Prescription Drugs - Research and Data from KFF

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

Sep 1, 2006

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…

Coordinating Medicaid and Medicare Prescription Drug Coverage: Findings from a Focus Group Discussion with Medicaid Directors

Oct 31, 2003

Report

This publication reports on the findings from an October 26 focus group discussion with state Medicaid officials on the implications of a Medicare drug benefit for states and dual eligibles. Report (.pdf)

Prescription Drug Procurement and the Federal Budget

May 8, 2012

Issue Brief

This brief commissioned by the Foundation considers areas where Medicare faces limited opportunity for market-based competition and price negotiation to drive down drug spending. These areas include drug purchasing for low-income people enrolled in Part D plans who face minimal cost-sharing requirements, and purchasing certain unique drugs, such as biologicals, that have no therapeutic alternatives or competitors. Authored by Richard G. Frank of Harvard University, the brief discusses policy options that could lower Medicare spending…

The Landscape of Private Firms Offering Medicare Prescription Drug Coverage in 2006

Feb 28, 2006

Issue Brief

describes key characteristics of the organizations that offer the new Medicare drug benefit and analyzes how companies are positioning themselves to attract Medicare enrollees. • Seven of the 10 organizations that sponsor stand-alone prescription drug plans nationwide are based in commercial insurance firms with substantial Medicare Advantage experience, and three of the 10 firms are in the pharmacy benefit management and service sector. • Nine of the 10 organizations that sponsor stand-alone prescription drug plans…

Prescription Drugs: Advertising, Out-of-Pocket Costs, and Patient Safety from the Perspective of Doctors and Pharmacists

Oct 30, 2006

Poll Finding

Prescription Drugs: Advertising, Out-of-Pocket Costs, and Patient Safety from the Perspective of Doctors and Pharmacists This document highlights additional findings from separate surveys of pharmacists and physicians related to their views and experiences on a wide range of health care issues. Issue Brief (.pdf)

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

Oct 31, 2003

Issue Brief

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)

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

Dec 31, 2003

Report

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)

Snapshots: Wages & Benefits: A Long-Term View

Nov 13, 2009

Issue Brief

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 in the costs of work-based health insurance in recent years: between 1999 and 2009, health insurance premiums rose 131%, a much faster rate of increase…

The Emerging Role of Group Medicare Private Fee-for-Service Plans

Nov 29, 2008

Issue Brief

This issue brief examines the recent boom in Medicare Advantage enrollment attributable to employers contracting with Private Fee-for-Service (PFFS) plans to cover their Medicare-eligible retirees. Between 2006 and 2008, the number of Medicare beneficiaries enrolled in Medicare Advantage group plans nearly doubled from 900,000 to nearly 1.7 million as of June 2008; most of this growth is attributable to contracts between employers and PFFS plans. The issue brief, prepared for the Foundation by Avalere Health,…

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

Feb 28, 2005

Issue Brief

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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