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Transcript of Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation Medicare Policy Project - Families...
Juliette Cubanski, Ph.D. Juliette Cubanski, Ph.D. The Henry J. Kaiser Family FoundationThe Henry J. Kaiser Family Foundation
Medicare Policy Project - www.kff.org/medicareMedicare Policy Project - www.kff.org/medicare
Families USAFamilies USAHealth Action 2007Health Action 2007Washington, D.C.Washington, D.C.
25 January 200725 January 2007
MEDICARE PART D MEDICARE PART D Where Do We Stand?Where Do We Stand?Where Are We Going?Where Are We Going?
OverviewOverview
Part D Plan Landscape and EnrollmentPart D Plan Landscape and Enrollment Private plan availability is higher in 2007 than 2006, and Private plan availability is higher in 2007 than 2006, and
there continues to be wide variation in coverage and there continues to be wide variation in coverage and benefit design benefit design
The majority of beneficiaries now have drug coverage, but The majority of beneficiaries now have drug coverage, but around 10% (~4 million) are not enrolledaround 10% (~4 million) are not enrolled
Views and Experiences of Beneficiaries and Views and Experiences of Beneficiaries and ProvidersProviders Most enrollees say they are satisfied with their Part D plans Most enrollees say they are satisfied with their Part D plans
so far, but many are still vulnerable to high out-of-pocket so far, but many are still vulnerable to high out-of-pocket costscosts
Pharmacists and physicians have played a key role in Pharmacists and physicians have played a key role in helping beneficiaries navigate their Part D planshelping beneficiaries navigate their Part D plans
Unanswered Questions and Issues to MonitorUnanswered Questions and Issues to Monitor
Exhibit 1
Part D - The Medicare Drug BenefitPart D - The Medicare Drug Benefit
Exhibit 2
Drug benefit is offered exclusively through private Drug benefit is offered exclusively through private organizations, not traditional Medicareorganizations, not traditional Medicare 2 types:2 types:
Stand-alone prescription drug plans (PDPs) that supplement Stand-alone prescription drug plans (PDPs) that supplement traditional fee-for-service Medicaretraditional fee-for-service Medicare
Medicare-Advantage prescription drug (MA-PD) plans – Medicare-Advantage prescription drug (MA-PD) plans – integrated medical and drug benefits – primarily HMOs, PPOsintegrated medical and drug benefits – primarily HMOs, PPOs
Plans can change from year to year – add, drop, modifyPlans can change from year to year – add, drop, modify
New approach to delivering a Medicare benefitNew approach to delivering a Medicare benefit Take-up is voluntary, not automaticTake-up is voluntary, not automatic Standard benefit available, but plans can varyStandard benefit available, but plans can vary Coverage and cost depends on plan chosenCoverage and cost depends on plan chosen
Additional subsidies (“extra help”) available to Additional subsidies (“extra help”) available to people with low incomes, but subject to income and people with low incomes, but subject to income and asset testasset test ““Dual eligibles” no longer have drug coverage through Dual eligibles” no longer have drug coverage through
MedicaidMedicaid
Changes in Plan Options from Changes in Plan Options from 2006 to 20072006 to 2007
Plan participationPlan participation Mostly the same organizations but far more plan optionsMostly the same organizations but far more plan options
PDPs: PDPs: 1,429 in 2006 1,429 in 2006 to to 1,875 in 20071,875 in 2007 MA plans: MA plans: 3,195 in 2006 3,195 in 2006 to to 3,971 in 20073,971 in 2007
Monthly premiumsMonthly premiums Lowest increasing from Lowest increasing from $1.87$1.87 to to $9.50$9.50 Highest increasing from Highest increasing from $104.89 $104.89 to to $135.70$135.70
Benefit design and formulariesBenefit design and formularies Minor changes in many plan offerings, along with major Minor changes in many plan offerings, along with major
changes in some otherschanges in some others According to CMS, at least a 13% increase in number of According to CMS, at least a 13% increase in number of
drugs covereddrugs covered
Exhibit 3
DC
61
57
57
55
54
56
56
5353 5
3
53
53
53
53
5357
60
53
57
55
5358
58
56
57
59
56
54 5
454 5
457
53
61
53
51
56
53
66
53
45
51
53
66
46
51
45-50 drug plans (2 states)45-50 drug plans (2 states)51-55 drug plans (26 states)51-55 drug plans (26 states)56-60 drug plans (18 states)56-60 drug plans (18 states)61-66 drug plans (5 states)61-66 drug plans (5 states)
