/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.
A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.
"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.
The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.
In addition to the increased cost to payers, other key findings included:
* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.
In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.
In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.
-----
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Showing posts with label part d. Show all posts
Showing posts with label part d. Show all posts
Wednesday, January 12, 2011
Friday, October 01, 2010
Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan with Lowest National Monthly Premium Offered in all 50 States and D.C.¹
(BUSINESS WIRE)--Today, Humana Inc. (NYSE: HUM) announced an innovative Medicare Part D prescription drug plan, co-branded with Wal-Mart Stores, Inc. (NYSE: WMT) or (“Walmart”), that can provide significant savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities.
The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.
“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”
Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details
* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.
* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.
* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.
How to Enroll in the Plan: Call, Click or Go
Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:
* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.
Medicare Part D Background
Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.
References
1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp
2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.
3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf
4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm
5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.
-----
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The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.
“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”
Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details
* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.
* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.
* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.
How to Enroll in the Plan: Call, Click or Go
Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:
* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.
Medicare Part D Background
Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.
References
1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp
2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.
3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf
4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm
5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.
-----
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Thursday, September 23, 2010
Medicare beneficiaries in donut hole will see 50-percent discount on brand name drugs in 2011
Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation's pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011.
Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.
"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."
The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.
"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."
Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.
"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."
Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.
-----
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Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.
"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."
The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.
"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."
Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.
"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."
Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.
-----
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www.FayetteFrontPage.com
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Thursday, November 12, 2009
New CVS/pharmacy Data Reveals Older Americans Could Save an Average of $612 Annually by Switching Medicare Part D Plans
/PRNewswire/ -- With the Annual Enrollment Period for Medicare Part D beginning on November 15, CVS/pharmacy and the National Council on Aging (NCOA) are urging older adults and their caregivers to review their Medicare Part D options in order to find the lowest cost plan that meets their needs.
Confusion around the number and variety of prescription drug plans often becomes a barrier to identifying and selecting the most cost effective plan. Free online tools like the CVS/pharmacy Medicare Part D Savings Calculator at www.cvs.com/medicare simplifies the comparison process, helping seniors more readily identify the plan with the lowest overall costs.
"Plan review can seem cumbersome, but completing a plan comparison each year is an essential step toward saving," said Fernando Gonzalez, R.Ph at CVS/pharmacy. "Tools like the Medicare Part D Calculator are designed to simplify the process to help older adults and their caregivers select a plan that provides them with the greatest value and peace of mind."
A CVS/pharmacy analysis of more than 10,000 older Americans using the Medicare Part D Savings Calculator last year revealed plan participants could save an average of $612 in annual drug costs just by switching to their optimal Medicare Part D plan.(1)
"This data underscores the importance for older adults and their caregivers to review Medicare Part D plans each year," said Wendy Zenker, Vice President of the NCOA Benefits Access Group. "With the number of changes to Part D plans from year to year, Medicare beneficiaries can expect to see significant savings and receive better coverage, if they compare and shop around."
To that end, CVS/pharmacy today launches a campaign with the goal of helping millions of seniors and their caregivers realize savings on 2010 prescription costs through education and assistance in Medicare Part D plan comparison. Starting November 12, CVS/pharmacy and the NCOA are offering Medicare Part D educational events throughout Annual Enrollment period at senior centers across the country.
Consumers can also go online at CVS.com/medicare to use the free Medicare Part D Savings Calculator. And, CVS pharmacists will be available throughout the enrollment period to provide plan comparisons in stores for those who would like assistance.(2)
Remembering the Three Cs: Cost, Coverage and Convenience
CVS/pharmacy and NCOA recommend considering three factors when evaluating plans:
-- Cost - What is the plan deductible, monthly premium and prescription
co-pay for the prescriptions you regularly take? Evaluate the total
cost and not just the co-pays. And, identify in advance if you fall
into the doughnut hole.
-- Coverage - Are the prescription medications you regularly take covered
in the plan? Are there restrictions such as prior authorization? Each
year insurance plans change, including premiums, co-pays, and the list
of covered drugs. Your own prescription needs change as well.
-- Convenience - Can you fill the prescription at the pharmacy of your
choice?
Before starting the plan selection process, older Americans should review their current medications with their pharmacist. Often, prescription costs can be lowered by switching to a generic alternative, consolidating pills or by switching to an over the counter alternative. Having these changes in place before selecting a plan can help in choosing the most affordable option and potentially avoiding the doughnut hole -- the gap in coverage if your prescription costs reach $2,830.
-----
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Confusion around the number and variety of prescription drug plans often becomes a barrier to identifying and selecting the most cost effective plan. Free online tools like the CVS/pharmacy Medicare Part D Savings Calculator at www.cvs.com/medicare simplifies the comparison process, helping seniors more readily identify the plan with the lowest overall costs.
"Plan review can seem cumbersome, but completing a plan comparison each year is an essential step toward saving," said Fernando Gonzalez, R.Ph at CVS/pharmacy. "Tools like the Medicare Part D Calculator are designed to simplify the process to help older adults and their caregivers select a plan that provides them with the greatest value and peace of mind."
A CVS/pharmacy analysis of more than 10,000 older Americans using the Medicare Part D Savings Calculator last year revealed plan participants could save an average of $612 in annual drug costs just by switching to their optimal Medicare Part D plan.(1)
"This data underscores the importance for older adults and their caregivers to review Medicare Part D plans each year," said Wendy Zenker, Vice President of the NCOA Benefits Access Group. "With the number of changes to Part D plans from year to year, Medicare beneficiaries can expect to see significant savings and receive better coverage, if they compare and shop around."
To that end, CVS/pharmacy today launches a campaign with the goal of helping millions of seniors and their caregivers realize savings on 2010 prescription costs through education and assistance in Medicare Part D plan comparison. Starting November 12, CVS/pharmacy and the NCOA are offering Medicare Part D educational events throughout Annual Enrollment period at senior centers across the country.
Consumers can also go online at CVS.com/medicare to use the free Medicare Part D Savings Calculator. And, CVS pharmacists will be available throughout the enrollment period to provide plan comparisons in stores for those who would like assistance.(2)
Remembering the Three Cs: Cost, Coverage and Convenience
CVS/pharmacy and NCOA recommend considering three factors when evaluating plans:
-- Cost - What is the plan deductible, monthly premium and prescription
co-pay for the prescriptions you regularly take? Evaluate the total
cost and not just the co-pays. And, identify in advance if you fall
into the doughnut hole.
-- Coverage - Are the prescription medications you regularly take covered
in the plan? Are there restrictions such as prior authorization? Each
year insurance plans change, including premiums, co-pays, and the list
of covered drugs. Your own prescription needs change as well.
-- Convenience - Can you fill the prescription at the pharmacy of your
choice?
Before starting the plan selection process, older Americans should review their current medications with their pharmacist. Often, prescription costs can be lowered by switching to a generic alternative, consolidating pills or by switching to an over the counter alternative. Having these changes in place before selecting a plan can help in choosing the most affordable option and potentially avoiding the doughnut hole -- the gap in coverage if your prescription costs reach $2,830.
-----
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