Download or read book Closing the Medicare Part D Coverage Gap written by Joohyun Park and published by . This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The standard Medicare Part D benefit structure contains a gap in coverage (or so-called "doughnut hole") which requires beneficiaries to pay 100% of the cost for prescription drugs until they reach the catastrophic coverage phase. This coverage gap has been linked to a financial burden for beneficiaries resulting in poor medication adherence and other cost-related access problems. Under the 2010 Affordable Care Act (ACA) reform, the coverage gap has been gradually phasing out since 2011 such that beneficiaries will only pay 25% of drug costs by 2020. This study evaluated the impact of closing the coverage gap under the ACA by conducting three separate studies using data from the 2008-2015 Medicare Current Beneficiary Survey. Outcomes assessed included the utilization of and expenditures for prescription drugs, as well as cost-related access problems. Chapter 3 (Manuscript #1) analyzes trends in the distribution of beneficiaries in each benefit phase, prescription drug utilization, and expenditures among Part D beneficiaries not receiving the Low-Income Subsidy (LIS). After the ACA, the proportion of beneficiaries reaching the catastrophic coverage threshold increased (from 4% in 2010 to 6% in 2015), and they reached the threshold earlier in the year. The overall number of 30-day drug fills also increased after the ACA, although no significant changes in the number of 30-day drug fills were seen among those reaching the catastrophic coverage threshold. Total drug spending steadily increased after the ACA, with the largest increase seen in those reaching the catastrophic threshold; however, out-of-pocket spending significantly decreased among all beneficiaries (17% decrease in 2015 compared to 2009). Chapter 4 (Manuscript #2) evaluates the effects of the ACA coverage gap reform on drug utilization and expenditures using a difference-in-differences study design. Over the first five years after implementation of the ACA, out-of-pocket drug spending significantly decreased among non-LIS beneficiaries (treatment) relative to LIS beneficiaries (control), with growing decreases over time (average decreases of $41 in 2011 versus $135 in 2015). This was particularly noticeable among those who reached the coverage gap but not the catastrophic threshold. Despite seemingly large reductions in cost-sharing in the coverage gap, there were no significant changes in the number of 30-day drug fills and total drug spending after the ACA reform between non-LIS and LIS beneficiaries. Chapter 5 (Manuscript #3) evaluates the effects of the ACA coverage gap reform on cost-related access problems among beneficiaries using a difference-in-differences study design. Cost-related access problems were estimated by the likelihood of having cost-related nonadherence (CRN) or the adoption of drug cost-reduction strategies (CRS) by beneficiaries. Compared to LIS beneficiaries, no significant changes in CRN were seen among non-LIS beneficiaries after the ACA; furthermore, the likelihood of adopting CRS increased by 4 percentage points for non-LIS beneficiaries relative to LIS beneficiaries. Although the ACA reform has helped reduce out-of-pocket drug costs for beneficiaries by gradually reducing the beneficiary cost-sharing rate in the Part D coverage gap, the significant reduction in cost-sharing rate did not translate into an increased use of prescription drugs or resolved cost-related access problems for beneficiaries. Additionally, this study provides evidence of increased Part D spending, which has been a growing concern for the Medicare program. The findings of this study provide empirical evidence on the effects of closing the Part D coverage gap and address gaps in the limited existing literature. Overall, although the ACA decreased out-of-pocket drug costs, this study suggests additional initiatives will be needed to provide better protection against the cost of prescription drugs for Part D beneficiaries.
Download or read book Medicare Prescription Drug Coverage for Dummies written by Patricia Barry and published by ReadHowYouWant.com. This book was released on 2008-10-28 with total page 474 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Prescription Drug Coverage For Dummies offers strategies to cut through the confusions of Part D, either for yourself or for someone you're helping. It explains the programs ins and outs in plain words. It shows you how to avoid or cope with pitfalls and suggests how you can lower your costs or find a better deal. Best of all, it convinces you that you can - yes, you can - handle Medicare Part D!
Download or read book Closing the Prescription Drug Coverage Gap written by and published by . This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides information on one-time $250 rebate for Medicare beneficiaries who have not already been receiving Medicare Extra Help.
Download or read book Medicare For Dummies written by Patricia Barry and published by John Wiley & Sons. This book was released on 2016-06-02 with total page 414 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare For Dummies, 2nd Edition (9781119293392) was previously published as Medicare For Dummies, 2nd Edition (9781119079422). While this version features a new Dummies cover and design, the content is the same as the prior release and should not be considered a new or updated product. Make your way through the Medicare maze with help from For Dummies America's baby boomers are now turning 65 at the rate of about 10,000 a day. Yet very few have any idea about how Medicare works, when they should sign up, or how the program fits in with other health insurance they may have. Medicare For Dummies, 2nd Edition provides a detailed road map for navigating Medicare's often-baffling complexities and helps consumers avoid pitfalls that could otherwise cost them dearly. In plain language, the new edition explains: How to qualify for Medicare, according to your personal circumstances, including new information on the rights of people in same-sex marriages When to sign up at the time that’s right for you, to avoid lifelong late penalties How to weigh Medicare’s many options so you can be confident of making the decision that's best for you What Medicare covers and what you pay, with up-to-date details of the costs of premiums, deductibles, and copays—and how you may be able to reduce those expenses By conveying not only the basics but also how to troubleshoot problems and where to find assistance, Medicare For Dummies, 2nd Edition helps you to get the most out of Medicare.
