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  • Medicare Part D 2008 Data Spotlight: Specialty Tiers

    Issue Brief

    This Medicare Part D data spotlight focuses on the use of specialty tiers for high-cost and injectible drugs in Medicare Prescription Drug Plans in 2008. It finds that the number of plans with specialty tiers has nearly doubled since 2006. It also looks at the drugs assigned to specialty tiers, the beneficiary cost sharing structure, and policy implications such higher out-of-pocket expenses and selection issues among beneficiaries who evaluate plans based on cost sharing. This…

  • Medicare Part D 2008 Data Spotlight: The Coverage Gap

    Issue Brief

    This Medicare Part D data spotlight examines the coverage gap, or “doughnut hole,” in Medicare drug plans available in 2008. Part D enrollees (other than those receiving low-income subsidies) will reach the coverage gap after they incur $2,510 in total drug costs in 2008. At that point, enrollees are required to pay 100 percent of drug costs until they qualify for catastrophic coverage. The analysis finds that in 2008, more than a quarter of stand-alone…

  • Medicare Part D 2008 Data Spotlight: Premiums

    Issue Brief

    This Medicare Part D data spotlight analyzes the premiums charged by the 1,824 stand-alone Medicare Part D plans that will be offered in markets across the country in 2008. The analysis finds premiums charged for Part D plans range widely, from $9.80 per month to $107.50 per month. The average monthly premium would increase from $27.39 in 2007 to $31.99 if enrollees remain in their current plans next year – a 17 percent increase. Nearly…

  • Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings

    Report

    This analysis provides a profile of the 2007 Medicare Part D stand-alone drug plans that are being offered to the program’s 43 million beneficiaries for 2007 and highlights some of the changes in plans between 2006 and 2007. It looks at premiums, covered drugs, the amount enrollees pay to fill a prescription, and other key features that would affect out-of-pocket costs and access to drugs for people with Medicare. The report describes the 1,875 stand-alone…

  • An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans

    Report

    This study of Medicare Part D plans offered in 2006 examines formularies, drug costs and utilization management tools in drug plans offered by 14 national and near-national organizations. Collectively, these organizations account for 1,222 of the 1,429 Part D plans available to Medicare beneficiaries. The analysis finds that Medicare’s new, private, stand-alone drug plans vary significantly in terms of covered drugs, out-of-pocket costs for specific medications and restrictions placed on the use of certain drugs. The…

  • The Policy Implications of Medicare’s New Measure of Financial Health

    Issue Brief

    This report examines a new measure of Medicare’s financial health established by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). The report, authored by Marilyn Moon, takes an in-depth look at the program’s new solvency test, which measures general revenues as a share of total Medicare spending and can trigger a “funding warning” that compels the President to propose and the Congress to consider a funding warning.

  • The Effects of Formularies and Other Cost Management Tools on Access to Medications:  An Analysis of the MMA and the Final Rule

    Issue Brief

    This report examines the formulary and cost management provisions of the final Medicare regulations implementing the new Medicare Part D drug benefit that was passed as part of the Medicare Modernization Act of 2003, and their implications for people with Medicare who enroll in new drug plans and their access to medications. It was prepared for the Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University. Issue Brief (.pdf)

  • Estimates of Medicare Beneficiaries’ Out-of-Pocket Drug Spending in 2006

    Report

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. This analysis from November 2004 estimates that 6.9 million beneficiaries are projected to be affected by the coverage gap (the so-called "doughnut hole") in the standard Part D drug benefit. This estimate is based on projected enrollment in Part D plans of 29 million (Congressional Budget Office, July 2004), prior to implementation of the drug…