Rx Drugs

Medicare: Prescription Drugs

Visit the Medicare Drug Coverage Center for help in navigating the new Medicare Part D prescription drug benefit.

From Families USA:

Buyer Beware: Higher Costs, More Confusion for the 2008 Part D Enrollment Season discusses several reasons why Part D enrollees, especially those with low incomes, should carefully examine their plans to see if the plans will continue to suit their needs. These reasons include rising premiums, the widening "doughnut hole," and other changes in coverage. (November 2007)

The CHAMP Act's Medicare Provisions Offer Real Help to Seniors and People with Disabilities discusses how this bill, passed by the House of Representatives on August 1, would level the playing field between traditional Medicare and private Medicare Advantage plans, improve benefits for beneficiaries, particularly for those with low incomes, and protect Medicare consumers. (September 2007)

Medicare Part D Drug Prices Are Climbing Quickly explains that private insurance plans have not been able to negotiate lower drug prices in the Medicare Part D drug program, creating a growing burden for seniors and taxpayers. (April 2007)

Rhetoric versus Reality: Comparing Medicare Part D Prices to VA Prices rebuts the main arguments against comparing drug prices under Medicare Part D and those obtained by the Department of Veterans Affairs. (April 2007)

No Bargain: Medicare Drug Plans Deliver High Prices presents an analysis of drug prices that Part D plans charge for the 20 drugs most frequently prescribed to seniors for each of the plans offered by the five largest Part D insurers compared to the prices secured by the VA. We found that VA prices are substantially lower than the lowest prices charged by the largest Part D insurers for all of these 20 drugs. We also found that the seven largest U.S. pharmaceutical companies spent more than twice as much on marketing, advertising, and administration as they did on R&D. (January 2007)

Stop Bad Ideas—Private Gain and Public Pain in Medicare discusses how the push to privatize Medicare has resulted in landmark profits for the drug and insurance industries at the expense of taxpayers and Medicare beneficiaries. (December 2006)

Picking a Part D Plan: Déjà Vu All Over Again? discusses why beneficiaries, advocates, and health care providers should be aware of changes in Part D plans that will affect coverage in 2007. It also urges all beneficiaries to examine premiums, drug costs, formularies, and drug restrictions to find the best Medicare drug plan. (November 2006)

Coverage through the "Doughnut Hole" Grows Scarcer in 2007 examines what will happen next year to stand-alone drug plans that provide meaningful doughnut hole coverage—plans that provide doughnut hole coverage of both the generic and non-generic drugs that most seniors need. (November 2006)

Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices asks two key questions: 1) What has happened to Part D prices for the most frequently prescribed drugs from November 2005 to April 2006?; and 2) How do Part D drug prices now compare to the prices secured by the VA? The answers are both clear and disappointing: 1) Virtually all of the Part D plans raised their prices for the majority of the top 20 drugs in this study. 2) For all of the top 20 drugs prescribed to seniors, VA prices in April were lower than the lowest prices charged by Part D plans. (June 2006)

Testimony of Ron Pollack, Executive Director, Families USA, before the U.S. House Committee on Ways and Means regarding the implementation of the Medicare Part D drug program. (June 14, 2006).

Statement: Senators Introduce Legislation to Waive Medicare Part D Enrollment Penalty (May 16, 2006)

Press Release: Key Medicare Drug Issues Lie Ahead after the End of the First Enrollment Period (May 12, 2006)

Statement: Bush Administration Playing "Fast and Loose" with New Medicare Enrollment Numbers (May 10, 2006)

Medicare Drug Program Fails to Reach Low-Income Seniors documents the slow pace of enrollment in Medicare Part D and, particularly, the program's failure to reach those most in need—the low-income seniors and people with disabilities who are entitled to special subsidies. (May 2006)

On April 1, 2006, Medicare beneficiaries lose the protection of extended transition benefits. April Fools for Medicare Part D Beneficiaries? Transitional Benefits End April 1 explains what this means for beneficiaries and what they can do about it. (March 29, 2006)

President Bush's Fiscal Year 2007 Budget: Analysis of Key Health Care Provisions Includes discussion and commentary on Health Savings Accounts (HSAs), Medicaid, and Medicare. (February 22, 2006)

Statement: New Medicare Drug Enrollment Figures Are Both Disappointing and Misleading (February 22, 2006)

Expectations Shrinking for Medicare Part D Enrollment assesses the first two months of enrollment in the new drug benefit. The report shows that: 1) enrollment so far is lagging well behind last year's projections; 2) most of those counted as covered already had drug coverage; and 3) low-income beneficiaries are being left behind. | Press Release (February 2006)