Download or read book Medicare Part D Coverage Gap written by U.s. Government Accountability Office and published by . This book was released on 2017-08-04 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The Patient Protection and Affordable Care Act of 2010 established the Discount Program to help Medicare Part D beneficiaries with their prescription drug costs while in the coverage gap, which occurs between the initial and catastrophic coverage periods where Medicare helps pay for drug costs. Until the Discount Program began in 2011, beneficiaries in the coverage gap paid 100 percent of drug costs. The Discount Program required manufacturers to provide a 50 percent discount on the price of brand-name drugs for beneficiaries in the gap.GAO was asked to describe (1) CMS's oversight of the Discount Program; (2) perspectives of plan sponsors, manufacturers, and PBMs on effects of the Discount Program; and (3) how prices for brand-name drugs used by beneficiaries in the coverage gap and by those who did not reach the gap changed before and after the start of the Discount Program. To describe CMS's oversight, GAO reviewed CMS documents and interviewed CMS officials. To describe perspectives on the effects of the Discount Program, GAO interviewed the 7 largest Part D plan sponsors based on enrollment data, 8 of 10 manufacturers of brand-name drugs with the highest expenditures in the gap, and 3 PBMs who contracted with sponsors GAO interviewed. To describe price changes, GAO used CMS Part D data from 2007 to 2011 to track prices for high-expenditure brand-name drugs used by those in and those who did not reach the gap. GAO compared prices"
Download or read book The Coverage Gap written by and published by . This book was released on 2009 with total page 3 pages. Available in PDF, EPUB and Kindle. Book excerpt: A unique feature of the Medicare Part D drug benefit is the coverage gap, or so-called "doughnut hole," where Part D enrollees are required to pay 100 percent of total drug costs after their spending exceeds the initial coverage limit and before reaching the catastrophic coverage limit. The coverage gap exists because the cost of providing continuous coverage with no gap exceeded the budgetary limit imposed on the legislation that established the Medicare drug benefit. In 2010, most Part D plans have a coverage gap, which totals $3,610 in drug costs for plans offering the standard Medicare Part D benefit; by 2019, the gap is projected to be nearly $6,000. Part D sponsors are permitted to offer an alternative benefit design that covers at least some drug costs in the gap. Part D enrollees who qualify for the low-income subsidy (LIS) are generally not responsible for costs in the coverage gap. This Part D Data Spotlight examines the coverage gap in Medicare stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans, based on the authors' analysis of data from the Centers for Medicare & Medicaid Services (CMS). This research is part of a broader effort analyzing Medicare Part D plans in 2010 and trends since 2006, with key findings summarized in a series of data spotlights.
Download or read book Mind the Gap written by Florian Heiss and published by . This book was released on 2007 with total page 100 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans.
Download or read book The Medicare Handbook written by and published by . This book was released on 1989 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Part D Prescription Drug Benefit written by Susanne M. Kirchhoff and published by Createspace Independent Publishing Platform. This book was released on 2016-11-11 with total page 70 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) established a voluntary, outpatient prescription drug benefit under Medicare Part D, effective January 1, 2006. Medicare Part D provides coverage through private prescription drugplans (PDPs) that offer only drug coverage, or through Medicare Advantage (MA) prescription drug plans (MA-PDs) that offer coverage as part of broader, managed care plans. Private drug plans participating in Part D bear some financial risk, though federal subsidies cover most program costs in an effort to encourage participation and keep benefits affordable. At a minimum, Medicare drug plans must offer a "standard coverage" package of benefits or alternative coverage that is actuarially equivalent to a standard plan. Plans also may offer enhanced benefits. Although all plans must meet certain minimum requirements, there can be significant differences among offerings in terms of benefit design, specific drugs included in formularies (i.e., list of covered drugs), cost sharing for particular drugs, or the level of monthlypremiums. In general, beneficiaries can enroll in a plan, or change plan enrollment, when they first become eligible for Medicare or during open enrollment periods each October 15 through December 7. For plan year 2016, there are between 19 and 29 PDPs in each of the nation's 34 PDP regions, as well as Medicare Advantage plans. Because sponsors are allowed to change planofferings from year to year, beneficiaries must review their annual choices carefully to select theplans that best meet their needs. A key element of the Part D program is enhanced coverage for low-income individuals. Personswith incomes up to 150% of the federal poverty level (FPL) and assets below set limits are eligible for extra assistance with Medicare Part D premiums and cost sharing. Individuals enrolled in both Medicare and Medicaid (so-called dual eligibles), and certain other low-incombeneficiaries, are automatically enrolled in no-premium plans, which are Part D plans that have premiums at or below specified levels. In 2015, about 39 million Medicare beneficiaries received prescription drug benefits through a PDP or an MA-PD, with almost one-third receiving a low-income subsidy. Another 2 million received drug assistance through a Part D-subsidized retiree health plan, and 8 million Medicare beneficiaries had separate, private drug coverage. Overall, about 88% of Medicare beneficiarieshad drug coverage through either PDP or MA-PD plans, retiree coverage, or private insurance ofcomparable scope. Total Part D expenditures were close to $90 billion in calendar year 2015. Medicare Part D has cost less than originally forecasted, due in part to lower-than-predicted enrollment and increased use of less expensive generic drugs. However, the Medicare Trustees project that spending on Part D benefits will accelerate over the next 10 years due to expectationof further increases in the number of enrollees, costs associated with the gradual elimination of the out-of-pocket cost coverage gap, changes in the distribution of enrollees among coverage categories, a slowing of the trend toward greater generic drug utilization, and an increase in the use and the prices of specialty drugs.
