Avalere Health LLC | The intersection of business strategy and public policy Part D Plans and Specialty Products Presented by Lovisa Gustafsson.

Slides:

Advertisements

Similar presentations

Peterson-Kaiser Health System Tracker What is behind the recent slowdown in health spending?

Advertisements

Value & Coverage Issue Brief Slides A Closer Look at Health Plan Coverage Policies and Approaches.

Challenges of Serving Low-income Medicare Beneficiaries: Impact of Cost Sharing Cindy Parks Thomas Brandeis University Schneider Institute for Health Policy.

Understanding Patient Access in Health Insurance Exchanges August 2014 avalerehealth.net.

Y0096_MRK_OK_PDSALPRE15 APPROVED bcbsok.com Your presenter today: Bob Archer Health Insurance Enrollment Center.

State Specific Example: Texas The intersection of business strategy and public policy.

Medicare Annual Enrollment Important Medicare Updates for 2015.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health? Get Educated, Get Enrolled An.

Medicare and the New Prescription Drug Benefit Presented by Tricia Neuman, Sc.D. Vice President and Director, Medicare Policy Project The Henry J. Kaiser.

Nearly one in four Medicare beneficiaries had a Medigap policy as a supplemental source of coverage in 2010 Multiple Sources of Coverage (without Medigap)

Exhibit 1 NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,734 for LIS enrollees), which.

Medicare Modernization Act, Part D Prescription Drug Benefit Presentation for County Program Administrators September 1, 2005.

Joint Informational Hearing The Federal Medicare Prescription Drug Act: State Readiness, Implementation, and Consumer Issues Bonnie Burns, Training and.

Avalere Health LLC | The intersection of business strategy and public policy The Medicare Drug Benefit: Beyond the Basics Third National Medicare Congress.

Agenda Trends in the Senior Market Part D Benefits & Guidelines

MEDICARE PRESCRIPTION DRUG BENEFIT Presented by Juliette Cubanski, Ph.D. Principal Policy Analyst Medicare Policy Project The Henry J. Kaiser Family Foundation.

Services provided by Mercer Health and Benefits LLC Employee Cost Sharing Medical, Dental, and Vision July 15, 2008 Mikel Gray, Seattle Sheree Swanson,

Welcome to Medicare Prescription Drug Coverage Discussion Topics  What is Medicare?  What is the Medicare Prescription Drug Plan benefit?  Can I also.

© 2005 National Mental Health Association The Medicare Drug Benefit: What Is It and What Does it Mean for Mental Health?

UNC Improved Health Care Initiative. Highest priority of UNC HR Directors Highest priority of UNC HR Directors Hewitt Health Value Initiative Study Hewitt.

Excess cost growth in Medicare, Medicaid, and all other health care spending Source: CBO, A Federal Perspective on Health Care Policy and Costs, 2008.

All CIGNA Medicare 2009 plan designs described in this document are pending government approval and are therefore subject to change. For producer use only.

The New Medicare Prescription Drug Benefit: An Overview Prepared by: Michelle Kitchman, M.H.S. Kaiser Family Foundation For the: California Senate Health.

THE COMMONWEALTH FUND Medicare Part D: What Are The Concerns? Stuart Guterman Director, Program on Medicare’s Future The Commonwealth Fund Association.

1 Variation in Medicare Part D Prescription Drug Plan Benefits, 2006 Leslie M. Greenwald, Ph.D. Principal Scientist RTI, International.

0 Beneficiary Choices in Medicare Part D and Plan Features in 2006 Supported by PhRMA September 13, 2006.

Avalere Health LLC | The intersection of business strategy and public policy The Potential Impact of the New Prescription Drug Benefit on Medicare Beneficiaries.

1 Medicare Part D: Cost Management Issues Jack Hoadley Research Professor Georgetown University Health Policy Institute National Academy of Social Insurance.

PEBB Meeting - August 6, Public Employees Benefits Board Meeting August 6, 2002 Procurement Overview & Medical Benefit Decisions for 2003.

Find Your Way Around The Health Care Law. 2 Agenda People with health insurance People who are uninsured or buy their own coverage People with Medicare.