Press Release: Less than 18 Percent of Low-Income Seniors Approved for New Medicare Drug Subsidies (January 6, 2006)

Statement: Administration's Report about Medicare Drug Enrollment Is Very Misleading (December 22, 2005)

Falling Short: Medicare Prescription Drug Plans Offer Meager Savings evaluates how well Medicare prescription drug plans (PDPs) did in giving seniors low drug prices. This report compares the base drug prices reported by Medicare drug plans with the prices negotiated through the Department of Veterans Affairs (VA). Press Release | Charts (December 2005)

Press Release: Only One Out of Nine Low-Income Seniors Approved for New Medicare Drug Subsidies (December 5, 2005)

Press Release: Medicare Information Resources for Your Community Listed in New Directory | State-by-State Directory (November 23, 2005)

Press Release: Medicare Prescription Drug Program and Plan Finder Complicated for Seniors | Comparison Chart l Evaluating Drug Plans l Glossary of Terms l Plan Finder Game: An Illustration (November 15, 2005)

Statement: A Confusing and Complicated Mess: A Review of the New Medicare Drug "Plan Finder" (November 4, 2005)

Getting the Best Price: Lessons Learned from the Medicare Discount Card Program Families USA examined how well the Medicare discount card program did in negotiating lower drug prices for those in Medicare. We found that, for the 50 drugs most frequently prescribed to seniors, the lowest Medicare discount card price was almost always much higher than the lowest price negotiated by one large government purchaser, the Department of Veterans Affairs (VA). | Press Release | Charts (September 2005)

Gearing Up Series--The Holes in Part D: Gaps in the New Medicare Drug Benefit (Part 1 of 2) This brief discusses the three major kinds of gaps associated with the Part D benefit: 1) the financial gap beneficiaries will face; 2) the drug coverage gap; and 3) the enrollment gap. (July 2005)

Gearing Up Series--Filling the Holes in Part D: The Essential Role of State Pharmacy Assistance Programs (Part 2 of 2) This brief examines the key decisions states will have to make when determining how their Pharmacy Assistance Programs can provide wraparound coverage and explains the special role of these programs under the Medicare drug law. It also discusses how these programs can help with enrollment. (July 2005)

Trouble Brewing? New Medicare Drug Law Puts Low-Income People at Risk The Medicare Modernization Act (MMA) was touted as a program that would help all Medicare enrollees, particularly the neediest, obtain prescription drug coverage. Now there is evidence that a flaw in the MMA will cause serious harm to many of the most vulnerable elderly and people with disabilities. | Press Release (July 2005)

Medicare Drug Law Materials for Advocates and Consumers: Click here for a collection of materials produced by Families USA covering different aspects of the new law.

Approximately Half of Americans in Medicare Are at Risk of Losing Coverage When the New Law Is Implemented This careful analysis of the new Medicare law and proposed regulations for the law shows that the new program will be more than a disappointment--half of America's Medicare beneficiaries are at risk of being worse off then they are today. (October 20, 2004)

Statement: Data Hidden in 2004 Medicare Trustees' Report Show Huge Harm to Seniors by New Drug Law (September 14, 2004)

Gearing Up: States Face the New Medicare Law Is Your State Ready for 2006? An Introduction to What the New Medicare Part D Prescription Drug Benefit Means for Medicaid (September 2004)

Statement: Sharp Contrast between Presidential Rhetoric and Reality of Medicare Drug Discount Card Program (June 14, 2004)

Statement: Medicare Drug Discount Card No Match for Real Savings Obtained by Department of Veterans Affairs (June 2, 2004)

Sticker Shock: Rising Prescription Drug Prices for Seniors This updated study examines price changes for the top 30 brand-name drugs prescribed for seniors. The survey found that the prices of these drugs have increased by nearly 22 percent over the past three years. (June 2004)

Statement: Medicare Drug Discount Card Fails To Make Drug Costs Affordable for Seniors (April 29, 2004)

Statement: Bush Administration Deliberately Withheld Real Cost of Medicare Law(March 12, 2004)

Release: Cronkite Video Helps Launch National Senior Education Campaign about New Medicare Law (February 25, 2004)

To read about the President's New Medicare Proposals in His Budget for Fiscal Year 2005, See The Bush Administration's Fiscal Year 2005 Budget: Analysis of Key Health Care Provisions (February 4, 2004)

The New Medicare Prescription Drug Discount Card: A Very Flawed Program (December 19, 2003)

To see Families USA Executive Director Ron Pollack discuss the new Medicare drug bill on The Newshour with Jim Lehrer, click here. (December 8, 2003)

Statement: Anger among Seniors Contrasts with Euphoria at White House As President Signs Medicare Bill (December 8, 2003)