Download or read book Rare Diseases and Orphan Products written by Institute of Medicine and published by National Academies Press. This book was released on 2011-04-03 with total page 442 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rare diseases collectively affect millions of Americans of all ages, but developing drugs and medical devices to prevent, diagnose, and treat these conditions is challenging. The Institute of Medicine (IOM) recommends implementing an integrated national strategy to promote rare diseases research and product development.
Download or read book Medicare Part D Coverage Gap written by United States. Government Accountability Office and published by . This book was released on 2012 with total page 41 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act of 2010 established the Discount Program to help Medicare Part D beneficiaries with their prescription drug costs while in the coverage gap, which occurs between the initial and catastrophic coverage periods where Medicare helps pay for drug costs. Until the Discount Program began in 2011, beneficiaries in the coverage gap paid 100 percent of drug costs. The Discount Program required manufacturers to provide a 50 percent discount on the price of brand-name drugs for beneficiaries in the gap. GAO was asked to describe (1) CMS's oversight of the Discount Program; (2) perspectives of plan sponsors, manufacturers, and PBMs on effects of the Discount Program; and (3) how prices for brand-name drugs used by beneficiaries in the coverage gap and by those who did not reach the gap changed before and after the start of the Discount Program. To describe CMS's oversight, GAO reviewed CMS documents and interviewed CMS officials. To describe perspectives on the effects of the Discount Program, GAO interviewed the 7 largest Part D plan sponsors based on enrollment data, 8 of 10 manufacturers of brand-name drugs with the highest expenditures in the gap, and 3 PBMs who contracted with sponsors GAO interviewed. To describe price changes, GAO used CMS Part D data from 2007 to 2011 to track prices for high-expenditure brand-name drugs used by those in and those who did not reach the gap. GAO compared prices for the two baskets because drugs used by those in the gap may be more susceptible to price increases since manufacturers must provide the discount for these drugs.
Download or read book Medicare Part D Prescription Drug Benefit written by United States. Congress. Senate. Special Committee on Aging and published by . This book was released on 2014 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Part D written by John E. Dicken and published by DIANE Publishing. This book was released on 2010-06 with total page 43 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Centers for Medicare and Medicaid Serv. (CMS) allows Part D plans to utilize different tiers with different levels of cost sharing as a way of managing drug utilization and spending. One such tier, the specialty tier, is designed for high-cost drugs (HCD) whose prices exceed a certain threshold. Beneficiaries who use these drugs typically face higher out-of-pocket costs than those who use only lower-cost drugs. This report provides info. about HCD eligible for a specialty tier incl. spending under Medicare Part D; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and Part D plan sponsors ability to negotiate price concessions. Illus.
Download or read book Frontiers in Health Policy Research written by David M. Cutler and published by MIT Press. This book was released on 2004 with total page 196 pages. Available in PDF, EPUB and Kindle. Book excerpt: Leading economists discuss current health policy challenges, including prescription drugs benefits as a component of Medicare and conversion to for-profit health plans.
Download or read book Medicare Part D Coverage Gap written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2018-01-11 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Part D Coverage GAP: Discount Program Effects and Brand-Name Drug Price Trends
Download or read book The Medicare Part D Coverage Gap written by Jack Hoadley and published by . This book was released on 2008 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Closing a Gap in Medicare Drug Coverage written by Public Policy Institute (AARP (Organization)) and published by . This book was released on 2009 with total page 3 pages. Available in PDF, EPUB and Kindle. Book excerpt:
