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Medicare Part D Strategies to Change Over Time
 
The second year of Medicare Part D coverage is drawing to a close. The vast majority of employers who sponsor a drug benefit for Medicare-eligible retirees are choosing to continue the benefit and collect the tax-free retiree drug subsidy (RDS).

There is evidence, however, that the landscape will change in 2008 and beyond. Findings of the Kaiser/Hewitt 2006 Survey on Retiree Health Benefits indicate company-sponsored plans that selected RDS are seriously evaluating alternatives.

When asked about their likely strategies beyond 2007, firms that accepted the subsidy in 2006 are less certain about which future they will pursue.

About 79 percent say it is very likely or somewhat likely they will offer drug coverage and accept the subsidy in 2008. That drops to 54 percent for 2010 (see Figure 5).

As anticipated, the RDS payment administrative process is cumbersome and can be costly for employers. The compliance risk and potential for government audits represent added challenges to employers who choose the subsidy.

Competitive Alternatives to RDS
Medicare Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) Plans are providing more options and becoming attractive alternatives to RDS. These plans also are marketing more aggressively to employers.

The number of national PDPs serving all regions and representing one-stop shopping for employers increased from 10 in 2006 to 17 in 2007, according to Centers for Medicare and Medicaid Services (CMS) data. PDPs are expanding their formularies, offering more donut hole coverage, and extremely competitive premiums.

MA-PDs offer a competitive alternative to PDPs. There are now 1,675 unique MA-PDs across the country, with 34 percent of them offering $0 premiums. The introduction of Medicare Advantage Medical Savings Accounts (MSAs) promises yet another alternative likely to find a market niche.

What’s Ahead
Benefits consultants expect employers to migrate to PDPs and, increasingly, to MAPDs.

Likely to increase are customized prescription drug plans (including employer group waiver plans), tailored to an employer’s retiree population and benefit structure.

Some retirees will be faced with premium increases in company-sponsored drug plans and Medigap policies. They may migrate to Medicare Advantage plans that offer lower premiums and more open access.

As a result, some employers may eventually decide to discontinue drug coverage and provide a subsidy to retirees. That will allow them to shop for the plan that best meets their needs.


Figure 5
: Likelihood of Continuing Drug Benefits and Accepting Subsidy Among Employers Taking the Subsidy in 2006



Proactive Management for Specialty Pharmacy

Lowering Copays to Increase Treatment Adherence

Changing the Drug Reimbursement Landscape

Decreased Copays Encourage Voluntary Pill Splitting

Strengthening Prescription Drug Safety

FDA Uses Many Tools to Monitor Drugs

 

 

 

 

 

 

 

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