Q&A: Understanding the New Medicare Prescription Drug Benefit | en Español (November 25, 2003)

FEHBP Rates Increase as Much as $4,572.12 a Year: Is This Really A Model for Medicare? examines whether the Federal Employee Health Benefits Program (FEHBP), a model used by the House Medicare prescription drug bill, is a good model for the seniors and people with disabilities that Medicare serves. (September 30, 2003)

The House Medicare Drug Bill's Doughnut Hole: A Chasm for Low-Income Beneficiaries? discusses the large gap in drug coverage low-income Medicare beneficiaries would experience under the House Medicare drug bill. (September 26, 2003)

Private Plans: A Bad Choice for Medicare discusses the role of private plans in Medicare up to this point. According to the piece, the evidence so far indicates that, for seniors and people with disabilities, particularly those living in rural areas, the traditional Medicare program works better than private plans. (September 26, 2003)

Prescription Drug Cost-Sharing and Low-Income People: Five Good Reasons to Keep It Minimal makes the point that prescription drugs aren't the only health expenses Medicare beneficiaries must pay for out of pocket. It goes on to assert that any final Medicare prescription drug bill should not raise cost-sharing amounts above the limits in the current Senate and House bills. (September 12, 2003)

More Red Tape for the Poor? Dual Eligibles in the Medicare Rx Bill describes the potential problems that the Senate's Medicare prescription drug bill, which would not cover dual eligibles (low-income people who are eligible for both Medicare and Medicaid), could create for such beneficiaries and for Medicare and state Medicaid programs. (September 3, 2003)

What's in the House and Senate Medicare Prescription Drug Bills? (July 17, 2003)

Low-Income Prescription Drug Benefit: Key Differences between House and Senate Medicare Bills (Revised July 10, 2003)

Out-of-Pocket Spending for Medicare Beneficiaries: Two Examples (July 9, 2003)

Immigrant Provisions of the Senate Prescription Drug Bill: A Good Investment in America's Future (July 14, 2003)

Tax-Free Savings Accounts for Medical Expenses: A Tax Cut Masquerading as Help to the Uninsured: This Issue Brief discusses Health Savings Accounts and Health Savings Security Accounts, two kinds of personal savings accounts that were created by a bill attached to the House Republican Medicare prescription drug legislation. (July 2003)

Out of Bounds: Rising Prescription Drug Prices for Seniors (July 2003)

Families USA Testimony on Controlling Drug Pricing before the House of Representatives (June 25, 2003)

Bitter Pill: The Rising Prices of Prescription Drugs for Older Americans (June 24, 2002)

Statement: House Republicans Prescription Drug Proposal Provides Little Relief to Seniors or People with Disabilities (June 24, 2003)

What Happens When Traditional Medicare Has to Bid Against Private Plans? An Example of How the House Bill Would Privatize Medicare (June 18, 2003)

Low-Income Medicare Beneficiaries Are Most in Need of Prescription Drug Coverage (June 17, 2003)

Issue Brief: WHY FEHBP Isn't a Good Option For Medicare - The Federal Employees Health Benefit Program (FEHBP) has frequently been pointed to as a model for Medicare. An FEHBP-style overhaul is favored by many, but before it is seen as a panacea for Medicare, it is worth considering how well its basic structure fits Medicare--a fit that is not the best. (March 2003)

The Bush Administration's Fiscal Year 2004 Budget: Analysis of Key Health Care Provisions (February 7, 2003)

Health Action in Depth: Summary of Congressional Action on Medicare Prescription Drug Legislation (September 2002)

Families USA's comments on the Bush Administration's proposed Medicare-Endorsed Prescription Drug Card and Drug Discount Card Assistance Initiative submitted to HHS Secretary Tommy Thompson. (May 6, 2002)

Families USA's Assessment of the Discount Card Plan (March 2002)

Bush's Prescription Drug Card Proposal Is Much Ado About Very Little (February 28, 2002)

President Bush's Medicare Drug Proposals (February 13, 2002)

Criteria For Assessing The Bush Administration's Proposed Medicare Drug Discount Card Program (February 2002)

Bush's Budget Outlines a Dangerous Path for America's Health Care: Families USA Statement on Administration's 2003 Budget (February 4, 2002)

President's "Helping Hand" Isn't. Families USA analysis shows administration's prescription drug proposal won't reach many of the people it is intended to help. (January 29, 2001)

Cost Overdose: Growth in Drug Spending for The Elderly 1992-2010: this report provides an in-depth analysis of the plight of Medicare beneficiaries who must contend with rising prescription drug prices. (July 2000)

Update on Patients' Rights and Medicare: Families USA updates the status of Patient's Rights legislation currently pending in Congress and outlines the issue of prescription drug benefits for seniors. (March 2000)