Beneficiaries in Most States Beneficiaries in Most States Had a Choice of At Least 50 PDPs in 2007Had a Choice of At Least 50 PDPs in 2007
1,875 Stand-alone PDPs Offered 1,875 Stand-alone PDPs Offered NationwideNationwide
Exhibit 4
57
Most Beneficiaries Had Access to One or Most Beneficiaries Had Access to One or More Medicare Advantage Plans in 2007More Medicare Advantage Plans in 2007
San Diego San Diego County: County: 24 MA-PD 24 MA-PD
Plans Plans (+ 55 PDPs (+ 55 PDPs
and and 2 SNPs)2 SNPs)
Miami/Miami/Dade Dade
County: County: 43 MA-PD 43 MA-PD
Plans Plans (+ 57 PDPs and (+ 57 PDPs and
19 SNPs)19 SNPs)
Polk County: Polk County: 20 MA-PD 20 MA-PD
Plans Plans (+ 53 PDPs and (+ 53 PDPs and
2 SNPs)2 SNPs)
3,971 MA Plans Offered Nationwide3,971 MA Plans Offered Nationwide
Exhibit 5
Standard Medicare Prescription Drug Benefit, 2007Standard Medicare Prescription Drug Benefit, 2007
$328 Average Annual Premium$328 Average Annual Premium
$265 Deductible$265 Deductible
$2,400 in $2,400 in Total Drug CostsTotal Drug Costs
$5,451 in $5,451 in Total Drug CostsTotal Drug Costs ($3,850 out of pocket)($3,850 out of pocket)
$3,051 Coverage Gap (“Doughnut
Hole”)
NOTE: Annual premium amount based on $27.35 national average monthly beneficiary premium (CMS, NOTE: Annual premium amount based on $27.35 national average monthly beneficiary premium (CMS, August 2006). Amounts for premium, coverage gap, and catastrophic coverage threshold rounded to August 2006). Amounts for premium, coverage gap, and catastrophic coverage threshold rounded to nearest dollar.nearest dollar.SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit, updated with Part D SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit, updated with Part D benefit parameters for 2007 (from CMS, OACT, May 22, 2006).benefit parameters for 2007 (from CMS, OACT, May 22, 2006).
Plan Pays 75%
Plan Pays 15%; Medicare Pays
80%
Enrollee Pays Enrollee Pays 100%100%
Enrollee Pays Enrollee Pays 5%5%
Enrollee Enrollee Pays Pays 25%25%
Beneficiary Out-of-
Pocket Spending
Exhibit 6
41%
8%
27%
47%
60%
1%
71%
32%
12%
SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings; November 2006.Offerings; November 2006.
EnhancedEnhancedActuarially Actuarially EquivalentEquivalent
StandardStandard $250$250 $0$0PartialPartial(<$250)(<$250)
No No CoverageCoverage
Generic Generic OnlyOnly
Brand and Brand and GenericGeneric
Benefit DesignBenefit Design Coverage in the Coverage in the GapGap
Deductible AmountDeductible Amount
The “Standard” Drug Benefit Design is Not The “Standard” Drug Benefit Design is Not the Typical Part D Plan Offering in 2007the Typical Part D Plan Offering in 2007
Percent of plans:Percent of plans:
Exhibit 7
Part D and the “Doughnut Hole”Part D and the “Doughnut Hole”
Of 22.5 million Part D enrollees in 2006:Of 22.5 million Part D enrollees in 2006: 9 million9 million received low-income subsidy and face no gap in received low-income subsidy and face no gap in
coveragecoverage Less than Less than 1 million1 million enrolled in plans with full gap coverage enrolled in plans with full gap coverage An estimated An estimated 11 million Part D enrollees had no coverage11 million Part D enrollees had no coverage in in
the doughnut hole in 2006the doughnut hole in 2006 Of that total, 4 million Part D enrollees were estimated Of that total, 4 million Part D enrollees were estimated
to have spending in the doughnut holeto have spending in the doughnut hole 2 million2 million were estimated to reach catastrophic coverage level were estimated to reach catastrophic coverage level
Between 2006 and 2007, the number of PDPs that Between 2006 and 2007, the number of PDPs that cover brand-name drugs in the doughnut hole cover brand-name drugs in the doughnut hole decreased slightlydecreased slightly From 33 PDPs in 2006 to 27 PDPs in 2007From 33 PDPs in 2006 to 27 PDPs in 2007
In 11 states there are no plans available with full In 11 states there are no plans available with full coverage of brands and generics in the gapcoverage of brands and generics in the gap
Exhibit 8
Average Monthly Premiums Are Highest for Average Monthly Premiums Are Highest for PDPs Offering Full Gap CoveragePDPs Offering Full Gap Coverage
$30.17
$51.11
$93.46
$0
$10
$20
$30
$40
$50
$60
$70
$80
$90
$100
No CoverageNo Coverage GenericsGenericsOnlyOnly
Generics and Generics and BrandsBrands
Exhibit 9
SOURCE: Hoadley et al. SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings; 2007 Offerings; November 2006.November 2006.
