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Per-patient-per-month drug costs in Medicare Part D protected classes.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
Pharmacoeconomics, Vol. 24 Suppl 3 (2006), pp. 79-84.

OBJECTIVE: The objective of this study was to estimate the per-patient-per-month (PPPM) costs of medications in the six Medicare Part D protected classes based on findings among Medicare and dual eligible beneficiaries with drug coverage before the enactment of the benefit. DESIGN: Data were from the Thomson Medstat MarketScan Medicare and Medicaid claims databases. The study sample was constructed by identifying patients who were enrolled either in Medicare or dually in Medicare and Medicaid. PPPM costs were calculated for each protected class. Drugs covered under Part B were excluded. OUTCOMES MEASURE: PPPM aggregated costs within each class. RESULTS: The classes in which generic formulations are available (antidepressants and anticonvulsants) show low PPPM costs ($ US 45.31 and $ US 50.97, respectively). The most expensive class is the antiretrovirals ($ US 829.73). This class is the costliest for all dual eligible patients including those aged 64 years and under. Among the dual eligible aged 65 years and older, the immunosuppressants are the most expensive class. The same result is seen qualitatively in the Medicare group. CONCLUSIONS: PPPM costs are not uniformly high among the protected classes. The claims data in this study allowed a 'real world' check of how much the protected classes may impact the finances of Part D. There are differences within the classes between the dual eligible and Medicare patients, and also within the dual eligible by age. This is an important message to policy makers that a change to the structure of the protected classes in Part D may have differential effects across classes and also within classes.
L Mucha, NA Masia, KJ Axelsen

Per-patient-per-month drug costs in Medicare Part D protected classes.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
Pharmacoeconomics, Vol. 24 Suppl 3 (2006), pp. 79-84.

OBJECTIVE: The objective of this study was to estimate the per-patient-per-month (PPPM) costs of medications in the six Medicare Part D protected classes based on findings among Medicare and dual eligible beneficiaries with drug coverage before the enactment of the benefit. DESIGN: Data were from the Thomson Medstat MarketScan Medicare and Medicaid claims databases. The study sample was constructed by identifying patients who were enrolled either in Medicare or dually in Medicare and Medicaid. PPPM costs were calculated for each protected class. Drugs covered under Part B were excluded. OUTCOMES MEASURE: PPPM aggregated costs within each class. RESULTS: The classes in which generic formulations are available (antidepressants and anticonvulsants) show low PPPM costs ($ US 45.31 and $ US 50.97, respectively). The most expensive class is the antiretrovirals ($ US 829.73). This class is the costliest for all dual eligible patients including those aged 64 years and under. Among the dual eligible aged 65 years and older, the immunosuppressants are the most expensive class. The same result is seen qualitatively in the Medicare group. CONCLUSIONS: PPPM costs are not uniformly high among the protected classes. The claims data in this study allowed a 'real world' check of how much the protected classes may impact the finances of Part D. There are differences within the classes between the dual eligible and Medicare patients, and also within the dual eligible by age. This is an important message to policy makers that a change to the structure of the protected classes in Part D may have differential effects across classes and also within classes.
L Mucha, NA Masia, KJ Axelsen

Medicare Part D: selected issues for pharmacists and beneficiaries in 2007.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
J Manag Care Pharm, Vol. 13, No. 1. (b 2007), pp. 59-65.

BACKGROUND: Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the Medicare program since its inception in 1965. MMA was implemented on January 1, 2006, and established the Medicare prescription drug benefit, also known as Medicare Part D. Community and managed care pharmacists were essential to the success in 2006 of this new benefit program with 33 million beneficiaries. Pharmacists will continue to be an essential and integral part of the continued success of the Medicare prescription drug benefit in 2007, in part by being informed about the policies and regulations. OBJECTIVE: To review policy statements released by the Centers for Medicare & Medicaid Services (CMS) for the Medicare prescription drug benefit in 2006 and to compile an abridged version of the highlights from the policy statements that may affect pharmacists and their interaction with Medicare beneficiaries. METHODS: We reviewed all policy statements that were released publicly via the CMS Web site (www.cms.gov) policy guidance section between January 1, 2006, and September 30, 2006. We read through approximately 100 guidance statements and summarized approximately 50 that were determined to be relevant to beneficiaries and pharmacists in various practice settings. RESULTS: Policy statements that may impact beneficiaries of the Medicare prescription drug benefit in 2007 include the timeline for the annual coordinated election period, managed care open enrollment period, and distribution of annual notices of change to beneficiaries. Changes have also occurred in the standard benefit and cost sharing for low-income subsidy (LIS) or extra help that some beneficiaries are eligible to receive based on their current financial status. Discontinuation of coverage of erectile dysfunction drugs is a noteworthy coverage change. For all health care providers, the National Provider Identification (NPI) number will be used beginning May 23, 2007. Once the system using NPI numbers is required, no other provider identification number will be valid for billing Medicare and Medicaid. CONCLUSION: Important policy updates to the Medicare prescription drug benefit in 2007 include the subject areas of: (1) beneficiary enrollment, (2) transition medication fills, (3) standard benefit, (4) cost sharing, particularly for those who qualify for LIS, (5) enhancement of the Medicare Prescription Drug Plan Finder, (6) beneficiary complaints, (7) discontinuation of coverage for erectile dysfunction drugs, (8) vaccine coverage by the Medicare prescription drug benefit, (9) syringes in long-term care, (10) donation of unused medications by beneficiaries, (11) implementation of the NPI, and (12) preventive services covered by the Medicare program.
J Kilian, J Stubbings