Still Rising: Drug Price Increases for Seniors, 1999-2000 examines the increasing costs of the 50 drugs that are most commonly prescribed for senior citizens. [Press Release with Key Findings] (April 2000)

Letter to the Senate from the Leadership Council of Aging Organizations including Families USA. This letter addresses the council's expectations for the creation of a Medicare prescription drug benefit. (March 2000)

From AARP:

FYI: The Cost of Prescription Drugs: Who Needs Help? This issue brief presents data on out-of-pocket spending on prescription drugs by poor and low-income beneficiaries, as well as by beneficiaries with modest incomes, such as those with incomes between 175% and 250% of the federal poverty level. It also shows differences in out-of-pocket drug spending between beneficiaries with and without drug coverage. (October 2000)

Medicare Beneficiaries and Prescription Drug Coverage: Gaps and Barriers provides information on four aspects of prescription drug coverage among Medicare beneficiaries including prescription drug coverage and supplemental insurance coverage. (June 1999)

From the Access to Benefits Coalition and the National Council on Aging:

The Department of Health and Human Services has estimated that at least 75 percent of the Medicare beneficiaries who do not have any prescription drug coverage are eligible for the Low-Income Subsidy. The Next Steps: Strategies to Improve the Medicare Part D Low-Income Subsidy identifies recommended legislative, administrative, and regulatory reforms that should be made to the Low-Income Subsidy to improve access to the program for seniors and people with disabilities with limited means. (January 2007)

From Avalere Health:

According to Enrollment-Weighted Average Premiums for the Top 10 PDPs by Enrollment as of April 2008, among the top 10 most popular Medicare prescription drug plans, which account for about three-fourths of all Medicare beneficiaries enrolled in such plans, six increased premiums this year, and four reduced them. The analysis also found that the Part D plan with the largest number of enrollees (AARP MedicareRX Preferred) increased its average monthly premium by 15 percent. (June 2008)

From the Center for American Progress:

Medicare Prescription Drug Legislation: What It Means for Rural Beneficiaries presents a new analysis showing that rural beneficiaries are, relative to their urban counterparts, older, sicker, have lower incomes, and are nearly twice as likely to lack any type of prescription drug coverage. They therefore have a greater need for a Medicare drug benefit. The report argues that such beneficiaries would not be served by a drug benefit that has weak protections for low-income beneficiaries and that relies exclusively on private insurers to provide the benefit. (September 2003)

From the Center for Economic and Policy Research:

The Origins of the Doughnut Hole: Excess Profits on Prescription Drugs describes how the Medicare Part D coverage gap, also known as the “doughnut hole,” increases drug costs for seniors while ensuring profits for the pharmaceutical and private insurance industries. (August 2006)

From the Center for Studying Health System Change:

Unequal Access: African-American Medicare Beneficiaries and the Prescription Drug Gap reports that African Americans' lower incomes, lack of supplemental insurance, and greater prevalence of certain chronic conditions all contribute to the prescription drug access gap between African American and white seniors. The authors assert that, as policy makers debate how to structure a Medicare drug benefit, designing a comprehensive benefit with minimal out-of-pocket costs for low-income elderly Americans could substantially narrow the prescription drug gap between African American and white Medicare beneficiaries. (July 2003)

From the Center on Budget and Policy Priorities:

About 1.7 Million Medicare Beneficiaries in Rural America Would Be Denied Medicare Prescription Drug Benefits under the Senate Prescription Drug Bill explains that these beneficiaries would not be covered under the Senate's bill because they are "dual eligibles"-low-income people who are eligible for both Medicare and Medicaid-that the Senate bill doesn't cover. Dual eligibles are more likely to live in rural areas than typical Americans, so this exclusion would disproportionately affect rural beneficiaries. This would represent the first time that a group of Medicare beneficiaries would be excluded from a Medicare benefit. (September 2003)

The Six Million Medicare Beneficiaries Excluded from Prescription Drug Benefits under the Senate Bill Are Disproportionately Minority reports that African American and Latino Medicare beneficiaries are at least twice as likely to be excluded from Medicare drug coverage under the Senate bill because they are "dual eligibles." However, a majority of dual eligibles are non-Hispanic whites. (September 2003)

Health Savings Security Accounts: A Costly Tax Cut That Could Weaken Employer-Based Health Insurance details provisions in the House Medicare prescription bill that would create a new tax break in the form of Health Savings Security Accounts. These tax-advantaged personal savings accounts could be used to pay for out-of-pocket medical expenses. According to the report, however, the bill would cost $163 billion and would likely lead to major changes in employer-based health coverage that would adversely affect low-income, older, and sicker workers. (June 2003)

