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Medicare Drug Program News
Medicare Finds Many Improvements in Drug Plan
Formularies for 2007
Issues information for those assisting in
'spreading the word'
October 23, 2006 Medicare has issued information
to organizations assisting with the communications to senior citizens
about the drug program that indicates significant improvement in the
lists of drugs (formularies) offered by the drug plans for 2007.
Highlights include a 13 percent increase by stand-alone plans in the
number of items and decrease in those with quantity limits. They also
found in the stand-alone plans an 8 percent increase in the top 100
drugs that seniors use. There are also improvements in the Medicare
Advantage plans.
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Medicare's Improved Prescription Drug Plan Finder
Web Tool Launches with 2007 Data
2007 Medicare & You handbooks also go into
mail this month
October 13, 2006 Medicare today officially
launched the improvements and additions for 2007 in the Medicare
Prescription Drug Plan Finder Web tool. The news release says the
changes will make it easier for beneficiaries to get personalized
information about their coverage options and costs for next year. The
2007 Medicare & You handbooks are also being mailed this month to
all senior citizens.
Read more...
Medicare Releases 2007 Drug Plans Available in Each
State
 Links below will take
readers to their state plans available for enrollment Nov. 15
September 29, 2006 The Medicare drug programs
available for 2007 in each state were released today by the Centers for
Medicare and Medicaid Services. Check
the link in the sidebar on this
page to find the information for your state. Open enrollment begins
November 15. Those satisfied with their current plans do not have to
take any action but CMS says in 2007 there are new options with lowers
costs and more comprehensive coverage.
Read
more...
Medicare's Claim of No Price Hike in Drug Plans'
Average Premium Challenged by Congressman
Rep. Waxman says
average up 13.2%, some find increases as high as 44%
 October
13, 2006 The average premium for Medicare drug plans will be the same
in 2007 as in 2006 - $24, according to the Centers for Medicare &
Medicaid Services. Rep. Henry Waxman (D-Calif.) had his staff check the
numbers and they say the average premium is more likely to be $29 a
13.2% jump.
Read more...
New Medicare Drug Plan Offerings for 2007 Get
Positive Reviews
More plans, lower prices, more drugs, even more
coverage in doughnut hole
October 2, 2006 The new line-up of Medicare drug
plans released on Friday received positive responses from most with
critics focusing on the confusion of too many choices. What was grabbing
the most attention were the increased number of national plans, lower
premiums in many cases, more plans offering some coverage in the
"doughnut hole," and more drugs added to the formularies.
Read
more...
Poll Finds Consumers Will Grab Generic Drug
Discounts, Spurn Brand Names
Wal-Mart discounts
being met by many competitors
October 20, 2006 With Wal-Mart's expansion of its
generic drug offer of $4 for a 30-day supply to 14 new states, the
competition, even in the local markets, is stepping up to meet the
challenge. And, all are likely to attract a big share of the
prescription drug market away from brand name drugs, says a news poll.
Read
more...
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Medicare Drug Program
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The Centers for Medicare & Medicaid Services says
these organizations helping with the information process are "a key to
helping people with Medicare maximize their benefits." They also assist
with enrollment.
CMS says the groups extend the reach and impact of
many programs aimed to improve the health and wellness of seniors,
people with disabilities, and even their caregivers or employers.
Organizations interested in joining CMS in this
effort can learn more by
clicking here.
Following is the information issued by Medicare in
"Medicare Part D 2007 Formulary Changes."
In 2007, Medicare is continuing to ensure that
people with Medicare Prescription Drug Coverage can get the prescription
drugs they need. Medicare reviews every Part D plans formulary and any
subsequent changes to that formulary. If a person with Medicare is
taking a Part D drug that is not on the plans formulary, a required
transition period allows the person to get a temporary supply of the
drug, while they arrange for an alternate prescription or ask for an
exception.
How will Part D plan formularies change in 2007?
In 2007, people with Medicare will have greater
access than ever before to the prescription drugs they need. Medicare
compared the Part D plan formularies from 2006 to those being offered in
2007, and found the following results.
Stand-alone Prescription Drug Plans (PDPs)
At least a 13 percent increase, on average, in
the number of items (reference NDCs) on formularies (plan level,
unweighted analysis)
A slight decrease, on average, in the percentage
of formulary items with quantity limit restrictions
No change in prior authorization rates
A small increase in the percentage of items that
require step therapy Medicare Advantage Prescription Drug (MA-PD) Plans
A greater than 10 percent increase on average, in
the number of items (reference NDCs) on formularies (plan level,
unweighted analysis)
No change, on average, in the rates of prior
authorization and quantity limits
A slight increase in the rate of step therapy
What do the formularies show about the drugs
seniors use most?
For the 2007 and 2006 formularies, Medicare
compared the top 100 drugs that seniors use, in the top 10 enrollment
plans in each PDP region. Medicare found that For the stand-alone
PDPs, there is an average increase of around 8 percent in the number of
these top drugs on the formularies.
For these top drugs in these top PDP plans, there
was a small decrease in the number of drugs requiring prior
authorization, and an increase in the drugs requiring step therapy and
quantity limits.
For the top 10 MA-PD enrollment plans in each
region (i.e., within the states included in the defined PDP regions),
there is an average increase of approximately 6 percent in the number of
these top drugs on the formularies.
For the top drugs in these MA-PD plans, there are
slight increases in step therapy, prior authorization, and quantity
limit requirements.
What is Utilization Management?
Utilization management includes special
requirements like prior authorization, step therapy or quantity limits
to better manage how prescription drugs are provided to people in the
plan. Utilization management tools like these were used in 2006 Medicare
Part D plan formularies and is common in commercial (private-sector)
drug plans. Medicare reviews the utilization management requirements in
each plans formulary to make sure they are appropriate.
Why is utilization management important?
These tools can protect people with Medicare and
keep them safe. In 2007, prior authorization requirements were often
added to drugs that may have safety concerns, especially for people with
Medicare, such as amphetamine-type central nervous system stimulants.
Some plans commonly added step-therapy requirements
to drugs to encourage people to try proven, cost-effective drugs first.
Some plans added quantity limits to some drugs with safety concerns to
make sure they are used in safe, recommended doses.
For example, prescription drugs used to treat some
mental health conditions commonly have quantity limitations that are
consistent with FDA-approved labeling. Others include drugs that could
be abused or overused, such as drugs to treat severe pain.
The utilization management tools also are often
necessary to bill Medicare correctly.
For example, some Part D plans added prior
authorization in 2007 to drugs, such as total parenteral nutrition (TPN)
products, that could be covered under Medicare Part B depending on the
use and/or setting.
What transition help is available to people who
are affected by formulary changes?
People with Medicare who are affected by formulary
changes from 2006 to 2007 can make use of their plans transition
processes or request exceptions. Transition processes are in place for
the following:
New plan enrollees starting on January 1, 2007
Enrollees who are newly-eligible to Medicare
joining a plan anytime in 2007
People who transfer from other Part D plans
(e.g., full benefit dual eligibles) joining anytime in 2007.
Plans may also provide transition processes for
current enrollees who are affected negatively by formulary changes
between 2006 and 2007. In general, these processes apply to
non-formulary drugs and those drugs beneficiaries have accessed through
the exceptions process in 2006. Transition supplies make sure that a
person enrolled in the plan can get a temporary fill of the prescription
they need. Plans will also send a transition notice to the enrollee
within 3 business days of filling a transition supply.
This notice will include directions for finding a
therapeutic equivalent drug that is on the formulary and a description
of the steps to take to file a formulary exception.
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