Number of PDPs Number of PDPs
in 2007:in 2007:1,3371,337 511511 2727
HHS Estimates 90% of Medicare HHS Estimates 90% of Medicare Beneficiaries Have Drug CoverageBeneficiaries Have Drug Coverage
4.4 million10%
5.4 million13%
10.4 million24% 6.0
million14%
6.1 million14%
10.4 million 24%
NOTES: Numbers do not sum to 100% due to rounding. NOTES: Numbers do not sum to 100% due to rounding. 11 Includes coverage from Veterans Administration, Includes coverage from Veterans Administration, Indian Health Service, employer plans without retiree subsidies, and employer plans for active workers. Indian Health Service, employer plans without retiree subsidies, and employer plans for active workers. 22 Includes employer/union, FEHB, and TRICARE coverage. Includes employer/union, FEHB, and TRICARE coverage. 3 3 Approximately 0.5 million dual eligibles are Approximately 0.5 million dual eligibles are enrolled in Medicare Advantage drug plans and are reported in this category. SOURCE: HHS, June 14, 2006. enrolled in Medicare Advantage drug plans and are reported in this category. SOURCE: HHS, June 14, 2006. Data as of June 11, 2006.Data as of June 11, 2006.
Total Number of Beneficiaries = 43 MillionTotal Number of Beneficiaries = 43 Million
Total in Total in Part D Part D
Plans: 22.5 Plans: 22.5 MillionMillion(53%)(53%)
Stand-Alone Stand-Alone PDPPDP
Medicare Medicare Advantage Drug Advantage Drug
PlanPlan33
Dual Eligibles Dual Eligibles in PDPsin PDPs
Creditable Creditable Employer/UnioEmployer/Unio
n n CoverageCoverage22
No Creditable No Creditable CoverageCoverage
Other Other Creditable Creditable CoverageCoverage11
Exhibit 10
PDP MA-PD
UnitedHealthUnitedHealth
WellpointWellpoint
HumanaHumana
WellCare Health WellCare Health PlansPlans
Kaiser PermanenteKaiser Permanente
Coventry Health CareCoventry Health Care
Universal American Universal American Financial CorporationFinancial Corporation
Member HealthMember Health
Medco Health Medco Health SolutionsSolutions
5.7 5.7 millionmillion
4.4 4.4 millionmillion
1.2 1.2 millionmillion
Health NetHealth Net
Enrollment in Medicare Drug Plans Is Enrollment in Medicare Drug Plans Is Concentrated in a Few OrganizationsConcentrated in a Few Organizations
SOURCE: CMS Medicare Drug Coverage Enrollment Data, July 26, 2006. SOURCE: CMS Medicare Drug Coverage Enrollment Data, July 26, 2006.
All other parent All other parent organizations (n=216) have organizations (n=216) have
fewer than 400,000 PDP fewer than 400,000 PDP and/or MA-PD enrolleesand/or MA-PD enrollees
1.0 1.0 millionmillion
1.0 1.0 millionmillion0.8 0.8
millionmillion0.7 0.7
millionmillion0.5 0.5
millionmillion0.4 0.4
millionmillion0.4 0.4
millionmillion
3 organizations have 3 organizations have 50% of total Part D 50% of total Part D
enrollmentenrollmentof 22.5 millionof 22.5 million
Top 10 Parent Top 10 Parent Organizations:Organizations:
Exhibit 11
Variation in Costs for 2007 Among the 10 Variation in Costs for 2007 Among the 10 PDPs with the Highest EnrollmentPDPs with the Highest Enrollment
Cost Sharing by TiersPremium*
Tier 1 Tier 2 Tier 3 Specialty
AARP Medicare Rx $27.83 $6 $28 $69.10 33%
Humana Standard $15.17Standard Benefit (25%
Coinsurance)
Humana Enhanced $22.03 $5 $30 $60 25%
Wellcare Signature $23.79 $0 $57 $85 33%
Community Care Rx Basic $29.03 $0 25% 50% No Tier
UnitedHealth Rx Basic* $29.18 $7 $20 $45.75 33%
Medicare RX Rewards Value $24.72
$5 $29 No Tier 25%
Humana Complete $80.43 $5 $30 $60 25%
Silverscript $27.50 $5 $37 No Tier 25%
Prescription Pathway Bronze
$25.23 Standard Benefit (25% Coinsurance)
Exhibit 12
Note: *Marketed as Pacificare Saver in 2006. Monthly premium amount is weighted average across all Note: *Marketed as Pacificare Saver in 2006. Monthly premium amount is weighted average across all regions where plan is offered.regions where plan is offered.SOURCE: Hoadley et al. SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings; 2007 Offerings; November 2006.November 2006.
