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  • How Do M+C Plans Manage Pharmacy Benefits? Implications for Medicare Reform

    Report

    Understanding how Medicare+Choice (M+C) plans manage their drug benefits may generate important lessons for Medicare. This report, based on interviews with both national and regional managed care firms, provides an in-depth look at how plans have managed their M+C outpatient pharmacy benefits in recent years. Findings show that plans rely on a number of cost management strategies to constrain the growth in drug spending including formularies, tiered-copayments, mail-order benefits, and fixed caps or dollar limits…

  • Medicare Chart Book 2005

    Other Post

    This updated resource features more than 80 charts and tables with detailed information about the Medicare program and the 42 million seniors and younger people with disabilities who rely on the program for health insurance coverage. It covers a wide range of relevant data, including state-by-state information when available. Each section can be accessed individually, or the full chartbook can be downloaded in its entirety. Complete Medicare Chartbook 2005 (.pdf) Overview (.pdf) Section 1: Medicare…

  • The Effect of Formularies and Other Cost Management Tools on Access to Medications: An Analysis of the MMA and Proposed Regulations

    Issue Brief

    This paper, by John F. Hoadley, Ph.D., of the Health Policy Institute at Georgetown University, examines how formulary designs and other cost-management tools may affect Medicare beneficiaries’ access to medications through their Medicare Part D prescription drug plans. It is one in a series commissioned by the Kaiser Family Foundation that analyzes issues surrounding the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the proposed regulations. Issue Brief (.pdf)

  • Medicare+Choice Withdrawals: Understanding Key Factors

    Report

    To help understand why M+C plans have exited or limited their participation in the M+C program in recent years, this report presents an empirical analysis of the factors associated with plan withdrawals between 1999 and 2001. This analysis explores factors such as M+C payment levels, local market characteristics, and individual health plan characteristics to help predict plan withdrawals and draw inferences about the types of plans and markets that have been most adversely affected. Report

  • The Wide Circle of Caregiving

    Poll Finding

    The Kaiser Family Foundation helped conduct a national survey of over 1,000 informal caregivers in 1998 to assess the policy issues involved with this new, growing role for many family members and friends. Nearly one of every four adults (23 percent) is an informal caregiver, and, as the American population ages, it is likely families will take on an even greater responsibility to keep their loved ones at home and in communities. The Foundation is…

  • State Variation in Medicaid Pharmacy Benefit Use Among Dual-Eligible Beneficiaries

    Report

    This study examines Medicaid pharmacy benefit use and spending among beneficiaries dually eligible for Medicare and Medicaid in 10 states by analyzing 1995 enrollment and claims data from a new 12-state database. The study finds that dual-eligibles are relatively high users of the Medicaid pharmacy benefit, with substantial variation in both drug use and spending among this population across the 10 study states. This variation appears to persist independent of beneficiaries' health status and is…

  • Support For Various Deficit Reducing Changes to Medicare

    Feature

    Support-For-Various-Deficit-Reducing-Changes-To-Medicare-POLLING Download Source Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health, The Public’s Health Care Agenda for the 113th Congress (conducted January 3-9, 2013)