Medicare Part D: selected issues for pharmacists and beneficiaries in 2007.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
J Manag Care Pharm, Vol. 13, No. 1. (b 2007), pp. 59-65.

BACKGROUND: Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the Medicare program since its inception in 1965. MMA was implemented on January 1, 2006, and established the Medicare prescription drug benefit, also known as Medicare Part D. Community and managed care pharmacists were essential to the success in 2006 of this new benefit program with 33 million beneficiaries. Pharmacists will continue to be an essential and integral part of the continued success of the Medicare prescription drug benefit in 2007, in part by being informed about the policies and regulations. OBJECTIVE: To review policy statements released by the Centers for Medicare & Medicaid Services (CMS) for the Medicare prescription drug benefit in 2006 and to compile an abridged version of the highlights from the policy statements that may affect pharmacists and their interaction with Medicare beneficiaries. METHODS: We reviewed all policy statements that were released publicly via the CMS Web site (www.cms.gov) policy guidance section between January 1, 2006, and September 30, 2006. We read through approximately 100 guidance statements and summarized approximately 50 that were determined to be relevant to beneficiaries and pharmacists in various practice settings. RESULTS: Policy statements that may impact beneficiaries of the Medicare prescription drug benefit in 2007 include the timeline for the annual coordinated election period, managed care open enrollment period, and distribution of annual notices of change to beneficiaries. Changes have also occurred in the standard benefit and cost sharing for low-income subsidy (LIS) or extra help that some beneficiaries are eligible to receive based on their current financial status. Discontinuation of coverage of erectile dysfunction drugs is a noteworthy coverage change. For all health care providers, the National Provider Identification (NPI) number will be used beginning May 23, 2007. Once the system using NPI numbers is required, no other provider identification number will be valid for billing Medicare and Medicaid. CONCLUSION: Important policy updates to the Medicare prescription drug benefit in 2007 include the subject areas of: (1) beneficiary enrollment, (2) transition medication fills, (3) standard benefit, (4) cost sharing, particularly for those who qualify for LIS, (5) enhancement of the Medicare Prescription Drug Plan Finder, (6) beneficiary complaints, (7) discontinuation of coverage for erectile dysfunction drugs, (8) vaccine coverage by the Medicare prescription drug benefit, (9) syringes in long-term care, (10) donation of unused medications by beneficiaries, (11) implementation of the NPI, and (12) preventive services covered by the Medicare program.
J Kilian, J Stubbings

Transition to Medicare Part D: an early snapshot of barriers experienced by younger dual eligibles with disabilities.

 Medicaid News, Syndicated  Comments Off
Aug 042007
 
Am J Manag Care, Vol. 13, No. 1. (January 2007), pp. 14-18.

OBJECTIVE: This study assessed the impact of transition from Medicaid drug coverage to Medicare Part D on a sample of dually eligible adults younger than age 65 years with disabilities. STUDY DESIGN: Telephone survey of employed adults participating in the Kansas Medicaid Buy-In program, Working Healthy, about their experiences in accessing medications after their transition to Part D. METHODS: A total of 328 (55%) individuals from a random sample of 600 agreed to participate in a survey administered by a university-based research unit during February and March 2006, which included 18 questions with yes/no, multiple choice, and open-ended responses. Participants resembled other Kansas dual eligibles demographically and medically, other than having slightly higher rates of mental illness and lower rates of mental retardation and some physical conditions. Participants' 2004 Medicare and Medicaid claims data were analyzed to obtain an overview of their comorbidities and previous prescription use. RESULTS: Twenty percent of participants reported difficulty obtaining medications, including drugs in Part D-protected classes; 13% were required to switch medications; and 8% stopped taking at least 1 medication. More than half did not know they could change plans monthly, potentially improving their access to medications. CONCLUSION: The high incidence of access problems despite Centers for Medicare & Medicaid Services (CMS) safeguards points to the need for ongoing monitoring of Part D. If the problems persist, CMS must be willing to modify the program and/or better enforce the rules already in place to avoid adverse outcomes for beneficiaries with disabilities.
JP Hall, NK Kurth, JM Moore

