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2007 Enrollment by Benefit Type. Beneficiaries are selecting alternative design plan types. Data as of Jan07 Analysis excludes FBDE & LIS. 2007 Enrollment by Deductible Category. Beneficiaries are selecting plans with no deductible. Data as of Jan07 Analysis excludes FBDE & LIS. - PowerPoint PPT Presentation
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Medicare Part D: What Now, What Next?CMS Continues to Improve Part D
November 5, 2007
Tracey McCutcheon, MHSA, MBADeputy Director,
Medicare Drug Benefit Group
Medicare Part D Panel Briefingsponsored by
The Commonwealth Fund
2007 Enrollment by Benefit Type
Beneficiaries are selecting alternative design plan types.
0%
20%
40%
60%
80%
100%
PDP MAPD
Enhanced Alternative
Basic Alternative
Actuarially EquivalentStandardDefined Standard
Data as of Jan07
Analysis excludes FBDE & LIS
2007 Enrollment by Deductible Category
Beneficiaries are selecting plans with no deductible.
0%
20%
40%
60%
80%
100%
PDP MAPD
$265 $1 - $264$0
Data as of Jan07
Analysis excludes FBDE & LIS
2007 Enrollment by Premium Category
Beneficiaries are selecting plans with low or no premiums
0%
20%
40%
60%
80%
100%
PDP MAPD
$32.20 and above$0.01 - $32.19$0
Data as of Jan07
Analysis excludes FBDE & LIS
2007 Enrollment by Gap Coverage
Coverage in the gap is not a significant factor in plan selection.
0%
20%
40%
60%
80%
100%
PDP MAPD
All Formulary DrugsGenerics & BrandsGenerics & Preferred BrandsGenericsNone
Data as of Jan07
Analysis excludes FBDE & LIS
2008 Costs Continue to be Lower than Expected
Fewer Part D plans offerings in 2008 than 2007 – Plan offerings within a sponsor have more meaningful
differences Overall, premiums will be stable for many
beneficiaries but slightly higher for some– 2008 standard average premium is $25 for basic
coverage Slow growth in Rx drug costs
– Increased generic use– Effective plan negotiation– Competition
Beneficiaries Continue to Have Multiple Low Cost PDP Choices
More than 90% of beneficiaries in stand-alone PDPs will have access to a plan in 2008 with premiums lower than they paid in 2007.
In every state, beneficiaries will have access to at least one PDP with premiums of less than $20, and a choice of at least 5 plans with premiums of less that $25 a month.
Beneficiaries in all states have access to a PDP with no drug deductible for a premium of less than $26 per month.
Beneficiaries in all states have access to PDP plans with coverage in the gap for generic drugs for under $50 a month.
Beneficiaries Have Even Lower Cost MA-PD Choices
There are more MA-PD health plan offerings in 2008 than in 2007.
MA-PD premiums will average $11 lower than premiums for PDPs in 2008 (vs. $7 lower in 2007).
Over 90% of people with Medicare will have access to a MA-PD for a $0 premium and with a $0 drug deductible.
Highlighted Improvements for 2008
Benefit and Formulary Reviews– Enhanced specificity in PBP software– Negotiation of meaningful differences & outliers
Systems Improvements– LIS data exchanged among CMS, States and SSA– Ability to correct data in CMS systems– “4Rx” data mandatory on plan-generated enrollments– Automation of plan TrOOP balance transfer processes
Performance Metrics– Additional measures developed– Increased transparency through integration with Drug
Plan Finder
More Robust Formulary Reviews
Prevent discrimination against beneficiaries by age, disease, or setting (e.g. long-term care)
Utilize reasonable benchmarks to check that drug lists are robust
Review tiering and utilization management strategies
Identify potential outliers at each review step for further CMS investigation and obtain reasonable clinical justification when outliers appear to create access problems
Ensure minimum transition coverage policies
2007 vs. 2008 Formularies (PDP)
0%2%4%6%8%
10%12%14%16%
Average Percentof Reference
NDCs with PriorAuthorization
Average Percentof Reference
NDCs with StepTherapy
Average Percentof ReferenceNDCs with
Quantity Limits
2007 2008
Note: Adjusted for drugs comparable on both the 2007 and 2008 Medicare Formulary Reference Files.
