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

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

1 Exhibit 1 NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,734 for LIS enrollees), which corresponds to True Out-of-Pocket (TrOOP) spending of $4,750 (the amount used to determine when an enrollee reaches the catastrophic coverage threshold. SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit for 2013 (standard benefit parameter update from Centers for Medicare & Medicaid Services, 2012). Amounts rounded to nearest dollar. Standard Medicare Prescription Drug Benefit, 2013 Deductible = $325 Initial Coverage Limit = $2,970 in Total Drug Costs Plan pays 75% Plan pays 15%; Medicare pays 80% Enrollee pays 5% Enrollee pays 25% Catastrophic Coverage Limit = $6,955 in Estimated Total Drug Costs Brand-name drugs Enrollee pays 47.5%; Plan pays 2.5% 50% manufacturer discount Generic drugs Enrollee pays 79%; Plan pays 21% INITIAL COVERAGE PERIOD COVERAGE GAP CATASTROPHIC COVERAGE DEDUCTIBLE

2 Exhibit 2 NOTE: Excludes PDPs in the territories. *Under a Medicare demonstration, de minimis plans were eligible to retain LIS beneficiaries despite exceeding the benchmark premium by $2 in 2007 and $1 in 2008. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS PDP Landscape Source Files, 2006-2013. Distribution of Medicare Part D Stand-Alone Prescription Drug Plans, by Benchmark Status, 2006-2013

3 Exhibit 3 2006-2013: 49% increase 2012-2013: 2% increase NOTE: Average premiums are weighted by enrollment in each year (March for 2013). Excludes Part D plans in the territories. SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation. Weighted Average Monthly Premiums for Medicare Part D Stand-Alone Prescription Drug Plans, 2006-2013

4 Exhibit 4 Name of PDP 2013 Enrollment (of 18.0 million) Weighted Average Monthly Premium 1 % Change Number % of Total 200620122013 2012- 2013 2006- 2013 AARP MedicareRx Preferred3,851,37221.4%$26.31$39.85$40.45+2%+54% SilverScript Basic3,022,20916.8%$30.94$30.75$33.05+7% Humana Walmart-Preferred 2 1,755,0079.7%--$15.10$18.50+23%-- Humana Enhanced1,313,7017.3%$14.73$39.58$43.74+11%+197% Cigna Medicare Rx Plan One684,5433.8%$35.05$31.09$35.72+15%+2% First Health Part D Premier676,3343.8%$24.98$32.56$38.32+18%+30% First Health Part D Value Plus 3 644,9203.6%--$25.43$29.50+16%-- NOTE: 1 Average premiums are weighted by enrollment in each region for each year. 2 Humana Walmart-Preferred PDP was not offered before 2011. 3 First Heath Part D Value Plus PDP was not offered before 2012. SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape Source Files for the Kaiser Family Foundation. Premiums in Medicare Part D Stand-Alone Prescription Drug Plans with Highest 2013 Enrollment, 2006-2013

5 Exhibit 5 2013 National Monthly Average Premium for Basic PDPs = $31.98 Less than $30 (9 regions) $30 to <$32 (7 regions) $32 to <$34 (9 regions) $34 or higher (9 regions) $28.82 $32.13 $31.81 $33.65 OR, WA $27.66 $23.13 $33.24 IA, MN, MT, NE, ND, SD, WY $25.53 $30.61 $28.53 $20.67 $32.18 $31.44 $32.22 $34.59 $34.21 IN, KY $32.11 $30.65 $31.85 $30.64 $34.56 $34.12 NJ $31.96 HI $32.34 $35.09 $29.56 CT, MA, RI, VT $33.23 ME, NH $28.47 $32.48 AL, TN $38.84 DE, DC, MD $35.09 PA, WV $38.83 ID, UT $41.50 $24.67 FL NOTE: PDP is stand-alone prescription drug plan. Average premiums are weighted by enrollment. SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File for the Kaiser Family Foundation. Weighted Average Premium for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013

6 Exhibit 6 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File for the Kaiser Family Foundation. Range of Monthly Premiums for National and Near- National Medicare Part D Basic Stand-Alone PDPs, 2013

7 Exhibit 7 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS 2013 PDP Landscape Source File and Plan Crosswalk for the Kaiser Family Foundation. Minimum and Maximum Monthly Premiums for Medicare Part D Basic Stand-Alone PDPs, by Region, 2013 PDP Regions, Sorted from Lowest to Highest Maximum Monthly Premium Delaware, Maryland, DC Hawaii Texas GeorgiaIllinois PDP Region # New YorkCalifornia Florida

8 Exhibit 8 Type of benefit package NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation. Weighted Average Monthly Premiums for Stand-Alone PDPs, by Type of Benefit Package, 2013