Variation in 2007 Cost Sharing in Top 10 Variation in 2007 Cost Sharing in Top 10 PDPs for PDPs for
Top 10 Brand-Name DrugsTop 10 Brand-Name Drugs
Note: *indicates drugs covered by all 10 PDPs with highest 2006 enrollment.Note: *indicates drugs covered by all 10 PDPs with highest 2006 enrollment.SOURCE: Hoadley et al. SOURCE: Hoadley et al. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and
2007 2007 Offerings; Offerings; November 2006.November 2006.
Exhibit 13
$17.97
$12.94
$17.97
$18.47
$28.00
$15.76
$29.00
$6.44
$34.61
$19.27
$57.00
$51.32
$57.00
$45.75
$37.00
$57.00
$85.00
$26.55
$69.10
$69.10
$87.81
$170.24
$168.85
$109.41
$0 $20 $40 $60 $80 $100 $120 $140 $160
Actonel*(Median=$28.50)
Diovan*(Median=$28.50)
Fosamax*(Median=$28.50)
Lipitor(Median=$29.50)
Nexium(Median=$33.91)
Norvasc*(Median=$29.50)
Plavix*(Median=$31.89)
Toprol XL*(Median=$25.76)
Zocor(Median=$153.42)
Zoloft (Median=$64.55)
Minimum Cost Sharing
Maximum Covered Cost Sharing
Maximum Uncovered Cost
Choice Matters – Even for Healthy SeniorsChoice Matters – Even for Healthy Seniors
ESTHERESTHER
Esther would pay between $577 and $1,309 per year
in a PDP, and between $300 and $970 in an MA-PD
plan, including premiums,
depending on the plan she chooses.
Esther is 67 and Esther is 67 and lives in lives in Bethesda.Bethesda.She takes only She takes only one one drug, Fosamax, drug, Fosamax, for osteoporosis.for osteoporosis.
CAROLYNCAROLYNCarolyn, age 60, on Carolyn, age 60, on SSDI and is about to go SSDI and is about to go on Medicare. She has on Medicare. She has rheumatoid arthritis rheumatoid arthritis and and other chronic other chronic conditions conditions and takes 8 and takes 8 medications.medications. The difference between her most The difference between her most and least expensive plan option is and least expensive plan option is at least at least $3,000 – greater for PDPs$3,000 – greater for PDPs
Carolyn would pay between $4,423 and $11,522 per year
in a PDP, and between $4,608 and $7,973 in an MA-
PD plan, including premiums,
depending on the plan she chooses.
The difference between her most The difference between her most and least expensive plan option is and least expensive plan option is roughly roughly $700 for either PDP or MA-$700 for either PDP or MA-PDPD
Exhibit 14
Only a third of surveyed seniors say there are Only a third of surveyed seniors say there are important differences among Part D Plansimportant differences among Part D Plans
ASKED OF SENIORS ONLY: ASKED OF SENIORS ONLY: Would you say there are important differences among the Medicare drug Would you say there are important differences among the Medicare drug
plans now available, or do you think they are all basically the same?plans now available, or do you think they are all basically the same?
SOURCE: KFF/HSPH SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign The Public’s Health Care Agenda for the New Congress and Presidential Campaign ((conducted Nov 9-19, 2006)conducted Nov 9-19, 2006)
24%
35%41%
Don’t know/ Don’t know/ RefusedRefused
They are They are basically the basically the
samesame
Important Important differencesdifferences
Exhibit 15
Part D Plan Enrollment Decisions in Part D Plan Enrollment Decisions in 20062006
Contrary to conventional wisdom, beneficiaries did not Contrary to conventional wisdom, beneficiaries did not report conducting extensive research before choosing a report conducting extensive research before choosing a Medicare drug plan Medicare drug plan
Many relied on “trusted sources” including pharmacists, Many relied on “trusted sources” including pharmacists, family members, and friendsfamily members, and friends
Most beneficiaries did not use resources provided by Most beneficiaries did not use resources provided by Medicare to help choose a planMedicare to help choose a plan Only 10% of beneficiaries said they or a family member Only 10% of beneficiaries said they or a family member
used Medicare.govused Medicare.gov
Name recognition and prior experience with the Name recognition and prior experience with the company were key factors for many in selecting a Part D company were key factors for many in selecting a Part D plan, possibly “trumping” other considerationsplan, possibly “trumping” other considerations
Exhibit 16
25%
32% 31%28%
23%
30%
55%
47% 45% 44% 42%
34%
50%45% 46%
42%
32%
21%
27%24%24%
17%
34%
30%
37%
0%
10%
20%
30%
40%
50%
60%
70%
Feb-04*
Apr-04*
Jun-04*
Oct-04*
Dec-04*
Apr-05
Aug-05
Oct-05
Dec-05
Feb-06
Apr-06
Jun-06
Nov-06
Favorable
Unfavorable
Trends in Seniors’ Impressions of Drug Benefit
*Question prior to Apr-05 referred to “new Medicare prescription drug *Question prior to Apr-05 referred to “new Medicare prescription drug lawlaw”. ”. Note: The increase in the percent saying “favorable” is statistically significant between Jun-06 and Nov-06.Note: The increase in the percent saying “favorable” is statistically significant between Jun-06 and Nov-06.SOURCE: Kaiser Family Foundation surveysSOURCE: Kaiser Family Foundation surveys..
