means to Our Community

2018 Medicare Prescription Drug Benefit

Director, Pennsylvania PACE Program National Medicare Congress

The Third National Medicare Congress David B. Snow, Jr.

MEDICAID AND MMA ADMINISTRATIVE CHALLENGES: SPECIAL NEEDS PLANS

Presented by Tricia Neuman, Sc.D.

Medicare Reform: Implications for Pharmaceutical Manufacturers

Presentation transcript:

Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5, 2007

AARP Goals for 2003 Conference Committee 1. Do no harm –protect underlying Medicare fee-for-service program 2. Get Rx coverage for all 65+ now without it 3. Provide generous support to low-income beneficiaries 4. Prevent erosion of employer-based retiree health plans 5. Contain pharmaceutical prices effectively

Millions more 65+ are covered Source: Unpublished preliminary research: H. Levy & D. Weir, Univ. of Michigan, Take-Up of Medicare Part D and the SSA Subsidy: Early Results from the Health and Retirement Study, Presented Aug 2007 at the Retirement Research Consortium Annual Joint Conference, Washington, DC 2. Rx coverage for 65+

Current Part D Enrollment 24 Million Stand-Alone Rx Plans11,000,000 Medicare Advantage w/Rx Drug (Includes.5 million Duals) 6,700,000 Dual Eligibles in PDPs (Auto-enrolled) 6,300,000 Estimated Creditable Coverage =VA, Indian Health Service, employer plans w/o retiree subsidies, active workers, and state pharmaceutical assistance programs 4,900,000 Employer/Union Ret. Coverage FEHB Feds retiree coverage --includes dependents TriCare Military retirees 10,300,000 No Creditable Coverage 4,000,000 (GAO = 4.7 million) Source: HHS, January 30, 2007

Whats Part D coverage worth? CMS 2007 Estimates Average worth per person $3,353 in 2007 for a low-income enrollee August 2007 Press Release $1,200 for a mid-income enrollee June 2007 Press Release. 3. Generous Support for Limited-Income Enrollees

Number of eligibles not enrolled in LIS CMS estimated 14.4 million would enroll, yet only 9 million so far Also, there are those who would qualify but for the asset limits --- estimated by KFF at 2.3 million

Why people fail to enroll: Lack of knowledge - Nearly half of LIS eligibles not enrolled reported they were not aware of program (2006 National Survey of Seniors and Rx Drugs- KFF) Welfare stigma from required place of enrollment and asset test Dont want or know how to answer asset questions at enrollment i.e. burial plots, life insurance, in kind support

Targeting: Key strategies for face-to-face enrollment Need IRS to share income data with SSA Need funding for outreach and enrollment at community level

Rx Rely heavily on formularies Works for most enrollees, but LIS enrollees exempt Duals will be forced into most restricted plans next year Need comparative-effectiveness studies to assure most effective drugs are available Drug cost-containment measures 5. Reduce the Rise in Rx Drug Prices

Friction Points Marketing abuses Problems with appeals, since many plans give people no info at the pharmacy when refusing to cover a drug LIS reassignments: real problem being inclusion of MA plans in benchmark Inaccurate and misleading data on Medicare plan finder Too many choices! Standardization and simplification needed

Immediate Steps to Strengthen Part D Strengthen limited-income protections Substantially raise or eliminate asset test Simplify LIS application Permit enrollment in MSP at SSA offices Bring Medicare Savings Program to LIS level Change formula to avoid "ping-ponging of LIS enrollees each year

Immediate Steps to Strengthen Part D Quality and Cost Improvements More aggressive oversight of plan performance Substantially fund comparative-effectiveness research Require physicians to E-Prescribe

Strengthening Medicare Part D Washington, DC November 5, 2007