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Medicare Drug Program News
Two Million Dual Eligibles Being Moved to New
Medicare Drug Plans
Avalere Health analysis of large dual eligible
population in Texas
 Dec. 5, 2007 - Over 2 million dual eligibles
(eligible for Medicaid and Medicare) must
switch Medicare Part D plans for 2008 because many plans with robust
dual eligible enrollment in 2007 submitted premium bids that exceed
certain states’ low-income subsidy benchmarks for 2008, according to Avalere Health, which analyzed the situation in Texas and found many of
the state’s lowest income residents will find themselves randomly
re-assigned into less generous Medicare Part D plans.
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Texas has one of the largest dual eligible
populations in the country.
Avalere researchers compared 2007 and 2008
standalone prescription drug plans (PDPs) that qualified to serve dual
eligibles (i.e., those eligible for both Medicare and Medicaid) in the
state of Texas, using its DataFrame database tool and proprietary
modeling.
Their analysis reveals that many of these
low-income beneficiaries, who are typically heavily reliant on
prescription drugs, may potentially experience disruptions in medication
access in 2008.
The research also shows which Part D plans are
poised to pick up or lose a significant number of insured lives based on
the pending transition.
Avalere’s analysis shows that the 13 PDPs in Texas
that can accept auto-enrolled dual eligibles in 2008 will cover 1,783
drugs on average and will require prior authorization for 15 percent of
drugs.
For comparison, the PDPs that covered these
individuals in 2007, but will no longer enroll dual eligibles in 2008,
covered 2,837 drugs in 2007 and required prior authorization for just 6
percent of drugs – a reduction of 1,054 drugs on average.
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"Changes are occurring at all levels of the
Medicare drug benefit – from significant movements in monthly premiums,
to the composition and copayment structure of formularies."
Read more...Click
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Humana and UnitedHealth Group will lose the most
dual eligible lives; entrants include offerings from Caremark (SilverScript),
Aetna (Aetna Medicare Rx Essentials), and Scott and White (Scott & White
Health Plan Texas Rx Value).
“The Medicare Part D offerings in Texas are fluid,
and many vulnerable beneficiaries will feel the effect of Humana and
United’s generous plans exiting the market,” said Jon Glaudemans, senior
vice president of Avalere Health.
Editor’s Notes:
Avalere Health is a leading advisory company
focused on business strategy and public policy. It serves a diverse
client base, which includes Fortune 500 healthcare technology companies,
federal government agencies, and major medical foundations. The company
is organized into seven substantive areas - Medicare, Medicaid,
Reimbursement, Long-Term and Post-Acute Care, Health Information
Exchange, Evidence-Based Medicine, and Education. Anchored by a
comprehensive research engine and staffed by experts in business,
medical product commercialization, and health policy, Avalere provides
strategic guidance, objective analytic research, and quality educational
programs focused on the full range of healthcare issues facing our
nation.
>>
Texas analysis report by Avalere Health
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