2007 vs. 2008 Formularies (PDP)
1,000
1,025
1,050
1,075
1,100
Average Number of Reference NDCs on Formulary
2007 2008
Note: Data limited to plans offered both in 2006 and 2007. Excludes employer sponsored plans. Formulary data from 2006 as of 4/20/2006, and 2007 as of 7/5/2006.
The Power of Part D Performance Metrics
Establishes performance benchmarks:– CMS’ long-term goal is to establish performance
benchmarks based on historical experience with Part D
– Once benchmarks are established, CMS will work with plans to improve performance
– If high performance in an area becomes standard for all plans then a measure may be retired
CMS will have composite scores for monitoring purposes beginning Nov. 15, 2007.
Creates a feedback loop
Example: Monitoring of Drug Pricing
CMS has a current performance metric to measure drug price changes.
The average drug increase in the CPI (Feb. –Aug. 2006) was 5%.
13% of PDP drug prices exceeded the CPI increase.
Plans were given a high rating if they had a lower percentage (<22%) exceeding the CPI.
Plans were given a low rating if they had a higher percentage (>33%) exceeding the CPI.– 7 PDPs and 34 MA-PDs received low ratings (1 or 2
stars).
Performance Measure in MPDPF – Domain Level
Plan Prescription Drug Plan A Prescription Drug Plan B Prescription Drug Plan CShow all categories
Customer Service
View Details
Access to Prescription Drugs
View DetailsDrug Pricing and Utilization
View Details
Performance Measures
Performance Measure in MPDPF – Measures Level
Plan Prescription Drug Plan A Prescription Drug Plan B Prescription Drug Plan CShow all categories
Customer Service Wait Time
Customer Service Disconnect Rate
Pharmacy Help Desk Average Wait Time
Pharmacy Help Desk Average Disconnect Rate
Beneficiary Understanding of Drug Costs and Coverage
Beneficiary Ability To Get Help From The Plan
Beneficiary Rating of Plan
Total Customer Service Complaints
Customer Service
Performance Measure in MPDPF – Data Level
Plan Prescription Drug Plan A Prescription Drug Plan B Prescription Drug Plan CShow all categories
Customer Service Wait Time
4 min 20 sec 2 min 10 sec 38 sec
Customer Service Disconnect Rate
6% 5% 3%
Pharmacy Help Desk Average Wait Time
4 min 37 sec 2 min 3 sec 40 sec
Pharmacy Help Desk Average Disconnect Rate
7% 6% 1%
Beneficiary Understanding of Drug Costs and Coverage
40% 65% 80%
Beneficiary Ability To Get Help From The Plan
86% 68% 95%
Beneficiary Rating of Plan
88% 93% 85%
Total Customer Service Complaints
1.9 1.6 0.6
View Details
Customer Service
LIS-Eligible Beneficiaries and Reassignment
CMS re-assigns LIS eligible beneficiaries who are enrolled in plans that will no longer have a premium within a $1.00 of LIS premium subsidy benchmark– Also to those whose plans are leaving Medicare
program
No major problems in 2007 For 2008, 1 in 6 dual eligible beneficiaries may
switch to a new plan to avoid a premium increase
LIS Outreach to Those Who Will Face a Change in 2008
Re-assignment Notices (blue) provide information on:
1. Moving to the new plan
2. Staying in the current plan
3. Selecting a different plan
New “Chooser” Notices (tan) provide information on:
1. Premium responsibility for 2008
2. Zero premium plans available
3. Evaluating plan options
LIS Outreach to Those Who Haven’t Applied for Extra Help
“The Community is Coming Together”
LIS national kick-off and partner meetingsData-sharing for targeting outreachNew materials – “Photo novellas”Stronger partnershipsCommunity outreach
