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Medicare Drug Program
Insurers Support Keeping Medicare Copays,
Medications Consistent
AHIP endorses CMS plan to keep
Medicare Part D plans firm for contract year
April 27, 2006 - The Board of Directors of
Americas Health Insurance Plans (AHIP), a national association
representing nearly 1,300 companies providing health insurance coverage,
today issued a statement in support of the principle of providing
"continuity of care" for beneficiaries in Medicare Part D. It
specifically supports CMS efforts to ensure that beneficiaries who have
been prescribed a medication on a Part D formulary will not be required
to change their medication or pay increased copays or coinsurance
throughout a contract year.
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Todays announcement gives beneficiaries the peace
of mind of knowing that they will be able to continue to receive their
Part D formulary drugs throughout the year while preserving flexibility
needed in plan formularies to maximize the value of the drug benefit
when safety concerns are raised or generic equivalents come to market,
said AHIP President and CEO Karen Ignagni.
Health insurance plans utilize formularies to meet
consumer demand for high-quality, affordable medications. Part D plans
have P&T committees, primarily composed of physicians and pharmacists,
that make decisions about which drugs to include on formularies based
upon a clinical review of the scientific evidence.
Formularies are producing results for Part D
beneficiaries, who are paying one-third less than expected for their
Part D premiums. Formularies also are a key reason why taxpayers are
expected to save $30 billion during the programs first five years.
Surveys show that a majority of those who voluntarily enrolled in Part D
already are saving on their out-of-pocket drug costs.
Todays Board announcement is the latest in a
series of AHIP initiatives designed to improve the new Medicare
prescription drug benefit for seniors.
AHIP recently collaborated with the American
Medical Association (AMA) and others to simplify Part D administration
by developing a standardized form that physicians can use to request
prior authorization and coverage for non-formulary drugs.
Last week, AHIP, the National Community Pharmacists
Association, the National Association of Chain Drug Stores, and others
announced a collaborative effort to simplify and standardize the
electronic claims processing messages going from Medicare Part D drug
plan sponsors to pharmacies.
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