Medicare Part "d"

Discussion in 'Social Security' started by TinCanMan, Dec 17, 2007.

  1. TinCanMan

    TinCanMan Active Member

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    Medicare beneficiaries are likely to see a smaller number of drugs covered under their Part D insurance plans next year, as insurers have revised offerings and the government has culled hundreds of products from a list of approved drugs. On average, the number of drugs offered by the 10 insurers with the largest enrollment shrank by 26% from this year to next, according to data analyzed by Washington consulting firm Avalere Health. Two of the largest insurers UnitedHealth (UNH) and Humana (HUM) saw drops of 30% in some of their plans, from more than 3,750 drugs to just more than 2,620, Avalere’s analysis shows. Even so, the two insurers still have among the largest drug lists of the 10 biggest insurers. The drop came mainly because of changes made by Medicare, which shrank the list of drugs it will pay for, culling those that have been pulled by the FDA, are no longer being made, had duplicative billing codes or were drugs deemed "less than effective" by the FDA.

    Medicare officials and the insurers say most beneficiaries are unlikely to be affected. Enrollees taking drugs that were pulled will usually be able to find alternates or can go through an appeals process to try to stay on their current drugs, they said. "Most of those (removed) drugs were not used," says Jeff Kelman, chief medical officer for Medicare’s Center for Beneficiary Choices. UnitedHealth spokesman Daryl Richard says even with the drop, the company’s Medicare Rx Preferred plan covers "100% of the drugs" on Medicare’s approved list. Humana spokesman Tom Noland says, "As the Part D program develops, the size of the formulary is becoming more aligned with utilization patterns, consumer preferences, health outcomes and value for consumers." Avalere’s Jon Glaudemans says the enrollees should check the drug lists of plans they are considering before signing up, to see if the medications they take are included. The deadline for enrolling is 31 DEC 07. "Every year, insurers revise their formularies, and every year, beneficiaries should reassess their choices," Glaudemans says.

    One group that may be particularly affected by the change are some beneficiaries who qualify for government premium subsidies because they are low-income. About 2.1 million low-income-subsidy enrollees will be automatically switched to new insurers in 2008 because their current insurers raised premiums above a government benchmark. An Avalere analysis of those being switched from plans in Texas to other plans found that, on average, enrollees will be switched to coverage with 14% fewer drugs than if they had been able to remain with their current insurers, based on the revised 2008 drug lists. In addition, the new insurers require prior authorization on 15% of all drugs offered, compared with 10% under the plans no longer eligible to take low-income enrollees in Texas. That means the patient has to get approval from the insurer before getting the drug. "This means they will have a harder time accessing what they need," says Dan Mendelson, president of Avalere. Medicare spokesman Jeff Nelligan says there is no way to determine if the Avalere findings from Texas also hold true nationally. Nelligan said that insurers must meet Medicare’s requirements for offering drugs in all classes of products, provide at least a 30-day transition for those who must change drugs and offer an appeals process. He added that subsidy-eligible enrollees can change insurers even after the open enrollment period closes. Other enrollees cannot change. Following is a breakdown by Part D insurer indicating their number of enrollees as of JUL 07, the number of drugs covered in 2007, and the number of drugs that will be covered in 2008.

    - AARP MedicareRx Preferred : 3.1 million : 3,763 : 2,627
    - Humana PDP Standard : 2.1 million : 3,752 : 2,623
    - Humana PDP Enhanced: 1.1 million : 3,755 : 2,623
    - Community Care Rx Basic: 1.0 million : 1,835 : 1,627
    - AARP MedicareRx Saver: 0.9 million : 3,167 : 2,184

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