This Medicare Part D data spotlight examines three common techniques used by Medicare stand-alone prescription drug plans in 2008 to manage enrollees’ use of formulary drugs, such as quantity limits, prior authorization, and step therapy rules. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices.

It analyzes data from the 47 stand-alone prescription drug plans available nationwide using a sample of 169 commonly-used and high-cost prescription drugs. It finds that utilization management restrictions are more common in 2008 than in 2006, with 30% of sample drugs subject to some use restriction in 2008, up from 20% in 2006.

The analysis was conducted jointed by Jack Hoadley of Georgetown University, Elizabeth Hargrave and Katie Merrell of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)

This Medicare Part D data spotlight examines the formularies (list of covered drugs) of Medicare stand-alone prescription drug plans in 2008, changes since 2006, and differences in how plans cover brand-name and generic drugs. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices.

It analyzes data from the 47 stand-alone prescription drug plans available nationwide using a sample of commonly-used and high-cost prescription drugs. The analysis finds that there has been relative stability in the coverage of sample drugs since 2006. It also finds that most drug plans (91 percent) cover more than 90 percent of the generic sample drugs, while only 28 percent of plans cover more than 90 percent of brand-name sample drugs.

The analysis was conducted jointed by Jack Hoadley of Georgetown University, Elizabeth Hargrave and Katie Merrell of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)

This brief focuses on moderate-income families and examines how family income and the types of jobs that parents have differs depending on whether the child is uninsured or privately insured. Uninsured children are significantly more likely to have parents who earn lower wages and have the types of jobs with lower rates of employer coverage.

Issue Brief (.pdf)

The Value of Extra Benefits Offered by Medicare Advantage Plans in 2006

As Medicare Advantage enrollment continues to climb, this report prepared for the Kaiser Family Foundation compares the value of extra benefits provided by private fee-for-service and other types of Medicare Advantage plans.

As of January 2008, 8.8 million people with Medicare were enrolled in a Medicare Advantage plan, an increase of 63% since 2005. Some say the recent growth in Medicare Advantage enrollment is due to the extra benefits offered by plans, which help to reduce out-of-pocket costs for enrollees. One of the reasons plans are able to provide extra benefits is that Medicare pays plans more, on average, to provide services for enrollees than it would pay for similar beneficiaries in traditional Medicare, according to the Congressional Budget Office and the Medicare Payment Advisory Commission.

The report’s analysis confirms that on average Medicare Advantage plans provided extra benefits above what traditional Medicare covers in 2006, but finds the value of extra benefits lower for private fee-for-service plans than for other Medicare Advantage plans. Private fee-for-service plans are of particular interest because they now account for more than one in five beneficiaries enrolled in a Medicare Advantage plan.

The analysis uses a model to estimate of the net value to enrollees of the benefit packages provided by different Medicare Advantage plans in 2006. Information on plan benefits came from the Medicare Compare database in September 2006, while data on Medicare utilization, unit costs, and expected cost-sharing are chiefly derived from the 2004 Medical Expenditure Panel Survey. The report was prepared for the Foundation by Mark Merlis.

Report (.pdf)

The Kaiser Family Foundation has also posted an appendix detailing the methodology used in the Medicare Part D 2008 Data Spotlight series. The series analyzes key aspects of the 2008 Medicare Part D prescription drug plan choices.

All of the spotlights in this series were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

Data Spotlight Appendix (.pdf)

Broadcast and cable stations donated an average of 17 seconds an hour to PSAs, totaling one-half of one percent of all TV airtime, according to the study, , released by the Kaiser Family Foundation. The most frequent time period for PSAs to air was between midnight and 6 a.m., accounting for 46% of donated PSAs across all stations in the study; looking only at broadcast stations, 60% of donated PSAs ran overnight. The time period with the fewest donated PSAs was during prime time (8-11 p.m.), with 13% of all donated PSAs.

The report was released on Thursday, January 24, 2008, at a forum that featured Federal Communications Commission Members Michael Copps, Jonathan Adelstein, and Deborah Taylor Tate along with representatives from News Corporation, CBS, Time Warner, Univision, the Ad Council and the American Legacy Foundation.

Report (.pdf)

Current Issues in Medicaid: A Mid-FY2008 Update Based on a Discussion with Leading Medicaid Directors

This report provides a brief mid-fiscal year 2008 update on current issues in Medicaid, from the perspective of state Medicaid directors who administer the program. Medicaid directors identified a number of key issues, concerns and priorities in mid fiscal year 2008. At the top of the list were the effects of an increase in fiscal stress across states, a number of federal – state issues, including those impacting Medicaid enrollment and access, and their current efforts to address the uninsured.

Report (.pdf)

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles

The seventh annual 50-state survey of eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and SCHIP for children and families reports that nearly two-thirds of states expanded access to Medicaid and SCHIP between July 2006 and January 2008.

Executive Summary (.pdf)

Report (.pdf)

This report describes the history of special needs plans, how they fit into the larger Medicare Advantage marketplace, and what information could help assess whether these plans are performing differently from other Medicare Advantage plans.

Special needs plans serve individuals such as those who are institutionalized, people covered under both Medicare and Medicaid, or those with chronic or disabling conditions. Enrollment in these plans doubled in the past year, and President Bush recently signed the bill reauthorizing Medicare’s special needs plans through 2009. This report also examines why companies are establishing special needs plans and the challenges to oversight and marketing of these plans. The report was prepared for the Foundation by researchers at Mathematica Policy Research.

Report (.pdf)

On May 25, 2006, Vermont Governor Jim Douglas signed into law comprehensive health care reform legislation. The plan is designed to increase access to affordable health care while reducing cost through quality improvement measures. The plan requires employers to provide or help finance coverage for their workers. For individuals, participation in the new coverage program is voluntary, though the state legislature will reevaluate the need for an individual mandate if 96 percent of state residents are not covered by 2010.

Fact Sheet (.pdf)