From The Commonwealth Fund:

Medicare Part D: How Do Vulnerable Beneficiaries Fare? surveyed counselors, attorneys, program managers, and health professionals about steps that could make Medicare Part D work better for the most vulnerable beneficiaries. For some enrollees, particularly those who must transition from Medicaid to Medicare drug coverage, the new program can be confusing or disruptive and result in delays in getting drugs. The report also suggests certain policy and procedural changes that could enhance program performance. (May 2008)

Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries considers specific options for simplifying Part D in several areas: standardizing the benefit descriptions and procedures used by plans and the Medicare program; further standardization of the plan's benefit parameters, particularly the rules for cost-sharing; and changes to the rules governing plan formularies. (May 2008)

The Medicare prescription drug program has improved access to needed medications for millions of Americans. However, an estimated 3.3 million of the 13.2 million beneficiaries eligible for the low-income subsidy are not receiving that help. Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries argues that administrators must find better ways to reach out to these beneficiaries, simplify the enrollment process, and provide hands-on assistance in navigating that process. (May 2007)

Before the Medicare drug law was enacted, many states already had programs in place to provide prescription drug coverage to some residents who did not qualify for Medicaid drug coverage. Now, states are trying to figure out whether and how to "wrap around" the new federal benefit in order to fill in coverage gaps. State Pharmacy Assistance Programs: A Chartbook offers policy makers and others comprehensive information on the 38 pharmacy assistance programs now in place, including how these efforts generally compare with the new Medicare drug benefit. (August 2004)

The Fall 2001 edition of the "Commonwealth Fund Quarterly," a compilation of current work in health policy and practice, has been released. It includes a cover story on the Medicare+Choice program, as well as articles on the need for a Medicare drug benefit, problems women face when attempting to obtain health coverage, and the kinds of help small companies need to provide health coverage to their workers. (Fall 2001)

Designing a Medicare Drug Benefit: Whose Needs Will Be Met?This policy brief explores options for designing a Medicare drug benefit that would serve the most beneficiaries. According to the brief, if annual income alone is used to determine eligibility, most beneficiaries wouldn't qualify for coverage. The brief proposes a broader definition of need that includes beneficiaries without continuous and stable coverage, those with high expenditures, and those with multiple chronic conditions. Under this expanded definition, nearly 90 percent of beneficiaries would be eligible for coverage. (December 2000)

From the Commonwealth Fund, Kaiser Family Foundation, and Tufts-New England Medical Center:

Medicare Prescription Drug Benefit Progress Report: Findings from A 2006 National Survey of Seniors provides an in-depth look at the experiences seniors have had with Medicare Part D. The survey, which was administered to approximately 16,000 seniors in English and in Spanish, found that most seniors enrolled in the program paid less out of pocket for drugs than those with no coverage, but they still paid more than those who had coverage from other sources (like employer-based coverage). (August 2007)

From the Congressional Black Caucus Foundation Center for Policy Analysis and Research:

Structured Inefficiency: The Impact of Medicare Reform on African Americans summarizes key aspects of the new Medicare prescription drug law and analyzes their likely effect on African-American seniors. This analysis answers three primary questions: Do the provisions of the new legislation increase African Americans' access to health care and prescription drugs?, Does the legislation increase the quality of health care provided to them?, and Does the legislation's fiscal structure promote the best interests of African American seniors and the African American community as a whole? (January 2004)

From Consumers Union:

Prescription Drugs for Medicare Beneficiaries: 10 Important Facts: this paper presents some of the most important data and facts policymakers need to shape a Medicare prescription drug benefit that is effective in reducing financial burdens on Medicare beneficiaries. (April 2000)

From the Department of Health and Human Services (HHS) Office of the Inspector General:

According to Dual Eligibles’ Transition: Part D Formularies’ Inclusion of Commonly Used Drugs, 18 percent of dual eligibles were enrolled in plans that cover all commonly prescribed medications, while 30 percent were enrolled in plans cover less than 85 percent of commonly prescribed drugs. In total, drug plans cover an average of 92 percent of the 178 medications most commonly prescribed to dual eligibles. (January 2006)

From Health Affairs:

Access to Cancer Drugs in Medicare Part D: Formulary Placement and Beneficiary Cost-Sharing in 2006 found that Part D greatly expanded Medicare beneficiaries’ access to cancer treatments. An analysis of nearly 3,000 Part D plans found that virtually all plans cover generic cancer drugs and the majority of brand-name drugs. Copayments for cancer drugs are relatively low, but prior-authorization requirements may limit access to some brand-name treatments. A subscription is necessary to view the full article. (September 2006)