9 Exhibit 9 PDPsMA-PD plans In 2013, the coverage gap is partially filled by a 50% price discount plus 2.5% plan coverage for brand- name drugs and 21% coverage of generic drug costs, as required by the ACA Level of gap coverage in 2006: Level of additional gap coverage in 2013: Little/no additional gap coverage Mostly generics Brands & generics NOTE: Estimates include Part D enrollees receiving low-income subsidies, but who receive coverage for costs in the gap regardless of whether their plan offers it. SOURCE: Georgetown/NORC analysis of CMS Part D landscape and enrollment files, 2006-2013, for the Kaiser Family Foundation. Share of Enrollment in Medicare Part D Plans, By Level of Gap Coverage, 2006 and 2013

10 Exhibit 10 In 2013, the coverage gap is partially filled by a 50% price discount plus 2.5% plan coverage for brand-name drugs and 21% coverage of generic drug costs, as required by the ACA Level of additional gap coverage in 2013 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation. Weighted Average Monthly Premiums for Medicare Part D Stand-Alone PDPs, by Level of Gap Coverage, 2013

11 Exhibit 11 Share of Medicare Part D Stand-Alone Prescription Drug Plans, By Deductible Amount, 2006-2013 NOTE: Estimates may not sum to total due to rounding and are unweighted. SOURCE: Georgetown/NORC analysis of CMS PDP landscape source files, 2006-2013, for the Kaiser Family Foundation. Standard deductible amount: 2006 20072008 2009 2010 201120122013 $250 $265$275 $295 $310 $320$325

12 Exhibit 12 FORMULARY TIER PART D PLAN TYPE PART D COST SHARING EMPLOYER PLANS 20062007200820092010201120122013 Generic PDP $5 $7 $5$2 $10 MA-PD $5 $6 $5 Preferred brand PDP $28 $30$37$42 $41$40 $29 MA-PD $26.70$29$30 $39$40$42$45 Non- preferred brand PDP $55$60$71.50$74.75$76.50$78$92$85 $52 MA-PD $55$60 $79$80$84$90 Specialty PDP 25%30% 33%30% 29%26% 32% MA-PD 25% 33% NOTES Part D cost-sharing amounts are medians; employer plan cost-sharing amounts are means. Part D plan estimates weighted by enrollment in each year; analysis excludes generic/brand plans, plans with coinsurance for regular tiers, and plans with flat copayments for specialty tiers. SOURCE: Georgetown/NORC analysis of data from CMS for MedPAC and the Kaiser Family Foundation; data on employer plans from Kaiser/HRET Employer Health Benefits Survey, 2013. Cost Sharing for Medicare Part D Plans, 2006-2013, and Employer-Sponsored Plans, 2013

13 Exhibit 13 MA-PD plans Coinsurance rates: NOTE: Estimates weighted by enrollment in each year. Analysis of MA-PD plans excludes Special Needs Plans. SOURCE: Georgetown/NORC analysis of data from CMS for the Kaiser Family Foundation. Share of Enrollment in Medicare Part D Plans with Specialty Tiers, by Specialty Tier Coinsurance Rate, 2009-2013 PDPs

14 Exhibit 14 NOTE: PDP is stand-alone prescription drug plan. Analysis is weighted by enrollment. Preferred brand includes plans using standard benefit without tiers. Non-preferred brand includes plans using specialty tiers. SOURCE: NORC/Social & Scientific Systems analysis of data from CMS. Share of Medicare Part D Stand-Alone PDP Enrollees with Coverage of Top Ten Brand-Name Drugs, by Formulary Tier, 2013

15 Exhibit 15 NOTE: PDP is stand-alone prescription drug plan. Calculations are share of listed chemical entities, weighted by enrollment in each year. SOURCE: NORC/Social & Scientific Systems analysis of data from CMS. Share of Covered Drugs with Utilization Management (UM) Restrictions Across All Medicare Part D Stand-Alone PDPs, 2007-2013

16 Exhibit 16 Top Brand- Name Drug % Enrollees with Drug Not Covered % Enrollees with Any UM % Enrollees with Prior Authorization % Enrollees with Step Therapy % Enrollees with Quantity Limits Nexium21%61%0% 57% Crestor26%83%0%9%82% Advair Diskus11%79%0%4%79% Namenda0%76%0% 76% Lantus13%30%0% 30% Spiriva0%78%0% 78% Cymbalta0%86%20%8%83% Zetia0%73%7%2%72% Celebrex22%74%40%26%73% Lyrica0%82%25%13%74% NOTE: PDP is stand-alone prescription drug plan. UM is utilization management. Presence of UM restrictions is measured as a share of plans with the drug listed on formulary. SOURCE: NORC/Social & Scientific Systems analysis of data from CMS. Share of Medicare Part D Stand-Alone PDP Enrollees Facing UM Restrictions for Top Ten Brand-Name Drugs, 2013

