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Published byPamela Flowers
Modified about 1 year ago
State Specific Example: Texas The intersection of business strategy and public policy
© Avalere Health LLC Page 2 Exits and Entrances to the LIS Market in Texas Will Result in the Shift of Many Lives in Auto-Enrollment Eligible Plans (Texas)2008 Auto-Enrollment Eligible Plans (Texas) Plans Eligible for Auto-Enrollment Lives in 2007 and 2008 BravoRx CIGNA Medicare Rx Plan One Health Net Orange Option 1 HealthSpring Prescription Drug Plan Community Care Rx Basic Prescription Pathway Bronze Plan Advantage Star Plan by Rx America WellCare Classic* Plans Not Eligible to Gain New LIS Lives in 2008, but Retaining LIS Enrollees from 2006 and 2007 Blue MedicareRx Standard First Health Part D - Premier Exits from the LIS MarketEntrants to Auto-Enrollment Market AARP MedicareRx Preferred AARP MedicareRx Saver Humana PDP Standard MedicareRx Rewards Value** WellCare Signature* Aetna Medicare Rx Essentials Health Net Orange Option 2 Scott and White Health Plan Texas Rx Value SilverScript MedicareRx Rewards Standard** Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features data from November 2007; 2007 data from November *Lives covered by WellCare Signature will be shifted to WellCare Classic in **Lives covered by MedicareRx Rewards Value will be shifted to MedicareRx Rewards Standard in 2008.
© Avalere Health LLC Page 3 Plans Gaining LIS Lives in Texas Cover Fewer Drugs and Apply More Utilization Management Than Plans Losing Lives* PDP Offering (Texas) # Drugs in 2007 # Drugs in 2008 % Brand in 2007 % Brand in 2008 % Drugs with PA 2007 % Drugs with PA 2008 Plans Losing All Dual Eligible Lives in 2008 AARP MedicareRx Preferred3,7632,62756%64%5%8% AARP MedicareRx Saver3,1672,18448%57%7%11% Humana PDP Standard3,7522,62356%64%6% MedicareRx Rewards Value**2,3871,81840%50%7%11% WellCare Signature***1,1151,12145%48%10%13% Average of Plans Losing All Dual Eligible Lives2,8372,07550%57%6%10% Plans Gaining Dual Eligible Lives in 2008 Advantage Star Plan by Rx America1,5681,37046%55%18%20% Aetna MedicareRx Essentials2,2322,58828%64%13%16% BravoRx1,9991,61145%50%12%10% CIGNA Medicare Rx Plan One3,6301,80156%54%16%27% Community Care Rx Basic1,8351,62744%51%4%14% Health Net Orange Option 12,7542,15352%60%33%21% Health Net Orange Option 23,7372,62456%64%27%19% HealthSpring Prescription Drug Plan1,8531,45544%53%6%12% MedicareRx Rewards Standard**n/a1,816n/a50%n/a11% Prescription Pathway Bronze Plan1,4621,28537%45%3%4% Scott and White Health Plan Texas Rx Value1,1341,13647%50%5%6% SilverScript1,4702,59046%64%7%9% WellCare Classic***1,1151,12145%48%10%13% Average of All Plans Gaining Lives in 20082,0661,78346%56%13%15% Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features data from November 2007; 2007 data from November *Unweighted **Lives covered by MedicareRx Rewards Value will be shifted to MedicareRx Rewards Standard in ***Lives covered by WellCare Signature will be shifted to WellCare Classic in 2008.
© Avalere Health LLC Page 4 Texas Plans Gaining LIS Lives in 2008: Smaller Formularies and More Prior Authorization 2,837 2,075 1,783 (n = 5) (n = 13) # Drugs on Formulary % Drugs with Prior Authorization Source: Avalere Health analysis using DataFrame®, a proprietary database of Medicare Part D plan features data from November 2007; 2007 data from November Plans Losing Dual Eligibles in 2008 (2007 formulary) Plans Losing Dual Eligibles in 2008 (2008 formulary) Plans Gaining Dual Eligibles in 2008 (2008 formulary)
© Avalere Health LLC Page 5 Some Texas Plans Expected to Gain or Lose Over 30,000 LIS Lives in 2008 Plan Name (Texas) Approximate # LIS Lives lost/gained ( )* Plans Expected to Lose LIS Lives in 2008 Humana PDP Standard-36,000 AARP MedicareRx Saver-31,000 WellCare Signature-25,000 MedicareRx Rewards Value-23,000 AARP MedicareRx Preferred-10,000 Plans Expected to Gain LIS Lives in 2008 First Health Part D - Premier+30 Blue Medicare Rx Standard+310 Health Net Orange Option 2+3,000 Health Net Orange Option 1+3,000 Scott and White Health Plan Texas Rx Value +6,000 SilverScript +6,000 CIGNA Medicare Rx Plan One +6,000 HealthSpring Prescription Drug Plan +6,000 Aetna Medicare Rx Essentials +7,000 BravoRx +7,000 Community Care Rx Basic +7,000 Prescription Pathway Bronze +7,000 Advantage Star Plan by Rx America +7,000 MedicareRx Rewards Standard +30,000 WellCare Classic +31,000 Source: Proprietary Avalere Health model; Kaiser Family Foundation reports CMS estimates of how many dual eligibles were auto-enrolled into PDPs by state as of June 11, 2006 and January 17, 2007 *Enrollment rounded to the nearest thousand; First Health Part D - Premier and Blue Medicare Rx Standard are exceptions.