Beneficiaries who choose to remain in traditional fee-for-service Medicare are charged much higher monthly premiums for drug coverage, on average, than those enrolled in managed care plans, according to A First Look at the New Medicare Prescription Drug Plans. The article also reports that, while variations in cost-sharing and formularies provide beneficiaries with choices, they also make the system much more complex. (May 2006) SUBSCRIPTION REQUIRED

Employer-sponsored health coverage is often described as the most reliable private source of Medicare supplementation for prescription drugs, but this study finds that employer coverage is becoming a less dependable source of coverage for new retirees and is likely to become even less so. Employer-Sponsored Health Insurance and Prescription Drug Coverage for New Retirees: Dramatic Declines in Five Years reports that the proportion of Medicare beneficiaries in the 65-69 age group with employer-sponsored drug coverage fell from 40 percent in 1996 to 35 percent in 2000. The authors assert that the erosion of retiree coverage, coupled with a lack of adequate alternatives, adds urgency to the current Medicare prescription drug debate. (July 2003)

From the Health Privacy Project at Georgetown University's Institute for Health Care Research and Policy:

New Proposed Medicare-Endorsed Prescription Drug Card Assistance Program Fails to Protect Privacy of Medicare Beneficiaries examines the limits on how drug card sponsors (PBMs) can use beneficiary information and disclose beneficiary information to others under the Administration's proposed Medicare drug discount card. The article is accompanied by a chart that provides a side-by-side comparison of the CMS proposed rule preamble and the actual proposed regulation text. (March 2002)
For the article, go to (http://www.healthprivacy.org/usr_doc/Rx_Program_Summary.pdf).
The chart can be found at (http://www.healthprivacy.org/usr_doc/Rx_program_chart.pdf).

From the Journal of the American Medical Association:

Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D presents an analysis of data from a government survey of 24,234 Medicare beneficiaries in 2004, 2005, and 2006. The percentage of seniors who said they skipped medications because of cost declined after Part D took effect in January 2006. However, the sickest beneficiaries still skip prescriptions because they cannot afford them. (April 2008)

From The Kaiser Family Foundation:

Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings covers topics ranging from premiums and the coverage gap to benefit design, cost-sharing, and the availability of plans for those who receive the low-income subsidy. The analysis found little change in Part D plans since 2006, but it concluded that increases in cost-sharing and utilization management restrictions may keep some beneficiaries from obtaining the drugs they need. (April 2008)

A unique feature of the Medicare Part D drug program is the so-called “doughnut hole”—the gap in coverage. Medicare Part D 2008 Data Spotlight: The Coverage Gap examines the effect of the doughnut hole in Medicare stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans today, and it attempts to forecast what it could mean for beneficiaries in the future. (November 2007)

Medicare Prescription Drug Benefit includes the latest information and data about Medicare Part D, including 2008 plan information and the most recent enrollment data. (November 2007)

Medicare Part D Plan Characteristics, by State, 2008 Stand-Alone Prescription Drug Plans is a quick fact sheet that shows the number and type of prescription drug plans being offered in each state. (October 2007).

Tracking Medicare Health and Prescription Drug Plans Monthly Report for September 2007 charts the private plan offerings, enrollment status, and changes within Medicare Part D. (October 2007)

Medicare Part D Plan Characteristics provides new state-specific summary data about available Medicare drug benefit options. It illustrates the number of stand-alone plans with coverage in the "doughnut hole," as well as the number of plans available at no cost to qualifying beneficiaries. (November 2006)

Early Experiences of Medicare Beneficiaries in Prescription Drug Plans: Insights from Medicare State Health Insurance Assistance Program (SHIP) Directors explores early experiences with the Part D drug benefit based on the observations of SHIP directors who work closely with Medicare beneficiaries and CMS. SHIP directors reported problems and concerns relating to enrollment, premium payments, dual eligibles, authorization requirements, data system errors, and the “doughnut hole.” (August 2006)

The Medicare Health and Prescription Drug Plan Tracker provides current and historical information about Medicare Advantage plans at the national, state, and county level. It includes such data as the numbers of eligible beneficiaries by county, breakdowns of Medicare managed care payment rates in different regions, as well as local data about the new Medicare stand-alone prescription drug plans (PDPs). (June 2006)

Premiums and Cost Sharing Features in Medicare’s New Prescription Drug Program, 2006 examines the premiums, deductibles, and selected cost-sharing features of Medicare Advantage prescription drug plans. It finds that Medicare Advantage plans, on average, charge less for drug coverage ($18 per month) than stand-alone drug plans ($37 per month). This is due in part to the fact that the government pays these plans more to participate in the program. (May 2006)

