Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5,...
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Transcript of Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5,...
![Page 1: Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5, 2007.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5514cd8d55034640138b5eb4/html5/thumbnails/1.jpg)
StrengtheningStrengtheningMedicare Part DMedicare Part D StrengtheningStrengtheningMedicare Part DMedicare Part D
John Rother John Rother DirectorDirector
Policy & StrategyPolicy & StrategyAARPAARP
Washington, DCNovember 5, 2007
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AARP Goals for 2003 Conference CommitteeAARP Goals for 2003 Conference Committee
1. Do no harm –protect underlying Medicare fee-for-service program
2. Get Rx coverage for all 65+ now without it
3. Provide generous support to low-income beneficiaries
4. Prevent erosion of employer-based retiree health plans
5. Contain pharmaceutical prices effectively
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Millions more 65+ are coveredMillions more 65+ are covered
77%
93%
40%
60%
80%
100%
2004 2006
Sou
rce:
Unp
ublis
hed
prel
imin
ary
rese
arch
: H. L
evy
& D
. W
eir,
Uni
v. o
f Mic
higa
n,
“Tak
e-U
p of
Med
icar
e P
art D
and
the
SS
A S
ubsi
dy:
Ear
ly
Res
ults
from
the
Hea
lth a
nd R
etire
men
t Stu
dy,”
Pre
sent
ed A
ug 2
007
at th
e R
etire
men
t Res
earc
h C
onso
rtiu
m
Ann
ual J
oint
Con
fere
nce,
Was
hing
ton,
DC
2. Rx coverage for 65+
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Current Part D Enrollment 24 Million Current Part D Enrollment 24 MillionStand-Alone Rx Plans 11,000,000
Medicare Advantage w/Rx Drug (Includes .5 million Duals)
6,700,000
Dual Eligibles in PDP’s (Auto-enrolled) 6,300,000
Estimated Creditable Coverage=VA, Indian Health Service, employer plans w/o retiree subsidies, active workers, and state pharmaceutical assistance programs
4,900,000
Employer/Union Ret. CoverageFEHB Feds retiree coverage --includes dependents
TriCare Military retirees
10,300,000
No Creditable Coverage 4,000,000 (GAO = 4.7 million)
Source: HHS, January 30, 2007
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What’s Part D coverage worth?What’s Part D coverage worth?
CMS 2007 EstimatesAverage worth per person
►$3,353 in 2007 for a low-income enrollee August 2007 Press Release
►$1,200 for a mid-income enrollee June 2007 Press Release
..
3. Generous Support for Limited-Income Enrollees3. Generous Support for Limited-Income Enrollees
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Number of eligibles not enrolled in LISNumber of eligibles not enrolled in LIS
CMS estimated 14.4 million would enroll, yet only 9 million so far
Also, there are those who would qualify but for the asset limits --- estimated by KFF at 2.3 million
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Why people fail to enroll:Why people fail to enroll:
Lack of knowledge -Nearly half of LIS eligibles not enrolled reported they were “not aware” of program (2006 National Survey of Seniors and Rx Drugs- KFF)
Welfare stigma from required place of enrollment and asset test
Don’t want or know how to answer asset questions at enrollment i.e. burial plots, life insurance, in kind support
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Targeting: Key strategies for face-to-face enrollmentTargeting: Key strategies for face-to-face enrollment
Need IRS to share income data with SSA
Need funding for outreach and enrollment at community level
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RxRx Rely heavily on formularies
Works for most enrollees, but LIS enrollees exempt
Duals will be forced into most restricted plans next year
Need comparative-effectiveness studies to assure most effective drugs are available
Drug cost-containment measures
5. Reduce the Rise in Rx Drug Prices
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Friction PointsFriction Points
Marketing abuses Problems with appeals, since many plans
give people no info at the pharmacy when refusing to cover a drug
LIS reassignments: real problem being inclusion of MA plans in benchmark
Inaccurate and misleading data on Medicare plan finder
Too many choices! Standardization and simplification needed
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Immediate Steps to Strengthen Part DImmediate Steps to Strengthen Part D
Strengthen limited-income protections
Substantially raise or eliminate asset test
Simplify LIS application
Permit enrollment in MSP at SSA offices
Bring Medicare Savings Program to LIS level
Change formula to avoid "ping-ponging“ of LIS enrollees each year
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Immediate Steps to Strengthen Part DImmediate Steps to Strengthen Part D
Quality and Cost Improvements
More aggressive oversight of plan performance Substantially fund comparative-effectiveness
research Require physicians to E-Prescribe
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StrengtheningStrengtheningMedicare Part DMedicare Part D StrengtheningStrengtheningMedicare Part DMedicare Part D
Washington, DCNovember 5, 2007