Exhibit 1 NOTE: Excludes plans in the territories. Total for 2014 includes 168 plans under CMS sanction and closed to new enrollees as of October 2013.
Strengthening Medicare Part D John Rother Director Policy & Strategy AARP Washington, DC November 5, 2007.
Federal Medicare Prescription Drug Coverage Sam Shore Center for Policy and Innovation DSHS.
MEDICAID MANAGED CARE: OPPORTUNITIES AND IMPLICATIONS OF STATE EXPANSIONS FOR SPECIAL NEEDS PLANS James M. Verdier Mathematica Policy Research, Inc. National.
1 Medicare Part D: Cost Management Issues Jack Hoadley Research Professor Georgetown University Health Policy Institute Families USA Health Action 2005.
Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation Medicare Policy Project - Families USA Health Action 2007 Washington,
Part Ds Low-Income Benefits: Theory and Reality Marc Steinberg, Families USA Health Action 2006 January 26, 2006 ** Washington, DC
Medicare Prescription Drug Discount Card Ranjani Varadarajan PYPC 7810.
Medicares New Alphabet Soup: A National and Historical Perspective by Marsha Gold, Senior Fellow Mathematica Policy Research Presentation to Families USA.
1 Navigating the Medicare Plan Finder New Jersey State Health Insurance Assistance Program November
The Medicare Part D Prescription Drug Benefit Understanding the Formulary Requirements and Related Implications Michael Sharp, R.Ph, Pharmacy Consultant.
Medicare and Deficit Reduction Alliance for Health Reform Inside Deficit Reduction: What it Means for Medicare Tricia Neuman Senior Vice President and.
Dual Eligible and Low-Income Medicare Beneficiaries and Part D Presentation to National Medicaid Congress by Andy Schneider, Senior Advisor June 5, 2006.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 The Transition of Dual Eligibles to Medicare Drug Coverage: Implications for Beneficiaries.
The Affordable Care Act and Ryan White 2013 United Conference on AIDS (USCA) New Orleans September 10, 2013 Jen Kates, Kaiser Family Foundation.
1 THE COMMONWEALTH FUND Source: The Commonwealth Fund Health Care Opinion Leaders Survey, July Assessment of Medicare Part D Now that the first-ever.
Presentation by Alison Hughes, MPA. September 20, 2013.
1 An Easy Guide to… Understanding Medicare’s new Prescription Drug Benefit Blue Cross and Blue Shield of Texas presents.
Illinois Cares Rx What Happens Behind the Scenes.
Medicares New Alphabet Soup Mmm Good? The Beneficiarys Perspective -- Families USA Conference -- January 26, 2007 Presenter: David Lipschutz California.
The Basics of Medicares Basic Drug Benefit January 26, 2006 Dee Mahan, Families USA Health Action 2006.
Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors.
MEDICARE IN PICTURES Provider Number: Course Number: Eric Johnson – Agent Allies, LLC.
THE ACA AND YOU AND MEDICARE TOO Angela Zeek Bluegrass SHIP Coordinator 2013.
Optima Medicare (PPO) Plans CY Medicare Medicare is a Federal health insurance program for those age 65 or older or individuals at any age who have.
Medicare Part D How are Vulnerable Beneficiaries Faring? Laura Summer Health Policy Institute, Georgetown University With Support from The Commonwealth.
The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington,
Medicare Prescription Drug Coverage Patrick Hamilton Rural Health Coordinator Centers for Medicare & Medicaid Services Philadelphia Regional Office 2005.
Copyright © Center for Medicare Advocacy, Inc. IN THE TRENCHES: MAKING MEDICARE CHANGES WORK FOR BENEFICIARIES Families USA January.
1 Mapping Enrollment Behaviors in Medicare Prescription Drug Coverage * AcademyHealth June 25, 2006 Beth Simon 1, Ph.D., Christopher Koepke 1, Ph.D., Barbara.
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