Medicare Drug Plans: Experiences of Dual Enrollees and Other Low-Income Beneficiaries is a forum in which experts discussed how well Part D has done in providing low-income subsidies to seniors and beneficiaries with disabilities, as well as dual eligibles. The following materials were released in conjunction with the forum (May 18, 2006):

Transitions 2006 is a video that shows the experiences of three dual eligibles whose drug coverage shifted from Medicaid to Medicare.
Observations on the Initial Implementation of the Medicare Prescription Drug program reports on the findings of a focus group discussion with state Medicaid directors.
Towards Making Medicare Work for Low Income Beneficiaries: A Baseline Comparison of the Part D Low-Income Subsidy and Medicare Savings Programs Eligibility and Enrollment Rules examines how the low-income subsidy interacts with the assistance that Medicaid provides to cover Medicare premiums and cost-sharing.

Talking about Medicare: Your Guide to Understanding the Program is designed to help beneficiaries and their families think through basic health care issues. It also provides information on how the Part D drug program works, how to choose a drug plan that meets beneficiary needs, and how low-income enrollees can get additional help with drug costs. (April 2006)

Kaiser Health Poll Report Survey--Selected Findings on Seniors’ Views of the Medicare Prescription Drug Benefit found that 45 percent of seniors said they had enrolled or planned to enroll in a drug plan, 29 percent said they did not intend to enroll in a drug plan, and another 23 percent said they were uncertain. The majority of those who did not plan to enroll said they had another program or plan that helps pay for their prescriptions. Overall, seniors’ views about the Medicare drug benefit were more unfavorable than favorable. (February 2006)

Four in five businesses that now provide retiree health benefits will accept government subsidies for continuing to provide retiree drug coverage that is at least as good as Medicare's coverage when the new drug benefit starts in 2006, according to Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins: Findings from the Kaiser/Hewitt 2005 Survey on Retiree Health Benefits. The survey examined 300 of the nation's largest private-sector employers that provide retiree health benefits. (December 2005)

African Americans and the New Medicare Drug Benefit: These materials include a slide show on how the new benefit will affect African Americans, as well as a chart pack with statistics on African Americans, Latinos, and whites with Medicare. These resources highlight potential implications for outreach efforts under the new Medicare drug benefit. (November 14, 2005)

The Medicare Prescription Drug Improvement and Modernization Act Implementation Timeline presents important dates and deadlines for key implementation activities related to the new Medicare prescription drug benefit. (March 2005)

Knowledge of the new Medicare prescription drug law remains sketchy, but 15 months from the date when the benefit is set to kick in, many more people on Medicare have an unfavorable than a favorable impression of the new law. Views of the New Medicare Drug Law: A Survey of People on Medicare assesses beneficiary attitudes toward the new Medicare drug law. It provides detailed insight in their perceptions and opinions about the law, the Medicare-approved drug-discount card program, and the new Medicare drug benefit. (August 2004)

New Kaiser Family Foundation Survey Shows Seniors Confused About Medicare Rx Drug Law argues that seniors are confused about the Medicare prescription drug debate and the resulting prescription drug law. While about two-thirds of seniors reported following the debate closely, just 15 percent said they understood the new drug law very well, and almost seven in 10 didn't know that it was passed and signed into law. (February 2004)

As legislators continue their work to enact a Medicare prescription drug benefit, it is helpful to understand how beneficiaries' needs. How Do Patterns of Prescription Drug Coverage And Use Differ for White, African American, and Latino Medicare Beneficiaries Under 65 and 65+ provides a snapshot of racial and ethnic differences in Medicare beneficiaries' drug coverage, use, and spending. The summary briefly discusses the relevance of the key findings to the current policy debate about prescription drug coverage. (July 2003)

Low-income assistance is one key feature of the Medicare prescription drug bills passed by the House and Senate. State-Level Poverty Data for the Medicare Population includes tables that present national and state-level data on the number of Medicare beneficiaries who may be eligible for additional assistance based on the income eligibility thresholds specified in the House and Senate bills (135 percent, 150 percent, and 160 percent of the federal poverty level). (July 2003)

The Federal Employees Health Benefits Program (FEHBP) has recently been cited as a model for new Medicare prescription drug legislation. The Federal Employees Health Benefits Program: Program Design, Recent Performance, and Implications for Medicare Reform provides a basic description of the FEHBP structure, benefits, financing, and operations. It also discusses how FEHBP and Medicare compare in terms of benefits and health plan choices, whether the FEHBP model could provide savings for Medicare, how FEHBP compares to Medicare+Choice, and FEHBP's recent performance in terms of cost, benefit changes, and access to providers. (May 2003)