AMONG SENIORS:AMONG SENIORS:
Given what you know about it, in general, do you have a favorable or Given what you know about it, in general, do you have a favorable or unfavorable impression of the new Medicare drug benefit?unfavorable impression of the new Medicare drug benefit?
Exhibit 17
Many Part D Plan Enrollees Say They Are Many Part D Plan Enrollees Say They Are Satisfied and Saving MoneySatisfied and Saving Money
All in all, have your All in all, have your experiences using your new experiences using your new Medicare drug plan been:Medicare drug plan been:
Compared to what you paid for Compared to what you paid for prescriptions last year, are you prescriptions last year, are you now saving money, paying more now saving money, paying more
or paying about the same or paying about the same overall? overall?
Don’t know/ Don’t know/ refusedrefused
Very Very positivepositive
SomewhaSomewhat positivet positive
SomewhaSomewhat t
negativenegativeVery Very
negativnegativee
Don’t Don’t knowknow
Saving Saving moneymoney
Paying Paying about about
the the samesame
Paying Paying moremore
46%30%
12%
7%5%
4%
14%52%
31%
Exhibit 18
AMONG SENIORS WHO SAY THEY ARE ENROLLED IN A MEDICARE PRESCRIPTION DRUG AMONG SENIORS WHO SAY THEY ARE ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN:PLAN:
SOURCE: KFF/HSPH SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential CampaignThe Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)(conducted Nov 9-19, 2006)
Yet Many Seniors Report Problems Related Yet Many Seniors Report Problems Related to Getting Prescriptions Under Their Part D to Getting Prescriptions Under Their Part D
PlanPlan
Exhibit 19
AMONG SENIORS WHO SAY THEY ARE ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN:
12%
6%
6%
11%
6%
6%
Have you had Have you had administrative administrative problemsproblems, such as problems getting , such as problems getting
enrollment cards, problems with enrollment cards, problems with premium payments, or billing premium payments, or billing
mistakes associated with your mistakes associated with your Medicare plan, or not?Medicare plan, or not?
Have you had any Have you had any problems problems getting your Rx drugsgetting your Rx drugs, such as , such as
drugs not being covered by drugs not being covered by your plan or being unable to your plan or being unable to
afford the cost of drugs under afford the cost of drugs under your plan, or not?your plan, or not?
