Medicare Part D roulette: potential implications of random assignment and plan restrictions

Background: Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. Objective: We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. Methods: Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary’s medications on plan formulary) were calculated for each benchmark plan. Results: Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. Conclusions: Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance

Cost variability of suggested generic treatment alternatives under the Medicare Part D benefit

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap. OBJECTIVE: To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PDP) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs. METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (ARBs), bisphosphonates, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California PDPs. RESULTS: The highest cost difference between a brand medication and a Centers for Medicare Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and$195.49 at full cost and between $51.37 and$82.35 in the coverage gap. The lowest cost difference varied between $38.45 and$76.93 at full cost and between -$4.11 and$18.52 during the gap. CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications made available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested generic treatment alternatives during the gap is less compelling and will decrease as subsidies increase

Medicare Part D Plan Optimization: The Need for an Annual Check-Up

Background: Since its inception, Medicare Part D requires beneficiaries to choose from a myriad of insurance plans in order to receive prescription drug coverage. Moreover, each year beneficiaries are confronted with plan cancellations, new plan offerings, changes in existing plan formularies and cost-sharing structure. Objective: This study prospectively examined the relationship between stand-alone prescription drug plan (PDP) costs, subsidy status, and the number of plans offered in California from 2009-2012. Methods: Forty-one community outreach events were held throughout Central/Northern California during the Medicare Part D annual election periods from 2008-2011. In total, 1,578 beneficiaries were assisted, 983 (62.2%) of whom had a PDP. During each intervention, beneficiary subsidy status, cost data for the beneficiary\u27s current plan and lowest cost plan for the upcoming year were recorded from the Medicare website. The percent of beneficiaries that did not need to switch plans to reduce their out-of-pocket (OOP) drug costs was compared to the number of available plans in the subsequent year.Results: On average, 14.3-23.7% of beneficiaries would have been enrolled in the lowest cost plan in the upcoming year had they remained in their current plan. Subsidy recipients were significantly more likely to be in the lowest cost plan each year. The chance of being in the lowest cost plan was significantly negatively correlated to the number of drug plans offered in the subsequent year. Conclusion: Annual Part D plan reexamination is essential to ensure that beneficiaries optimize their prescription medication coverage and minimize their OOP costs

British Women Writers and the French Revolution. Citizens of the World

Le récent article de Matthew O. Grenby dans le n° 342 d’octobre-décembre 2005 des Annales Historiques de la Révolution française soulignait la vitalité et l’abondance des travaux anglo-saxons concernant l’impact de la Révolution française sur la littérature anglaise, ce dont témoignait la riche bibliographie qui suivait son analyse historiographique. Le nouvel ouvrage d’Adriana Craciun, spécialiste de littérature britannique, en est un exemple. Il s’insère dans la lignée de ses recherches pré..

Bridging the Gap: Collaboration between a School of Pharmacy, Public Health, and Governmental Organizations to provide Clinical and Economic Services to Medicare Beneficiaries

Objective: Promoting healthy communities through the provision of accessible quality healthcare services is a common mission shared by schools of pharmacy, public health departments, and governmental agencies. The following study seeks to identify and detail the benefits of collaboration between these different groups. Methods: In total, 112 mobile clinics targeting Medicare beneficiaries were held in 20 cities across Northern/Central California from 2007 to 2016. Under the supervision of licensed pharmacists, trained student pharmacists provided vaccinations, health screenings, Medicare Part D plan optimization services, and Medication Therapy Management (MTM) to patients at each clinic site. Clinic support was extended by public health departments, governmental agency partners, and a health professional program. Results: Since clinic inception, 8,996 patients were provided services. In total, 19,441 health screenings and 3,643 vaccinations were collectively provided to clinic patients. We assisted 5,549 beneficiaries with their Part D benefit, resulting in an estimated aggregate out-of-pocket drug cost savings of $5.7 million. Comprehensive MTM services were provided to 4,717 patients during which 8,184 medication-related problem (MRP) were identified. In 15.3% of patients, the MRP was determined severe enough to warrant prescriber follow-up. In total, 42.9% of clinic patients were from racial/ethnic minority groups and 25.5% had incomes ≤150% of the Federal Poverty Level. Conclusion: Collaboration between a school of pharmacy, public health departments, and governmental organizations can effectively serve Medicare beneficiary populations and result in: 1) lower out-of-pocket drug costs, 2) minimization of medication-related problems, 3) increased vaccination uptake, and 4) increased utilization of health screenings. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Researc

Bridging the Gap: Collaboration between a School of Pharmacy, Public Health, and Governmental Organizations to provide Clinical and Economic Services to Medicare Beneficiaries

