Amid heightened public concern, the cost of prescription drugs is a focus of attention by the Biden administration and lawmakers in Congress and state capitals. Proposed actions range from allowing Medicare to negotiate the prices of certain drugs to limiting some drug price increases to inflation and capping out of pocket costs for Medicare beneficiaries in Part D, among other initiatives. See KFF’s research, analysis and public opinion data, as well as Kaiser Health News’ journalism, related to prescription drugs and their costs.

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

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…

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Unintended Consequences: The Potential Impact of Medicare Part D on Dual Eligibles with Disabilities in Medicaid Work Incentive Programs

Individuals with disabilities who are eligible for both Medicare and Medicaid must also shift to a Medicare prescription drug benefit in 2006. This report analyzes how younger dual eligibles in Kansas enrolled in work incentive programs differ than other Medicare enrollees in the types of drugs they use and how…

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Chartpack: Seniors and the Medicare Prescription Drug Benefit

These charts highlight data from a poll on Seniors and the Medicare Prescription Drug Benefit, conducted jointly by the Kaiser Family Foundation and the Harvard School of Public Health between November 9 and 19, 2006. It included a nationally representative sample of 718 seniors, including 275 who reported being enrolled…

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Snapshots: Health Benefit Offer Rates and Employee Earnings

Employer-provided health insurance is the primary source of insurance coverage in the United States, covering almost 160 million people.1 About 90 percent of the non-elderly privately-insured population is covered by employer-sponsored plans, meaning that employer decisions about whether to offer health benefits will influence overall rates of insurance coverage in the…

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

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…

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Shifting the Cost of Dual Eligibles: Implications for States and the Federal Government

This issue paper provides state-level estimates on spending on dual eligibles and illustrates the fiscal effects of scenarios where the federal government assumes the cost of prescription drugs, Medicare premiums, acute care, and long-term care for this population.Issue Paper (.pdf)

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Oregon’s Medicaid PDL: Will an Evidence-Based Formulary with Voluntary Compliance Set a Precedent for Medicaid?

This report is a case study of Oregon’s experience with its new prescription drug policy in its Medicaid fee-for-service pharmacy program. The report describes Oregon’s clinical review process, and assesses the results relative to other state preferred drug lists.Report (.pdf)

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A Primer on Medicare Financing

As Congress and the Administration increasingly focus on the nation’s budget deficit, many policy experts and several bipartisan deficit reduction panels have proposed significant changes to Medicare to reduce federal spending and address rising health care costs. This primer provides an overview of Medicare spending trends, how the program is…

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Snapshots: Wages & Benefits: A Long-Term View

Recent polls show that a substantial portion of families worry about whether their incomes will keep pace with rising prices generally and whether they will have to pay more for health care or health insurance.1 This concern about the cost of health insurance may result in part from the rapid increases…

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A Comparison of Proposed and Final Regulations Governing Medicare Part D Plan Enrollment and Part D Benefit Appeal and Grievance Procedures

This table highlights changes in the appeal and grievance procedures included in the proposed and final regulations implementing the drug benefit. It was prepared for the Foundation by Sara Rosenbaum, J.D., of the George Washington University School of Public Health.Issue Brief (.pdf)

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