Yes, had a MINOR problem
Yes, had a MAJOR
problem
Have had either type of Have had either type of problemproblem
12%12%
12%12%
23%23%
SOURCE: KFF/HSPH SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential CampaignThe Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted Nov 9-19, 2006)(conducted Nov 9-19, 2006)
Problems Filling Prescriptions by Number of Problems Filling Prescriptions by Number of Prescriptions and by IncomePrescriptions and by Income
≤ ≤ 3 Rx3 Rx dailydaily
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation Health Poll Report SurveyHealth Poll Report Survey (conducted June 8-18, 2006) (conducted June 8-18, 2006)
≥ ≥ 6 Rx6 Rxdailydaily
Percent who report having problems Percent who report having problems related to getting prescriptions by related to getting prescriptions by the number of prescriptions taken the number of prescriptions taken
daily…daily…
4 or 5 4 or 5 Rx dailyRx daily
Percent who report having problems Percent who report having problems related to getting prescriptions by related to getting prescriptions by
2005 income…2005 income…
12%18%
29%15%
16%
17%
15%
15%
18%
26%
Income Income > 20K> 20K
Income Income ≤ 20K≤ 20K
AMONG SENIORS WHO HAVE USED THEIR MEDICARE DRUG PLAN:AMONG SENIORS WHO HAVE USED THEIR MEDICARE DRUG PLAN:
Minor Minor Problems Problems ReportedReported
Major Major Problems Problems ReportedReported
27%27%
34%34%
46%46% 41%41%
33%33%
Exhibit 20
22% 58%
12%16% 63%
10%
How well would you say the new Medicare drug benefit works for How well would you say the new Medicare drug benefit works for your customers in each of the following areas…your customers in each of the following areas…
Very Very wellwell
Not well Not well at allat all
SomewhaSomewhat wellt well
Lowering Lowering their out-of-their out-of-pocket costspocket costs
Not Not too too wellwell
Getting them Getting them access to the access to the prescription prescription
drugs they needdrugs they need
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation National Survey of PharmacistsNational Survey of Pharmacists (conducted April 21-June 27, 2006) (conducted April 21-June 27, 2006)
Most Pharmacists Say Benefit Works Most Pharmacists Say Benefit Works Well for Their CustomersWell for Their Customers
Exhibit 21
3%3%
4%4%
44%17%
18%
19%
Yet nearly one in five pharmacists say Yet nearly one in five pharmacists say mostmost of their of their Medicare customers have had problems with their drug Medicare customers have had problems with their drug
planplan
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation National Survey of PharmacistsNational Survey of Pharmacists (conducted April 21-June 27, 2006) (conducted April 21-June 27, 2006)
To the best of your knowledge, have any of your Medicare customers To the best of your knowledge, have any of your Medicare customers experienced problems experienced problems getting their prescriptions filled getting their prescriptions filled since joining a new since joining a new
Medicare drug plan? Medicare drug plan? IF YES: Would you say most, some or just a few of your customers who IF YES: Would you say most, some or just a few of your customers who
joined Medicare drug plans have had problems filling prescriptions?joined Medicare drug plans have had problems filling prescriptions?
Most
None
Some
Just a few
Exhibit 22
67%
66%
58%
49%
Had to pay out-of-pocket for their Had to pay out-of-pocket for their prescription because pharmacist prescription because pharmacist
couldn’t verify their enrollmentcouldn’t verify their enrollment
Had problems getting enrollment Had problems getting enrollment cards or letters of enrollment cards or letters of enrollment
after signing up for a planafter signing up for a plan
Left the pharmacy without their Left the pharmacy without their prescription because the drug prescription because the drug
wasn’t on their plan’s formularywasn’t on their plan’s formulary
Left the pharmacy without their Left the pharmacy without their prescription because they prescription because they
couldn’t afford the copaymentcouldn’t afford the copayment
Specific Problems Reported by PharmacistsSpecific Problems Reported by Pharmacists
Percent of pharmacists who say any of their customers have experienced the Percent of pharmacists who say any of their customers have experienced the following specific problems filling prescriptions since joining a Medicare drug following specific problems filling prescriptions since joining a Medicare drug
plan…plan…
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation National Survey of PharmacistsNational Survey of Pharmacists (conducted April 21-June 27, 2006) (conducted April 21-June 27, 2006)
Exhibit 23
8% 41%
24%8% 43%
25%
7%
5%
19%
21%
About half of surveyed doctors say the About half of surveyed doctors say the Medicare drug benefit works well for their Medicare drug benefit works well for their
patientspatientsAmong the 78% of doctors who say at least a few of their patients are Among the 78% of doctors who say at least a few of their patients are enrolled in Medicare drug plans: How well would you say the new enrolled in Medicare drug plans: How well would you say the new
Medicare drug benefit works for your patients in each of the Medicare drug benefit works for your patients in each of the following areas…following areas…
Very Very wellwell
Not Not well at well at allall
Somewhat Somewhat wellwell
Lowering Lowering their out-of-their out-of-pocket costspocket costs
Not too Not too wellwell
Getting them Getting them access to the access to the prescription prescription
drugs they needdrugs they need
Don’t Don’t know/ know/ RefusedRefused
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation National Survey of Physicians National Survey of Physicians (conducted April 25-July 8, 2006)(conducted April 25-July 8, 2006)
Exhibit 24
37%
15%
8%
59%33%
7%
No
Don’t Don’t know/ know/
RefusedRefused
Among the 78% of doctors who say at least a few of their patients are Among the 78% of doctors who say at least a few of their patients are enrolled in Medicare drug plans…enrolled in Medicare drug plans…
SOURCE: Kaiser Family Foundation SOURCE: Kaiser Family Foundation National Survey of Physicians National Survey of Physicians (conducted April 25-July 8, 2006)(conducted April 25-July 8, 2006)
To the best of your knowledge, have any To the best of your knowledge, have any of your Medicare patients experienced of your Medicare patients experienced
problems getting their prescriptions filled problems getting their prescriptions filled since joining a new Medicare drug plan, since joining a new Medicare drug plan,
or not?or not?