17 Exhibit 17 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape and Enrollment files for the Kaiser Family Foundation. Distribution of Monthly Part D Premiums for Low-Income Subsidy PDP Enrollees Paying Premiums, 2006-2013 Of Total LIS Enrollees, Share Paying Premiums: 20062007200820092010201120122013 6%7%21%26%22%13%17%19% Number Paying Premiums: 488,400530,1001,718,8002,042,2001,731,0001,040,1001,433,9001,597,500 Average premiums:$9.20$12.69$6.87$11.10$9.95$14.71$12.45$11.82

18 Exhibit 18 NOTE: PDP is stand-alone prescription drug plan. SOURCE: Georgetown/NORC analysis of CMS 2006-2013 PDP Landscape and Enrollment files for the Kaiser Family Foundation. Number of Low-Income Subsidy PDP Enrollees Paying Monthly Premiums, 2006-2013

19 Exhibit 19 NOTE: PDP is stand-alone prescription drug plan. Unrated plans are excluded from percentages. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Ratings, 2013. Share of Medicare Part D Stand-Alone PDPs and PDP Enrollees, by Plan Star Ratings, 2013 4 or more stars Total number of PDPs = 1,031Total enrollment = 17.9 million Distribution of PDPs by quality ratings: Distribution of PDP enrollees, by quality ratings:

20 Exhibit 20 Name of firm 20132006 Change in Total Enrollment, 2006-2013 Rank Enrollment (in millions) % of Total Part D in 2013 Rank UnitedHealth Group 17.8622.3%1+38% Humana 25.1714.7%2+19% CVS Caremark 34.5112.8%11+920% Express Scripts 42.757.8%10+563% Aetna 52.587.3%12+530% CIGNA 61.654.7%17+675% Kaiser Permanente 71.123.2%6+44% Wellpoint 81.063.0%3-19% WellCare Health Plans 91.012.9%4+3% Envision 100.471.3%N/A TOTAL TOP 10 FIRMS28.2 mil79.9% TOTAL PART D35.3 mil100.0% NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, 2006-2013. Top 10 Firms Offering Medicare Part D Plans Ranked by 2013 Enrollment

21 Exhibit 21 Name of Plan 20132006 Change 2006-2013 Rank Enrollment (in millions) % of Total Part D in 2013 Rank AARP MedicareRx Preferred PDP 13.8711.0%1+21% SilverScript Basic PDP* 23.048.6%5+284% Express Scripts Medicare PDP (Employer)** 32.336.6%11+461% Humana Walmart-Preferred PDP 41.765.0%N/A Humana Enhanced PDP 51.323.7%3+37% SilverScript Group Calendar PDP (Employer) 60.942.7%N/A Humana Gold Plus HMO 70.812.3%14+113% Kaiser Permanente Senior Advantage HMO 80.772.2%7+16% Cigna Medicare Rx Plan One PDP 90.692.0%29+470% First Health Part D Premier PDP 100.681.9%18+157% NOTE: Includes plans in the territories and employer plans. SOURCE: Georgetown/NORC/Kaiser Family Foundation analysis of CMS Enrollment Files, 2006-2013. Top 10 Medicare Part D Plans Ranked by 2013 Enrollment

22 Exhibit 22 Top 5 Medicare Part D Stand-Alone PDPs, Ranked by 2013 LIS Enrollment and Non-LIS Enrollment Prescription Drug Plan Total LIS Enrollment Share of All LIS Enrollees Share LIS in Plan Number of Regions Where PDP is Benchmark Plan SilverScript Basic2,601,00031.6%86.0%30 Humana Walmart-Preferred Rx Plan926,00011.2%52.8%34 AARP MedicareRx Preferred737,0008.9%19.1%0 Cigna Medicare Rx Plan One592,0007.2%86.4%21 WellCare Classic436,0005.3%69.0%19 TOTAL FOR TOP 5 LIS PDPs 5,292,00064.2% Prescription Drug Plan Total Non- LIS Enrollment Share of All Non-LIS Enrollment Share Non- LIS in Plan Number of Regions Where PDP is Benchmark Plan AARP MedicareRx Preferred3,114,00031.9%80.9%0 Humana Enhanced1,134,00011.6%86.3%0 Humana Walmart-Preferred Rx Plan829,0008.5%47.2%34 First Health Part D-Value Plus617,0006.3%95.7%0 SilverScript Basic422,0004.3%14.0%30 TOTAL FOR TOP 5 NON-LIS PDPs6,116,00062.6% NOTE: LIS is low-income subsidy. Excludes employer group plans and plans in the territories. SOURCE: Georgetown/NORC analysis of CMS PDP Landscape and Enrollment Files, 2013, for the Kaiser Family Foundation.

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