Slide -1 Medicare Prescription Drug Coverage Atlanta Regional Office Centers for Medicare & Medicaid Services September 12, 2005.

April 12, REVISED 1 Catamount Health Financial Facts Under the Senate Bill Kenneth E. Thorpe Emory University.

Exhibit 1 NOTES: LIS is Low-Income Subsidy. PDP is prescription drug plan. MA-PD is Medicare Advantage Prescription Drug Plan. Analysis includes non-LIS.

Retiree Health Benefits Program Medicare Part D and Your State Benefits Your Benefits Choices.

Avalere Health LLC | The intersection of business strategy and public policy The Medicare Modernization Act: The Impact on States and Low-Income Beneficiaries.

Avalere Health LLC | The intersection of business strategy and public policy Formulary Design: Balancing Cost and Access November 1, 2005 Presented By:

Benefit Trends in Minnesota’s Small Group and Individual Health Insurance Markets State Health Research and Policy Interest Group Meeting June 24, 2006.

American Society of Consultant Pharmacists America’s Senior Care Pharmacists ® Effects of Medicare Part D on Dual Eligibles in LTC Settings Thomas R. Clark,

Third National Medicare Congress Marta Schroeder Divisional Vice President Public Health Policy & Strategy October 2006.

Growth in prescription spending had slowed, but increased rapidly in 2014 and 2015 Average annual growth rate of prescription drug spending per capita.

Avalere Health LLC | The intersection of business strategy and public policy Enrollment in the Medicare Drug Benefit Medicare Congress Audioconference.

Avalere Health LLC | The intersection of business strategy and public policy The Impact of Enrollment in the Medicare Prescription Drug Benefit on Premiums.

John R. Kasich, Governor Mary Taylor, Lt. Governor/Director Presented by Medicare & You.

Cost-Sharing Subsidies in Federal Marketplace Plans.

Peterson-Kaiser Health System Tracker What are the recent and forecasted trends in prescription drug spending?

Percentage of Plans with General Annual Deductible, Marketplace and Employer-Based Plans, 2016 Exhibit 2 * Most recent employer survey data are from 2015.

Percentage of Plans with Annual Deductible, by Metal Tier, Cost-Sharing Reduction, and Employer Plans, 2016 Notes: Base silver plans have an actuarial.

Private Insurance Payers and Plans Chapter 3

Total Medicare Spending in 2014 = $613.3 billion

Growth in prescription spending had slowed, but increased rapidly in 2014 and 2015

For a middle-age person, before tax credits, premiums for comparable coverage would be similar under each plan Annual individual market premium for a silver.

Total U.S. prescription drug spending, in $ billions:

MMA, Private Plans, and Competition: Commercial Health Plan Response to MMA November 1, 2005 David F. Ogden, F.S.A. Milliman, Inc.

Web Event: Rx Drugs and the U. S

Current Medicare benefits* New Public Plan in Exchange

Lindy Hinman Avalere Health LLC

Access to Cancer Drugs in Medicare Part D

Health Strategies Group

Access to Pharmaceuticals Under Part D Jennifer Bowman Director, Medicare Practice Avalere Health LLC October 16, 2006.

What is behind the recent slowdown in health spending?

Growth in prescription spending had slowed, but increased rapidly in 2014 and 2015

The Future of Biologics in Part D

Presented by Tricia Neuman, Sc.D.

* Most recent employer survey data are from 2015.

Exhibit 1.7 Distribution of Annual Premiums for Single and Family Coverage Relative to the Average Annual Single or Family Premium, 2016 Percentages.

Percentage of Plans Where the Beneficiary Must Meet a Deductible Before Primary Care Office Visits or Prescription Drugs Are Covered, Marketplace and.

Estimated Premiums for New Public Plan Compared with Average Current Premiums, Individual/Small Employer Private Market, 2010 Average annual premium.

Exhibit 6.20 Distribution of the Percentage of Total Premium Paid by Covered Workers for Single and Family Coverage, by Firm Wage Level, 2016 SINGLE COVERAGE.

Exhibit 6.18 Distribution of the Percentage of Total Premium Paid by Covered Workers for Single and Family Coverage, by Wage Level, 2013 SINGLE COVERAGE.

