10 Companies To Offer Medicare Prescription Drug Coverage Nationwide; Others To Offer Plans Regionally, CMS Announces, USA
Details about the coverage to be offered by specific plans were not available on Friday but should be provided in the next several weeks, the Baltimore Sun reports (Salganik, Baltimore Sun, 9/24). Under law, prescription drug plans are required to provide coverage at least as good as Medicare's standard coverage (New York Times, 9/24). The 2003 Medicare law defined standard prescription drug coverage as the following: Individuals will be responsible for a $250 annual deductible and 25% of subsequent drug costs up to $2,250. The beneficiary then will be responsible for all of the next $2,850 in out-of-pocket drug costs until total spending reaches $5,100, after which Medicare will pay 95% of drug costs (Lee, Washington Post, 9/24). Medicare rules require that participating drug plans cover at least two drugs in each major medication category (Baltimore Sun, 9/24). The Bush administration has estimated the coverage, which will cost the federal government $720 billion over the first 10 years, will save beneficiaries an average of $1,300 annually. An estimated 30 million beneficiaries are expected to enroll in 2006 (Washington Post, 9/24). Plan Differences
Many plans likely will cost less or provide more generous coverage than the standard, CMS officials said. According to the Wall Street Journal, some plans will eliminate the deductible, provide additional coverage for generic medications or require beneficiaries to make copayments for prescriptions instead of paying a percentage of the cost (Lueck/Fuhrmans, Wall Street Journal, 9/24). According to CMS, monthly premiums will average $32, and every state except Alaska will have at least one Medicare drug plan with a monthly premium less than $20. In 44 states, at least one Medicare Advantage plan will offer coverage without premiums (New York Times, 9/24). Plan Premiums
Aetna will charge premiums ranging from $27 to $68 per month, depending on the plan and where the beneficiary lives. Cigna, which will offer three different drug plans in all 50 states, will require premiums ranging from $30 to $52 per month. Cigna's most generous plan will cover generic drugs during the so-called "doughnut hole" in coverage. PacifiCare also will offer three plans nationally, charging premiums ranging from $19.02 per month to $34.88 per month, depending on the state. MemberHealth, a Cleveland-based PBM, will cover generic drugs at no cost under one of its plans, and Medco will offer coverage for premiums ranging from $27 to $35 per month. Humana, which will offer drug plans in 46 states, said at least one of its plans will cost consumers less than $20 in monthly premiums in many states (Wall Street Journal, 9/24). Blue Cross and Blue Shield officials said they will provide stand-alone plans in 41 states (New York Times, 9/24). According to CMS, Medicare Advantage plans will offer prescription drug benefits in every state except Vermont and Arkansas, and 37 states will offer coverage through regional PPOs. Comments
"Medicare is taking a historic step today toward coverage that will bring the best of modern medicine to our beneficiaries," HHS Secretary Mike Leavitt said on Friday (Pugh, Philadelphia Inquirer, 9/24). He added, "Thanks to the range of options; ... everyone in Medicare will be able to choose a prescription drug plan that addresses their individual concerns about cost, coverage and convenience" (Reichard, CQ HealthBeat, 9/23). McClellan said, "Drug plans are offering better benefits and lower prices than independent experts had predicted because they are competing to serve everyone in Medicare. A lot of people said this couldn't be done on time, couldn't be done nationwide. We proved them wrong" (New York Times, 9/24). Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, said, "It's really clear the drug benefit has attracted many, many businesses from throughout the country. What's less clear and really important is what they're offering and how seniors will respond to the opportunity to enroll" (AP/Long Island Newsday, 9/23). She added, "Choices can present opportunities, but the question is: What will seniors do when they face so many choices? Some will comparison shop, others might be heavily influenced by marketing and some may be paralyzed by so many choices" (Washington Post, 9/24). Educational Efforts
CMS officials said that they will be increasing efforts to help beneficiaries select a prescription drug plan. Officials said they already have helped organize 140 networks of community groups -- including businesses and pharmacies -- to counsel beneficiaries (Japsen, Chicago Tribune, 9/24). CMS also included an insert in Sunday's Parade magazine that contains information on the drug benefit. In addition, beginning in mid-October, consumers will be able to call a toll-free number and check the Medicare Web site to learn more about plans. In addition, CMS next month will mail to beneficiaries the "Medicare & You" handbook, which will contain information about plan choices. "Based on costs, coverage and convenience, we will help people find a personalized plan that is best for their specific needs," McClellan said, adding, "There are going to be a lot of resources to help people sort through the information" (Washington Post, 9/24). CMS on Friday also established a Web-based "cost estimator" to show how much money beneficiaries can save by signing up for a plan, but according to the Journal, the tool "assumed the lowest published premium in a person's state, which tended to be lower than what a person might actually pay" (Lueck/Fuhrmans, Wall Street Journal, 9/24). Reaction
Ron Pollack, executive director of Families USA, said, "Seniors are going to be absolutely bewildered by the choices" (Mussenden, Media General/Richmond Times-Dispatch, 9/24). Robert Hayes, president of the Medicare Rights Center, said, "The number and complexity of these plans are paralyzing for people on Medicare" (Baltimore Sun, 9/24). Hayes also expressed concern about the risk for fraud and identity theft because insurers will be able to promote their products to beneficiaries through telemarketing. "It's going to be open season for bad guys to exploit vulnerable older Americans," he said, adding, "Some legitimate companies will play by the rules, but let's face it -- it's an open invitation for confused consumers to give out personal information." McClellan said CMS is working with private contractors to detect fraudulent schemes and improper business practices (Washington Post, 9/24). He also said CMS is working with law enforcement agencies to monitor fraud and abuse in the program, the Los Angeles Times reports. "Not one of these plans is allowed to call them up or go to their homes unsolicited and ask for personal financial information," McClellan said, adding, "If someone calls up saying they are from Medicare and asks you to give them financial information, don't do it" (Alonso-Zaldivar/Vrana, Los Angeles Times, 9/24). 'Shakeout' Ahead?
According to CQ HealthBeat, the announcement on Friday "fueled industry speculation that many plans would drop out in 2007 and that others would sharply raise premiums." Some experts on the Medicare managed care market expressed concern that the large number of insurers offering coverage under the new drug benefit means many of them are only "testing the waters" (CQ HealthBeat, 9/23). McClellan said independent actuaries reviewed the proposals by participating insurers to ensure they had viable business plans. He added that beneficiaries will be able to switch plans in one year, predicting that many will do so because competition will result in "better benefits" over time (Chicago Tribune, 9/24). Related Coverage
The Journal on Monday published a question-and-answer piece designed to help beneficiaries understand the new drug benefit before enrollment begins. The article addresses such issues as which choices will be available, how to enroll, subsidies for low-income beneficiaries, drugs that will be covered and employer-sponsored coverage (Lueck, Wall Street Journal, 9/26). Broadcast Coverage
NPR's "All Things Considered" on Friday reported on the announcement. The segment includes comments from McClellan (Rovner, "All Things Considered," NPR, 9/23).
The complete segment is available online in RealPlayer.
"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Pentru a 10 companii Oferta Medicare de medicamente Acoperire Nationwide; pe alþii sã Oferta Planuri de regiune, CMS Announces, SUA - 10 Companies To Offer Medicare Prescription Drug Coverage Nationwide; Others To Offer Plans Regionally, CMS Announces, USA - articole medicale engleza - startsanatate