The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries
11
THE COMMONWEALTH FUND The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries Stuart Guterman Director, Program on Medicare’s Future The Commonwealth Fund AcademyHealth Annual Research Meeting June 27, 2006
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The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries. Stuart Guterman Director, Program on Medicare’s Future The Commonwealth Fund AcademyHealth Annual Research Meeting June 27, 2006. What Do We Want From The New Drug Benefit?. - PowerPoint PPT Presentation
Transcript of The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries
THE COMMONWEALTH
FUND
The Potential Impact of theNew Prescription Drug Benefit on
Medicare BeneficiariesStuart Guterman
Director, Program on Medicare’s FutureThe Commonwealth Fund
AcademyHealth Annual Research MeetingJune 27, 2006
THE
COMMONWEALTH FUND
What Do We Want FromWhat Do We Want FromThe New Drug Benefit?The New Drug Benefit?
• Continuity—Will beneficiaries with coverage before have corresponding (or better) coverage under Part D?
• Availability—Will beneficiaries be able to find a plan that’s best for them?
• Access—Will beneficiaries be able to get the drugs they need?
THE
COMMONWEALTH FUND
Concern AboutConcern AboutVulnerable PopulationsVulnerable Populations
• Medicaid recipients• Other low-income beneficiaries• Nursing home residents• Frail and disabled beneficiaries• Chronically ill beneficiaries• Racial and ethnic minorities
THE
COMMONWEALTH FUND
Source of Prescription Drug CoverageSource of Prescription Drug Coveragefor Community-Dwellingfor Community-Dwelling
Medicare Beneficiaries, 1998-2000Medicare Beneficiaries, 1998-2000
24.7
16.5
10.5
34.8
11.815.8
0
5
10
15
20
25
30
35
40
45
50
None Medicare
HMO
Medicaid Employer Medigap Other
Source: B. Stuart, et al. “Riding the Roller Coaster: The Ups and Downs in Out-of-Pocket Spending Under the Standard Medicare Drug Benefit.” Health Affairs. 24(4). (July/August 2005): 1025.
Percent
THE
COMMONWEALTH FUND
Source of Prescription Drug Coverage for Source of Prescription Drug Coverage for Medicare Beneficiaries Residing in Nursing Medicare Beneficiaries Residing in Nursing Homes, 2001Homes, 2001
No Rx coverage 20%
Other supplement
with Rx coverage
9 %
Other supplement with Rx coverage unknown
15 %
Full Medicaid 56%
Source: Stuart, B. et al. “Coverage and Use of Prescription Drugs in Nursing Homes: Implications for the Medicare Modernization Act.” Medical Care. 44(3). (March 2006): 243.
THE
COMMONWEALTH FUND
Coverage, Income, and Chronic Illness Are Coverage, Income, and Chronic Illness Are Factors in Adherence toFactors in Adherence to
Prescribed Drug RegimensPrescribed Drug Regimens
26.3
36.835.2 34.9
0
10
20
30
40
50
All seniors No prescription drug
coverage
Low income Three or more chronic
conditions
Source: Safran, D. et al. “Prescription Drug Coverage and Seniors: Findings From a 2003 National Survey.” Health Affairs Web exclusive. April 19, 2005.
Percent of Seniors Not Adhering to Prescribed Drug Regimens
THE
COMMONWEALTH FUND
Beneficiary Out-of-Pocket Costs Under the Beneficiary Out-of-Pocket Costs Under the Medicare Part D Standard Benefit, 2006Medicare Part D Standard Benefit, 2006
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
Total Covered Drug Cost
Total Out-of-pocket Out-of-pocket+premium
Out-of-Pocket Cost
THE
COMMONWEALTH FUND
Deductibles Offered by Medicare Stand-Deductibles Offered by Medicare Stand-Alone Prescription Drug Plans, 2006Alone Prescription Drug Plans, 2006
$0
58% of plans
$50-$100
8%
$250
34% of plans
$150-$175
0%
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
THE
COMMONWEALTH FUND
Availability of Coverage in theAvailability of Coverage in thePart D “Coverage Gap”Part D “Coverage Gap”
No coverage
84% of plans
Generics and Brand
3% of plans
Generics only
13% of plans
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
THE
COMMONWEALTH FUND
Average Plan Premiums by Deductible and Average Plan Premiums by Deductible and Availability of Coverage in theAvailability of Coverage in the
Part D “Coverage Gap”Part D “Coverage Gap”
$30.74$35.91
$48.09
$61.28
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
$70.00
$250 deductibleand no
coverage
$0 deductibleand no
coverage
$0 deductibleand generics
only
$0 deductibleand generics
+brand
Plan Premium
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
THE
COMMONWEALTH FUND
The Papers in This Session The Papers in This Session • Defining and Measuring Performance of Medicare Prescription Drug
Plans’ FormulariesTanisha Carino, Ph.D., Avalere Health
• Following Doctors’ Orders…or Not: Medication Adherence Among Medicare Beneficiaries and What We Can Expect Part D Coverage to AccomplishDana Gelb Safran, Ph.D., Tufts/New England Medical Center
• Drug Coverage, Disease Burden, and the Intensity of Medication
Use among Medicare Beneficiaries Bruce Stuart, Ph.D., University of Maryland at Baltimore
• Discussant:Scott Young, MD, AHRQ