Transition to Medicare Part D: an early snapshot of barriers experienced by younger dual eligibles with disabilities.

 Medicaid News, Syndicated  Comments Off
Aug 042007
 
Am J Manag Care, Vol. 13, No. 1. (January 2007), pp. 14-18.

OBJECTIVE: This study assessed the impact of transition from Medicaid drug coverage to Medicare Part D on a sample of dually eligible adults younger than age 65 years with disabilities. STUDY DESIGN: Telephone survey of employed adults participating in the Kansas Medicaid Buy-In program, Working Healthy, about their experiences in accessing medications after their transition to Part D. METHODS: A total of 328 (55%) individuals from a random sample of 600 agreed to participate in a survey administered by a university-based research unit during February and March 2006, which included 18 questions with yes/no, multiple choice, and open-ended responses. Participants resembled other Kansas dual eligibles demographically and medically, other than having slightly higher rates of mental illness and lower rates of mental retardation and some physical conditions. Participants' 2004 Medicare and Medicaid claims data were analyzed to obtain an overview of their comorbidities and previous prescription use. RESULTS: Twenty percent of participants reported difficulty obtaining medications, including drugs in Part D-protected classes; 13% were required to switch medications; and 8% stopped taking at least 1 medication. More than half did not know they could change plans monthly, potentially improving their access to medications. CONCLUSION: The high incidence of access problems despite Centers for Medicare & Medicaid Services (CMS) safeguards points to the need for ongoing monitoring of Part D. If the problems persist, CMS must be willing to modify the program and/or better enforce the rules already in place to avoid adverse outcomes for beneficiaries with disabilities.
JP Hall, NK Kurth, JM Moore

Variation in estimated Medicare prescription drug plan costs and affordability for beneficiaries living in different states.

 Medicare News, Syndicated  Comments Off
Aug 042007
 
J Gen Intern Med, Vol. 22, No. 2. (February 2007), pp. 257-263.

BACKGROUND: Medicare Part D prescription drug plans (PDPs) implemented in January 2006 are designed to improve beneficiaries' access to pharmaceuticals and use market competition to yield affordable drug costs. Variations in estimated PDP costs for beneficiaries living in different states have not previously been characterized. OBJECTIVE: To describe variations in the estimated costs of PDPs (plan premium, copays, and coinsurance) within and across states. DESIGN: To estimate PDP costs based on 4 actual patient cases that exemplify common conditions and prescription drug combinations for Medicare beneficiaries, we used the online tool provided by the Centers for Medicare and Medicaid Services. MEASUREMENTS: Principal study outcomes included (a) variation across states in the estimated annual cost of the lowest-cost PDP for each case and (b) variation in the estimated affordability of the lowest-cost PDPs across states, based on cost-of-living-adjusted median income for zero-earner households. RESULTS: For all 4 patient cases, we found substantive within-state and between-state differences in the estimated costs of Medicare PDPs incurred by beneficiaries. The estimated annual costs to beneficiaries of the lowest-cost PDPs varied across states by as much as $320 for medications in the least expensive scenario, and by as much as $13,000 for the most expensive scenario. On average across states, a beneficiary with cost-of-living-adjusted median income would expect to spend 3%-28% of annual income to pay for medications in the lowest-cost PDPs in the 4 patient cases. The affordability of the lowest-cost plans varied across states, and for 2 of the 4 cases the lowest-cost PDP estimates were negatively correlated with cost-of-living-adjusted median income. CONCLUSIONS: Substantive differences in estimated PDP costs are evident across states for patients with common Medicare conditions. Importantly, the lowest-cost plans were not proportionally affordable with respect to state-specific cost-of-living-adjusted median income. Refinement of the Medicare drug program may be needed to improve national balance in PDP affordability for beneficiaries living in different states.
MM Davis, MS Patel, LK Halasyamani
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