Managed Care - December 2008 - (Page 20)

Price Hikes Spur Part D Debate As premiums soar, the new Democratic majority weighs the benefits of restrictive regulation vs. the free market implications for the managed care companies that serve the market. Many think that President-elect Barack Obama and a Democratic majority in the House and Senedicare officials have consistently emate are almost certain to repeal the non-interference phasized the positive about the Part D clause in the Medicare Prescription Drug, Imdrug program, and they weren’t provement, and Modernization Act of 2003 changing their tune going into open (MMA) that prevents Medicare from negotiating enrollment season for 2009. drug prices. Some legislators have been rooting for In a teleconference with reporters in November, a system that dictates lower drug prices for the duacting Administrator Kerry Weems said that 97 ally eligible Medicaid population, which percent of all Medicare beneficiaries would could affect how plans negotiate their prices have access to a drug plan that was no more for all their members. expensive — or even less expensive — than Other proposals relating to cost sharing they would have paid in 2008. That was pormay well hit the bargaining table. A law autrayed as something to cheer about for the thorizing drug reimportation, which could 25.4 million Americans enrolled in some type have implications for the way that Part D of Part D coverage. plans negotiate prices and how members jugBut analysts note that the CMS presentagle out-of-pocket costs, is likely to be back up tion didn’t exactly paint the full picture of Some insurers for a new vote that won’t face a Bush veto what lies ahead. found that they again. This year, says Bonnie Washington, vice could increase president of Avalere Health, the average Part premiums and not D premium is shooting up close to 25 percent. lose membership, Problem with premiums says Richard Among the 10 most popular Part D plans on Stefanacci, DO, After a flurry of complaints during the inioffer, the average price hike is 31 percent. MBA, of the Unitial ramp-up of Part D in 2005, the drug subOne of the biggest plans in the country, of- versity of the sidy swiftly became a big hit among seniors fered by Humana, is jacking up premiums Sciences in who had long complained about the growing Philadelphia. by 60 percent. Out-of-pocket drug expenses cost of pharmaceuticals. That popularity has are higher as well. Part D plans for low-inendured. In mid November, RetireSafe, an come seniors are gradually disappearing, leaving far advocacy group, found 92 percent of seniors exfewer to choose from. pressing satisfaction with the drug program. “There are a number of ways of looking at numNinety-six percent said it was easy to use. bers,” notes Tricia Neuman, vice president and di“The satisfaction with Part D continues to be rector of the Medicare Policy Project at the Kaiser high,” says Washington. “I do think that with the Family Foundation. “It’s true there are lowpremium increases as high as they are this year, premium plans throughout the country, but the along with everything else going on in the economy, most popular plans are posting significant increases you may hear more complaints. Until now, many in premiums.” have chosen not to change plans. This year, we may Against that backdrop of spiking prices, legislasee that tipping point.” tors in Washington are gearing up to debate the fuThere’s nothing unusual these days about a ture of Part D come the new year and new adminhealth plan choosing to push significant increases istration. What they decide will have far-reaching in rates. By John Carroll Contributing Editor M 20 MANAGED CARE / DECEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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