Medicare Payment Policy

FIguRe FIGURE
15–1
15-1
Enrollment in millions
18
16
14
12
10
8
6
4
2
0
2006
2007
2010
2011
Note: PDP (prescription drug plan), MA–PD (Medicare Advantage–Prescription Drug [plan]).
Source: MedPAC analysis of CMS landscape, plan report, and enrollment data.
PDP enrollees...
pDp enrollees are less likely to have benefits in the coverage gap
PDPs MA–PDs
2012
18
16
14
12
10
8
6
4
2
0
2006
Drugs covered in the gap
were in plans that offered benefits in the coverage gap Some generics In 2010, but about no 28 brand-name percent of Part drugs D enrollees had 1.2 1.2 2.2
beyond what is required by PPACA. However, over Some 40 generics spending and high some enough brand-name to put them in drugs the coverage 0.2 gap, 0.4 a
percent of PDP enrollees received Part D’s LIS, which None decrease 3.6 from 3.3 over 30 2.1 percent 2.4 in previous 2.9 years 3.9(Figure
effectively eliminated their coverage gap. By comparison, 15-2, p. 344). Part D enrollees who entered the coverage
1.4
52 percent of MA−PD enrollees were in plans offering gap in 2010 faced 100 percent of the plan’s negotiated
gap coverage. About half of these enrollees were in plans price of the drug for prescriptions filled in the coverage
that covered some generics but not brand-name drugs in gap, unless they were in a plan that provided some
the gap.
Notes about this graph:
benefits in the gap or were an LIS enrollee, for whom the
gap is eliminated. LIS enrollees accounted for more than
use • of Data part is D in benefits the datasheet. and share Make of updates enrollees in the datasheet. half of the enrollees with spending high enough to reach
reaching the coverage gap
the coverage gap (nearly 4.7 million, or about 16 percent
• I reformatted the years from the x-axis.
Prescription drugs are used widely by Medicare
of all Part D enrollees). Slightly over 2.6 million, or about
beneficiaries. • I had According to manually to the draw Commission’s tick marks analysis and axis lines 9 because percent of they Part D kept enrollees, resetting had when spending I changed high enough any data.
of 2010 • Use prescription direct selection drug event tool data to taken select from items Part for modification. to reach Part Otherwise D’s catastrophic if you use coverage the black phase. selection About 2 tool, they w
D claims, default about when 93 percent you change of Part D the enrollees data. filled at million of them (7 percent of Part D enrollees) received
least one prescription during the year. Enrollees filled an the LIS.
• Use paragraph styles (and object styles) to format.
average of 4.2 prescriptions per month, with considerably
higher average utilization among those who received the
LIS (5.1 per month) than among beneficiaries who did not
Most part D enrollees have good access to
prescription drugs
(3.7 per month).
Surveys indicate that beneficiaries enrolled in Part D are
generally satisfied with the Part D program and with their
2007
2010
2011
2012
No gap
coverage
Some generics
and some
brand-name
drugs in the
coverage gap
Some generics
but no
brand-name
drugs in the
coverage gap
Report to the Congress: Medicare Payment Policy | March 2013
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