Exhibit 6.19 Distribution of the Percentage of Total Premium Paid by Covered Workers for Single and Family Coverage, by Wage Level, 2014 SINGLE COVERAGE.

Presentation transcript:

Avalere Health LLC | The intersection of business strategy and public policy Part D Plans and Specialty Products Presented by Lovisa Gustafsson

© Avalere Health LLC Page 2 Tiered Benefit Structures Are Common in Both Part D and the Commercial Marketplace, But Part D Designs Tend to Have More Tiers Prevalence of Tiering Structures in Part D in 2006 Prevalence of Tiering Structures in Commercial Market in 2005 Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February Kaiser Family Foundation. Employer Health Benefits Annual Survey. Four-tier designs are most common in Part D Three-tier designs are most common in commercial plans

© Avalere Health LLC Page 3 Plans With Specialty Tiers Have Lower Premiums and More Tiers Than Plans Without Them PDP and MA-PD Plans with Specialty Tiers PDP and MA-PD Plans without Specialty Tiers Premium $26.20$29.50 Coverage in gap* 19%20.7% Deductible $44.17$ Most frequent # tiers 43 Average # tiers Number of drugs covered % of drugs with prior authorization 7.6%11.1% % of drugs with quantity limits 9.0%10.6% *Includes both coverage of generics only and generics and brands. Plans with specialty tiers appear to have lower premiums and deductibles than plans without Plans with specialty tiers have more tiers than plans that do not Source: Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February 2006.

© Avalere Health LLC Page 4 Average Specialty Tier Holds 4-6% of Covered Drugs  Plans typically place fewer than 200 drugs on specialty tier »PDPs place 4% of covered drugs »MA-PD plans place 6% of covered drugs »But, a few plans place drugs on specialty tier at over twice this rate  Average number of drugs on specialty tier = 100  Drugs on specialty tiers have higher cost-sharing and higher rates of prior authorization relative to the rest of plans’ formularies  An average of 8 specialty tier drugs are subject to quantity limits on PDP formularies, and 13 on MA- PD plan formularies. Treatment of Drugs on Specialty Tiers Drugs on Specialty Tier Source: Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February 2006.

© Avalere Health LLC Page 5 Part D Plans Are More Likely to Use Both Copays and Coinsurance; Copays Are the Norm in Commercial Type of Cost-Sharing Employed by Express Scripts Clients in 2003 Type of Cost-Sharing Used by Part D Plans in 2006 Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February Express Scripts. Drug Trend Report June 2004.

© Avalere Health LLC Page 6 Most common cost- sharing for 3-tier PDPs Most common cost- sharing for 4-tier MA-PD plans Average cost- sharing in employer- sponsored plans* $4 Tier 1 PDPsMA-PD PlansCommercial Plans $20 Tier 2 25% Tier 3 $0 Tier 1 $28 Tier 2 $58 Tier 3 25% Tier 4 $10 Tier 1 $22 Tier 2 $35 Tier 3 Part D Plans Tend to Have Greater Cost-Sharing Requirements on the Highest Tier than Do Commercial Plans Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February * Kaiser Family Foundation. Employer Health Benefits Annual Survey. ** BCBS is the national FEHB plan sponsor with the highest enrollment.

© Avalere Health LLC Page 7 Cost-Sharing on Specialty Tiers Typically Is High Almost all plans use percentage coinsurance on specialty tier Fewer than 5% of plans use copays MA-PD plans are more likely to use copays Most plans without specialty tiers use flat copays on every tier, with highest tier at $25-60 Number of Plans N = 1312 Source: Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February 2006.

© Avalere Health LLC Page 8 Medications for Many Debilitating and Life-Threatening Diseases Are Found on Specialty Tiers Diseases with 3 or More of Top 20 Drugs Found on Specialty Tier:  Multiple Sclerosis  Rheumatoid Arthritis  Cancer  Hepatitis C  Psoriasis Diseases with Key Drug(s) in Top 20 Drugs Found on Specialty Tier:  Anemia  Crohn’s Disease  HIV/AIDS  Fabry Disease  Gaucher Disease Source: Avalere Health analysis using DataFrame TM, a proprietary database of Medicare Part D plan features. Data from February 2006.