July 26, 2018
- Dual Eligibles and Access to Part D Drugs: Pretty Good News from the OIG
- Health Care Sabotage: Poll Shows Voters are Watching
How has Medicare, Medicaid or the Affordable Care Act (ACA) helped you or your family? Your stories about the value of Medicare, Medicaid and the ACA help us protect and strengthen the health care programs we all rely on.
The Office of the Inspector General for the Department of Health and Human Services released a report recently regarding Part D coverage of prescription drugs used by people dually eligible for Medicare and Medicaid. The June report, Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2018, found that most Part D plan formularies include prescription medications commonly used by dual eligible beneficiaries. The report’s findings include:
- On average, Part D plan formularies include 96 percent of the 197 commonly used drugs (the list of the 200 drugs most commonly used by dual eligible was developed using data from the 2013 Medicare Current Beneficiary Survey – the most recent data available at the time of the study. The drugs most commonly used by dual eligible MCBS survey participants in 2013 account for 88 percent of all prescriptions dispensed to the dual-eligible respondents in the 2013 MCBS).
- The average rate of inclusion decreased slightly between 2017 and 2018, from 97 percent to 96 percent.
- 68 percent of the commonly used drugs are included by all Part D plan formularies.
- The percentage of drugs to which plan formularies applied utilization management tools increased slightly between 2017 and 2018. On average, formularies applied utilization management tools to 29 percent of the unique drugs reviewed in 2018, an increase of 1 percentage point from 2017.
- There are 386 unique formularies used by Part D plans in 2018. 12 formularies include 100 percent of the commonly used drugs. Two formularies include 85 percent of the commonly used drugs.
- Of the approximately 10.8 million dual eligibles enrolled in Part D plans nationwide, approximately 93 percent are enrolled in Part D plans with formularies that include at least 90 percent of the commonly used drugs.
- Seven percent of dual eligibles are enrolled in Part D plans that use formularies that include less than 90 percent of the commonly used drugs.
Access to Medicare Part D prescription drugs for people who are eligible for both Medicare and Medicaid appears to be holding fairly stable. However, the report cautions that variation in plan formularies, and their use of utilization management might still force beneficiaries to make additional efforts to access the drugs they need, which could result in administrative barriers to accessing certain prescription drugs.
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This week, the Kaiser Family Foundation released a poll showing that 56% of Americans believe that the Administration is “trying to make the ACA fail.” The polling also shows that by nearly seven to one, people think this is a negative thing. Over the last few months, we’ve highlighted negative actions taken by the Administration – from cutting the open enrollment period in half to not defending the ACA before the courts. Fortunately, the public is also watching and understands the value of having comprehensive quality health coverage. This is one of the clearest signs yet that the public wants efforts to undermine the ACA to end.
Fortunately, the Administration decided to reverse its position and continue payments under the ACA’s risk adjustment program. CMS released a final rule that brings clarity to the program’s payment methodology and other issues. The Center for Medicare Advocacy has previously written about the misguided decision to end the risk adjustment payments, and the impact on premiums. The reversal by CMS will help insurers provide critical coverage to consumers who are sicker and have complex conditions. Now it is also time for the Administration to reverse course and fully fund navigators; prevent the expansion of inadequate insurance; restore funding for enrollment outreach; reinstitute payments for cost sharing reductions; and defend the ACA because it is the law of the land.
These actions will be critical to ensuring that all Americans concerned about access to quality care will get the information and enrollment assistance they need.
For more information see:
- Kaiser poll here: https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-july-2018-changes-to-the-affordable-care-act-health-care-in-the-2018-midterms-and-the-supreme-court/?utm_campaign=KFF-2018-July-Poll-Candidate-Position-Pre-Existing-Protections
- Protect Our Care’s Summer of Sabotage report here: https://www.protectourcare.org/summer-of-sabotage/
- Center for American Progress’ ACA sabotage report here: https://www.americanprogress.org/issues/healthcare/news/2018/07/24/453917/estimated-increases-2019-premiums-congressional-district-due-aca-sabotage/
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