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  • 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…

  • Beneficiary Challenges in Using the Medicare Part D Appeals Process To Obtain Medically Necessary Drugs

    Issue Brief

    This paper describes the various steps of the Medicare Part D appeals process for obtaining necessary drugs not on a plan’s formulary. Using case reports collected from a network of beneficiary advocates, it illustrates the challenges and problems some beneficiaries encountered when navigating this aspect of the drug benefit. The paper concludes with a discussion of potential policy options including the implications of establishing an exceptions and appeals process that is uniform in paperwork and…

  • Current Trends and Future Outlook for Retiree Health Benefits:  Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits

    Other Post

    Current Trends and Future Outlook for Retiree Health Benefits: Findings from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits A new survey of large employers finds businesses and retirees experienced double-digit increase in retiree health costs, with further increases expected in 2005. The survey also includes an early look at employers' responses to the new Medicare drug law. News Release Report - Interactive online version and downloadable chapters Chartpack Materials From the December 14, 2004…

  • Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?

    Report

    Since 2006, Medicare beneficiaries have had the opportunity to choose from among dozens of plans to get the Part D prescription drug benefit, facing wide variation in benefits, premiums and cost-sharing. The array of choices, with more than 50 stand-alone drug plans in many states, could allow beneficiaries to select a plan that provides the best value for their individual medical and economic needs. This study uses actual pharmacy claims experiences, and premium and cost-sharing…

  • The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

    Issue Brief

    This issue brief describes how Medicare beneficiaries navigate the Medicare Part D exceptions, appeals, and grievances processes to get access to medically necessary prescriptions not covered under their Medicare prescription drug plans. It identifies and describes policy issues that may make it difficult for beneficiaries to utilize the processes. Issue Brief (.pdf)

  • Observations on the Initial Implementation of the Medicare Prescription Drug Program:  Perspectives of State Medicaid Directors Through a Focus Group Discussion

    Report

    Observations on the Initial Implementation of the Medicare Prescription Drug Program: Perspectives of State Medicaid Directors Through a Focus Group Discussion Medicaid directors express the need to continue to focus on the interaction between Medicaid and the Medicare prescription drug benefit and to address the key system and coordination issues that remain, particularly with the potential disruptions that could occur in January 2007 when new Medicare drug plan contracts and recalculated benchmarks for the low-income…

  • 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…

  • Understanding The Effects of The Medicare Part D Coverage Gap in 2008 and 2009

    Report

    This Kaiser Family Foundation study examines how the coverage gap in Medicare’s drug benefit known as the “doughnut hole” affects Medicare beneficiaries and their prescribing patterns. Based on actual claims data from 2008 and 2009, before the 2010 health reform law began to close the gap, the study finds that most Part D enrollees with high drug costs who fall in the gap one year are likely to do so in future years. Enrollees who…