Yes
Would you say that most, Would you say that most, some, or just a few of your some, or just a few of your
patients who joined Medicare patients who joined Medicare drug plans have had problems drug plans have had problems
filling prescriptions?filling prescriptions?
SomeSome
Just a fewJust a few
MostMost
Yet most doctors say at least some of their Yet most doctors say at least some of their Medicare patients experienced problems in their Medicare patients experienced problems in their
drug plandrug plan
Exhibit 25
6%2%
92%
9%
91%
Seniors, Pharmacists, and Doctors Agree: Medicare Drug Benefit is Too Complicated
Percent who agree or disagree that the Medicare prescription drug benefit is too Percent who agree or disagree that the Medicare prescription drug benefit is too complicatedcomplicated
SOURCES: KFF/HSPH SOURCES: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign The Public’s Health Care Agenda for the New Congress and Presidential Campaign ((conducted Nov 9-19, 2006); Kaiser Family Foundation conducted Nov 9-19, 2006); Kaiser Family Foundation National Survey of PharmacistsNational Survey of Pharmacists (conducted April 21- (conducted April 21-June 27, 2006); Kaiser Family Foundation June 27, 2006); Kaiser Family Foundation National Survey of Physicians National Survey of Physicians (conducted April 25-July 8, 2006)(conducted April 25-July 8, 2006)
Ages 65 and Ages 65 and overover
PharmacistsPharmacists DoctorsDoctors
20%7%
73%
AgreeAgree DisagreeDisagree Don’t know/RefusedDon’t know/Refused
Exhibit 26
Which statement better reflects your opinion?Which statement better reflects your opinion?
9%
60%
31%
Statement A: Statement A: Medicare should offer Medicare should offer
seniors dozens of plans seniors dozens of plans so they can select their so they can select their
ownown
Statement B: Statement B: Medicare should select a Medicare should select a
handful of plans that meet handful of plans that meet certain standards, so certain standards, so
seniors have an easier time seniors have an easier time choosingchoosing
Don’t Don’t know/ know/
RefusedRefused
Support for Limiting Plan Choice
ASKED OF SENIORS ONLY:
SOURCE: KFF/HSPH SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign The Public’s Health Care Agenda for the New Congress and Presidential Campaign ((conducted Nov 9-19, 2006)conducted Nov 9-19, 2006)
Exhibit 27
Message to Congress About Medicare Part D
AMONG SENIORS:Overall, what message would you send to policymakers in Washington
regarding the new Medicare drug benefit?
Is working well and no real Is working well and no real changes are neededchanges are needed
Is not working well and Is not working well and should be repealedshould be repealed
Is not working well and Is not working well and needs major changesneeds major changes
Could be improved with Could be improved with some minor changessome minor changes 41%
28%
12% 10%
Note: “Don’t know/refused” responses not shownNote: “Don’t know/refused” responses not shownSOURCE: KFF/HSPH SOURCE: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign The Public’s Health Care Agenda for the New Congress and Presidential Campaign ((conducted Nov 9-19, 2006)conducted Nov 9-19, 2006)
Exhibit 28
Cut the program back because it is Cut the program back because it is costing the government too much costing the government too much
moneymoney
Proposals to Change Medicare Part D
SomewhaSomewhat favort favor
Strongly Strongly favorfavor
Percent of seniors who favor Percent of seniors who favor each of the following proposals:each of the following proposals:
Source: KFF/HSPH Source: KFF/HSPH The Public’s Health Care Agenda for the New Congress and Presidential Campaign (The Public’s Health Care Agenda for the New Congress and Presidential Campaign (conducted conducted Nov 9-19, 2006)Nov 9-19, 2006)
13%
11%
46%
45%
44%
58%
67%
12%
15%
19%
21%
24%
18%
14%Allow government to negotiate with drug Allow government to negotiate with drug
companies for lower pricescompanies for lower prices
Waive the penalty for late enrollmentWaive the penalty for late enrollment
Reduce the number of available Reduce the number of available drug plansdrug plans
Keeping the program exactly as Keeping the program exactly as it isit is
Spend more federal money to get Spend more federal money to get rid of doughnut holerid of doughnut hole
Allow seniors to get drug plan Allow seniors to get drug plan directly from Medicaredirectly from Medicare
81%81%
76%76%
68%68%
66%66%
65%65%
26%26%
25%25%
Exhibit 29
Nationwide, 1 in 4 beneficiaries estimated to be Nationwide, 1 in 4 beneficiaries estimated to be eligible for Part D low-income subsidies are not eligible for Part D low-income subsidies are not
receiving themreceiving themBeneficiaries Eligible for Low-Income Subsidies (LIS) = 13.2 million
2.0 million (15%) Eligible by SSA and receiving subsidy
0.5 million (4%)0.5 million (4%)Eligible but Eligible but estimated estimated
to have creditable to have creditable coveragecoverage
SOURCE: Testimony of Mark McClellan, CMS Administrator, June 14, 2006. Data from CMS, as of June 11, SOURCE: Testimony of Mark McClellan, CMS Administrator, June 14, 2006. Data from CMS, as of June 11, 2006, and updated LIS eligibility determinations from SSA, as of July 14, 2006.2006, and updated LIS eligibility determinations from SSA, as of July 14, 2006.
