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  • One State’s Medicaid Managed Care Formulary Operations:  A Look at Pennsylvania, 2001-2002

    Report

    One State’s Medicaid Managed Care Formulary Operations: A Look at Pennsylvania, 2001-2002 This report examines formulary implementation under mandatory Medicaid managed care in Pennsylvania between 2001 and 2002. It looks at one state during a yearlong period; formulary operations are likely to vary across states and programs and over time. The report includes findings about Pennsylvania’s formulary operation and observations about improving the system. Report (.pdf)

  • Issue Briefs Describe Changes in Private Plan Market and Effects on Medicare Beneficiaries

    Issue Brief

    These two issue briefs describe the different types of private plan options available to people on Medicare, identify key characteristics of the organizations offering the new Medicare drug benefit, and analyze how companies are positioning themselves to attract Medicare enrollees. The Growth of Private Plans in Medicare, 2006 The Landscape of Private Firms Offering Medicare Prescription Drug Coverage in 2006

  • Medicare Part D 2008 Data Spotlight: Formularies

    Issue Brief

    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…

  • Public Views on Direct-to-Consumer Prescription Drug Advertising

    Poll Finding

    Mollyann Brodie, Kaiser vice president and director of Public Opinion and Media Research, testified before the House Energy and Commerce Subcommittee on Oversight and Investigations about the public's views of prescription drugs, the pharmaceutical industry, and direct-to-consumer drug advertising. Brodie's testimony was a part of the hearing titled, "Direct-to-Consumer Advertising: Marketing, Education, or Deception?" Testimony (.pdf)

  • The New Medicare Drug Benefit:  Potential Effects of Pharmacy Management Tools on Access to Medications

    Issue Brief

    The New Medicare Drug Benefit: Potential Effects of Pharmacy Management Tools on Access to Medications This report describes the pharmacy benefit management tools that will be available to private plans administering the new Medicare drug benefit, including formularies, the definition of categories and classes, and cost sharing requirements. The authors conclude that substantial flexibility given to plans to design management tools could have significant implications for beneficiaries’ access to needed medications and out-of-pocket spending. Issue…

  • Medicare’s Coverage Decision for the New Alzheimer’s Drug and Why It Matters

    Policy Watch

    This policy watch discusses the implications of Medicare's preliminary National Coverage Determination for the new Alzheimer's drug, Aduhelm, on the 2022 Medicare Part B premium and the possibility of an adjustment based on the coverage decision. The piece also discusses the implications for Medicare spending and the connection to ongoing policy discussions around prescription drug proposals in the Build Back Better Act.

  • Why Medicare’s Aduhelm Coverage Decision Could Increase Pressure on Officials to Roll Back the Record Part B Premium Increase for 2022

    News Release

    In a new Policy Watch, KFF experts explain why Medicare’s preliminary decision to cover a new Alzheimer’s drug only for a limited group of beneficiaries is likely to intensify pressure on officials to reconsider the increase in the Medicare Part B premium for 2022. Earlier this week, CMS issued a preliminary National Coverage Determination that would limit coverage of the new drug, Aduhelm, to beneficiaries with mild cognitive impairment who participate in approved clinical trials…

  • Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020

    Issue Brief

    Recent legislation would require drug companies to pay rebates to the federal government when annual increases in prescription drug prices for Medicare and private insurance exceed the rate of inflation. As context for understanding the possible impact of this proposal, this analysis compares price changes for drugs covered by Medicare Part B (administered by physicians) and Part D (retail prescription drugs) between 2019 and 2020 to the inflation rate over the same period.