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  • How Do M+C Plans Manage Pharmacy Benefits? Implications for Medicare Reform

    Report

    Understanding how Medicare+Choice (M+C) plans manage their drug benefits may generate important lessons for Medicare. This report, based on interviews with both national and regional managed care firms, provides an in-depth look at how plans have managed their M+C outpatient pharmacy benefits in recent years. Findings show that plans rely on a number of cost management strategies to constrain the growth in drug spending including formularies, tiered-copayments, mail-order benefits, and fixed caps or dollar limits…

  • A Side-by-Side Comparison of the Prescription Drug Coverage Provisions of S.1 and H.R. 1

    Report

    This document, prepared by Health Policy Alternatives, Inc., provides a detailed side-by-side comparison of the prescription drug provisions of the House and Senate Medicare proposals, as passed on June 27, 2003. Along with these provisions, the side-by-side compares the major provisions relating to the role of private health plans in Medicare. This document includes a more in-depth description of the bills, which were previously summarized in publication #6095, which is also available on the Foundation?s…

  • Kaiser Health Poll Report Survey: Seniors’ Early Experiences with Their New Medicare Drug Plans – June 2006

    Poll Finding

    Kaiser Health Poll Report Survey: Seniors' Early Experiences With Their New Medicare Drug Plans - June 2006 More than eight in 10 seniors who are enrolled in a Medicare drug plan are satisfied with their plan, although almost two in 10 say they encountered a major problem in using it, according to the latest Kaiser Family Foundation tracking survey of seniors' experiences under the new Medicare drug benefit. The survey of 1,585 seniors, including 623…

  • 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…

  • Additional Help with Rx Drug Costs For Low-Income People on Medicare

    Other Post

    Additional Help with Prescription Drug Costs For Low-Income People on Medicare (For 2007 Benefits and Cost-Sharing) As of 2007, Medicare helps pay for outpatient prescription drugs. Medicare provides additional help with drug costs to beneficiaries who qualify based on low incomes and limited resources. The information below describes the different levels of assistance available to people who meet the eligibility requirements. People on Medicare Who Also Have Full Medicaid Benefits (Dual Eligibles) pay: No premium…

  • Medicare Chart Book 2005

    Other Post

    This updated resource features more than 80 charts and tables with detailed information about the Medicare program and the 42 million seniors and younger people with disabilities who rely on the program for health insurance coverage. It covers a wide range of relevant data, including state-by-state information when available. Each section can be accessed individually, or the full chartbook can be downloaded in its entirety. Complete Medicare Chartbook 2005 (.pdf) Overview (.pdf) Section 1: Medicare…

  • The Effect of Formularies and Other Cost Management Tools on Access to Medications: An Analysis of the MMA and Proposed Regulations

    Issue Brief

    This paper, by John F. Hoadley, Ph.D., of the Health Policy Institute at Georgetown University, examines how formulary designs and other cost-management tools may affect Medicare beneficiaries’ access to medications through their Medicare Part D prescription drug plans. It is one in a series commissioned by the Kaiser Family Foundation that analyzes issues surrounding the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the proposed regulations. Issue Brief (.pdf)

  • Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

    Issue Brief

    This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities. Issue Brief (.pdf)