3.1 million (24%)
NOT receiving subsidy
7.5 million (57%)Full/partial
dual eligibles and SSI recipients
receiving subsidy
0.1 million (1%) 0.1 million (1%) Anticipated Anticipated facilitated facilitated enrollmentenrollment
Total = 5.7 Total = 5.7 Million Million
Non-Duals Non-Duals Eligible for Eligible for
LISLIS
Exhibit 30
Part DPart D Successes and Challenges to Successes and Challenges to DateDate
Exhibit 31
According to HHS, 90% of all Medicare beneficiaries now have According to HHS, 90% of all Medicare beneficiaries now have “creditable” drug coverage – including over 23 million in Part D “creditable” drug coverage – including over 23 million in Part D plansplans
Plan participation was greater than expected in 2006, and the Plan participation was greater than expected in 2006, and the market expanded in 2007market expanded in 2007
Initial implementation problems were overcome, and not repeated Initial implementation problems were overcome, and not repeated on a large scale in 2007on a large scale in 2007
Most enrollees say they are satisfied with their plans so farMost enrollees say they are satisfied with their plans so far
HOWEVER…HOWEVER… Some beneficiaries still lack drug coverage and could face late Some beneficiaries still lack drug coverage and could face late
enrollment penaltyenrollment penalty Plans vary greatly in terms of coverage and benefit designPlans vary greatly in terms of coverage and benefit design
Unknown how well beneficiaries can choose a plan that meets their individual needs Unknown how well beneficiaries can choose a plan that meets their individual needs with so many choiceswith so many choices
Difficulty getting “extra help” to those with low incomesDifficulty getting “extra help” to those with low incomes LIS participation lower than projected; outreach difficultLIS participation lower than projected; outreach difficult Asset test excludes many with low incomesAsset test excludes many with low incomes
Even with drug coverage, many enrollees could face high costsEven with drug coverage, many enrollees could face high costs No coverage in the “doughnut hole”No coverage in the “doughnut hole” High cost sharing for specialty drugsHigh cost sharing for specialty drugs
Questions aQuestions and Unknowns nd Unknowns about Part about Part DD
Enrollment and Plan ParticipationEnrollment and Plan Participation Which plans will stick around over time? What will happen to other sources of Which plans will stick around over time? What will happen to other sources of
coverage, especially retiree plans? Do beneficiaries understand changes to coverage, especially retiree plans? Do beneficiaries understand changes to their coverage? How do beneficiaries react?their coverage? How do beneficiaries react?
Variations Across Drug Plans and FormulariesVariations Across Drug Plans and Formularies What are the implications of these variations for patients, especially those with What are the implications of these variations for patients, especially those with
chronic and/or rare conditions?chronic and/or rare conditions? Experiences in the Doughnut HoleExperiences in the Doughnut Hole
How many people will be affected each year? What will their experiences be? How many people will be affected each year? What will their experiences be? Does utilization change?Does utilization change?
Exceptions and Appeals ProcessesExceptions and Appeals Processes How many enrollees are affected? How do these processes work for enrollees?How many enrollees are affected? How do these processes work for enrollees?
Outreach to the UnenrolledOutreach to the Unenrolled What more can be done to get low-income subsides to those who are eligible What more can be done to get low-income subsides to those who are eligible
but not receiving them? What happens to beneficiaries whose LIS status but not receiving them? What happens to beneficiaries whose LIS status changes? How many beneficiaries will end up paying the late enrollment changes? How many beneficiaries will end up paying the late enrollment penalty?penalty?
Future Directions for Part DFuture Directions for Part D How will the benefit and the program evolve over time? What are the How will the benefit and the program evolve over time? What are the
prospects for possible reforms, such as drug price negotiation, simplification?prospects for possible reforms, such as drug price negotiation, simplification?
Exhibit 32
……thank you. thank you. Any questions? Any questions?