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  • 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…

  • Medicaid Prescription Drug Spending and Use

    Issue Brief

    This issue paper provides the latest data and trend analysis on Medicaid prescription drug spending and utilization. In 2002, Medicaid programs spent $30 billion for prescribed drugs. Issue Paper (.pdf)

  • Snapshots: Wages & Benefits: A Long-Term View

    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…

  • 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)

  • The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States

    Issue Brief

    This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by researchers at the Foundation's Kaiser Commission on Medicaid and the Uninsured and Avalere Health. Policy Brief (.pdf)

  • Illustrating the Potential Impacts of Adverse Selection on Health Insurance Costs in Consumer Choice Models

    Other Post

    Health Care Spending in the United States and OECD Countries  Health spending is rising faster than incomes in most developed countries, which raises questions about how these countries will pay for future health care needs.  The issue may be particularly acute in the United States, which not only spends much more per capita on health care than any other country, but which also has had one of the fastest growth rates in health spending among…