The Current State of Retiree Health Benefits: Findings from the Kaiser/Hewitt 2002 Retiree Health Survey presents findings from a study of large private-sector employers conducted between July and September of 2002. Information was collected on a variety of topics, including costs, premiums, retiree contributions, benefit design, prescription drug benefits, recent changes, changes expected within the next three years, and the implications of a Medicare drug benefit for employers. (December 2002)

"Prescription Drug Discount Card Programs: Implications for Medicare Beneficiaries" is the title of testimony given by Patricia Newman, director of the Medicare Policy Project with the Foundation, for the Senate Finance Committee's hearing on the Bush Administration's Medicare modernization proposal. The statement provides an overview of existing prescription drug discount card programs, describes some features of the Administration's recent proposal for a Medicare-endorsed discount card program, and raises some of the key issues consumers face in comparing the programs currently available. (March 7, 2002)

Medicare and Prescription Drug Focus Groups: Summary Report from the Kaiser Family Foundation discusses the findings from their recently completed focus groups designed to assess public perceptions and attitudes about Medicare and current options for reform, including the addition of a prescription drug benefit. Eight focus groups with both elderly and non-elderly participants were held in four locations: Atlanta, Baltimore, Cincinnati, and San Diego. Among the key findings are that "seniors are VERY satisfied with the Medicare system" and that "participants suffer a severe case of sticker shock when they consider the price tag of a drug benefit program for seniors." (July 2001)

Medicare and Prescription Drugs This fact sheet from the Kaiser Family Foundation includes updated information on current sources of drug coverage for Medicare beneficiaries, characteristics of beneficiaries who lack drug coverage, and provides data on prescription drug use and spending. (February 2001)

Prescription Drug Coverage for Medicare Beneficiaries: A Side-by-Side Comparison of Selected Proposals: This document provides a side-by-side comparison of five major federal proposals that have been considered to provide outpatient prescription drug coverage to Medicare beneficiaries. It begins with a summary table comparing key features of each proposal, followed by a detailed comparison of the following major proposals: Breaux/Frist, Clinton, Kennedy/Stark, Snowe/Pallone and Bilirakis/Peterson. (February 2000)

From the Kaiser Family Foundation

From the Kaiser Family Foundation and the Commonwealth Fund:

Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate over Drug Benefits was conducted to provide policymakers with better information on disabled beneficiaries' need for prescription drug coverage. The report concludes that Medicare beneficiaries with disabilities have few coverage options for prescription drugs besides Medicaid. (September 2002)

From the Kaiser Family Foundation, the Commonwealth Fund, and Tufts-New England Medical Center:

Survey Finds Four in 10 Seniors Do Not Take Medications as Prescribed; Poor Experiences with Drugs and Costs Contribute to Non-Adherence: According to this national survey, four in 10 seniors say they have not taken all the drugs their doctors prescribed them in the previous year, either because the costs were too high, because they did not think the drugs were helping them, or because they did not think they needed them. Nationally, slightly more than one in four seniors (27 percent) reported that they did not have any prescription drug coverage at the time of the survey. Full article available with subscription. (April 2005) From the Kaiser Family Foundation and Health Affairs:

Outlook for Health Spending, the first report resulting from a continuing Health Affairs and Kaiser Family Foundation partnership, has leading health policy experts examining new projections of future health care spending, including implications of the new Medicare prescription drug benefit. This partnership will publish a series of Web exclusives to speed dissemination of critical health care data. Web casts and related links are part of the package. (February 2004)

From Public Citizen:

Medicare Privatization: Bad for Seniors and People with Disabilities includes new information on the Bush Administration's PPO demonstration program (an attempt to introduce a new type of managed care plan into Medicare) and on HMO premiums and drug benefits for 2003. The report concludes that relying more heavily on private plans is not the approach to Medicare reform that is in the best interests of beneficiaries, nor is it what beneficiaries desire. Instead, the report recommends that the existing Medicare program be expanded to include prescription drug coverage. (February 2003)

Medicare Privatization: The Case Against Relying on HMOs and Private Insurers to Offer Prescription Drug Coverage examines government and private sector research on the Medicare program's current experience with private sector plans. The report finds that coverage offered through private insurers would be unreliable, inefficient, and confusing to beneficiaries. It also concludes that private plans would not be able to negotiate the steep drug price discounts that would be achievable if Medicare offered a prescription drug benefit directly. (September 2002)

From the Urban Institute:

Prescribing the Best Medicare Drug Prices, available as a webcast and transcript, examines one of the most pressing and expensive domestic issues - a prescription drug benefit for Medicare Beneficiaries. In this discussion, leading experts discussed the pros and cons of securing the best prescription prices through the private market, pharmacy benefit managers, and government negotiation. (March 4, 2003)

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