Objective: Promoting healthy communities through the provision of accessible quality healthcare services is a common mission shared by schools of pharmacy, public health departments, and governmental agencies. The following study seeks to identify and detail the benefits of collaboration between these different groups. Methods: In total, 112 mobile clinics targeting Medicare beneficiaries were held in 20 cities across Northern/Central California from 2007 to 2016. Under the supervision of licensed pharmacists, trained student pharmacists provided vaccinations, health screenings, Medicare Part D plan optimization services, and Medication Therapy Management (MTM) to patients at each clinic site. Clinic support was extended by public health departments, governmental agency partners, and a health professional program. Results: Since clinic inception, 8,996 patients were provided services. In total, 19,441 health screenings and 3,643 vaccinations were collectively provided to clinic patients. We assisted 5,549 beneficiaries with their Part D benefit, resulting in an estimated aggregate out-of-pocket drug cost savings of $5.7 million. Comprehensive MTM services were provided to 4,717 patients during which 8,184 medication-related problem (MRP) were identified. In 15.3% of patients, the MRP was determined severe enough to warrant prescriber follow-up. In total, 42.9% of clinic patients were from racial/ethnic minority groups and 25.5% had incomes ≤150% of the Federal Poverty Level. Conclusion: Collaboration between a school of pharmacy, public health departments, and governmental organizations can effectively serve Medicare beneficiary populations and result in: 1) lower out-of-pocket drug costs, 2) minimization of medication-related problems, 3) increased vaccination uptake, and 4) increased utilization of health screenings. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Researc

A patient-perspective approach to Medicare Part D prescription drug plan costs

Since its inception in 2003, Medicare Part D has become the largest addition to the Medicare benefit since it was signed into law in 1965. Despite this novel prescription drug coverage, the design and benefit structure of Medicare Part D has been challenging for beneficiaries and healthcare providers alike. Beneficiaries have been faced with a plethora of drug plan offerings. Additionally, the unique benefit structure and annual variation in plan offerings and plan parameters have left beneficiaries unaware of gaps in coverage and reluctant to re-evaluate plan offerings. Despite these issues, to date the total out-of-pocket costs for beneficiaries enrolled in Medicare Part D have not been examined. To mitigate this void, three studies were conducted to determine trends in the total out-of-pocket costs incurred by Medicare beneficiaries enrolled in Medicare Part D prescription drug plans. Pharmacy claims data of 50 randomly sampled patients from a database of Medicare-eligible individuals were used to generate medication profiles. To maintain a patient-perspective approach, these profiles were then entered into the Plan Finder Tool on the Medicare website in order to determine the estimated annual costs for each stand-alone prescription drug plan in each Medicare region. It was determined that Medicare Part D plan costs increased from 2007 to 2008 in most regions, however in 13 of 34 regions patients may not have paid more if they were enrolled in the lowest cost plan each year. Based on these findings, the opportunity cost of neglecting to re-evaluate prescription drug plan offerings for 2008 was examined. A significant increase ranging from $277 to$562 was observed nationally if patients did not switch to the lowest cost plan. Only 12% of the plans remained the lowest cost plan in 2008. Lastly, prescription drug plan cost trends in California were examined from 2007 to 2009 and confirmed that the estimated annual cost of a plan was the most consistent plan parameter. Collectively these studies indicate that Medicare Part D beneficiaries must annually re-evaluate all prescription drug plan offerings in order to minimize out-of-pocket drug costs

A patient-perspective approach to Medicare Part D prescription drug plan costs

Since its inception in 2003, Medicare Part D has become the largest addition to the Medicare benefit since it was signed into law in 1965. Despite this novel prescription drug coverage, the design and benefit structure of Medicare Part D has been challenging for beneficiaries and healthcare providers alike. Beneficiaries have been faced with a plethora of drug plan offerings. Additionally, the unique benefit structure and annual variation in plan offerings and plan parameters have left beneficiaries unaware of gaps in coverage and reluctant to re-evaluate plan offerings. Despite these issues, to date the total out-of-pocket costs for beneficiaries enrolled in Medicare Part D have not been examined. To mitigate this void, three studies were conducted to determine trends in the total out-of-pocket costs incurred by Medicare beneficiaries enrolled in Medicare Part D prescription drug plans. Pharmacy claims data of 50 randomly sampled patients from a database of Medicare-eligible individuals were used to generate medication profiles. To maintain a patient-perspective approach, these profiles were then entered into the Plan Finder Tool on the Medicare website in order to determine the estimated annual costs for each stand-alone prescription drug plan in each Medicare region. It was determined that Medicare Part D plan costs increased from 2007 to 2008 in most regions, however in 13 of 34 regions patients may not have paid more if they were enrolled in the lowest cost plan each year. Based on these findings, the opportunity cost of neglecting to re-evaluate prescription drug plan offerings for 2008 was examined. A significant increase ranging from $277 to$562 was observed nationally if patients did not switch to the lowest cost plan. Only 12% of the plans remained the lowest cost plan in 2008. Lastly, prescription drug plan cost trends in California were examined from 2007 to 2009 and confirmed that the estimated annual cost of a plan was the most consistent plan parameter. Collectively these studies indicate that Medicare Part D beneficiaries must annually re-evaluate all prescription drug plan offerings in order to minimize out-of-pocket drug costs