Managed Care - December 2008 - (Page 49) MANAGED CARE OUTLOOK Rising deductibles for Part D beneficiaries edicare Part D beneficiaries can look forward to increases in deductibles come 2009 for standard benefit plans, i.e., the minimum plan that may be offered by insurers. Participating Part D plans must offer beneficiaries a statutorily defined standard benefit or an alternative actuarial equivalent. The Medicare Modernization Act (MMA) directs the Centers for Medicare and Medicaid Services (CMS) to update the statutory elements for the standard Part D drug benefit each year. These elements include the standard deductible, initial coverage limit, and catastrophic coverage threshold, along with other related factors. The 2008 standard benefits generally had a $275 deductible and coinsurance of 25 percent after the deductible to the coverage limit of $2,510. This is followed by a coverage gap in which beneficiaries pay 100 percent — up to an out-of-pocket spending limit of $4,050. Once the out-of-pocket spending reaches this level, the plan pays 95 percent of drug costs for catastrophic coverage. The graphs on the right show highlights from standard benefit plans for 2006 to 2009. Of note, for 2008 to 2009: M Elements of standard Part D benefit, 2006–2009 Total covered Part D drug out-of-pocket spending, including coverage gap $5,451 $5,100 $5,276 $6,134 $3,600 $3,850 $4,050 $4,350 Out-of-pocket threshold $2,400 $2,510 $2,700 $2,250 Initial coverage limit $250 2006 Deductible $265 2007 $275 2008 $295 2009 • The initial deductible will increase from $275 to $295 • Initial coverage limit increases from $2,510 to $2,700 • Out-of-pocket threshold increases from $4,050 to $4,350 • Minimum cost sharing in the catastrophic coverage portion of the benefits increases from $2.25 for generic or preferred drug that is a multisource drug and $5.60 for all other drugs in 2008 to $2.40 for generics and $6 for other drugs in 2009 I Generic/preferred multisource drug I Other drugs $5.00 $5.35 $5.60 $6.00 $2.00 $2.15 $2.25 $2.40 2006 Source: Centers for Medicare and Medicaid Services and www.Medicare-PartD.com 2007 2008 2009 DECEMBER 2008 / MANAGED CARE 49 http://www.Medicare-PartD.com
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 Managed Care - December 2008 - Managed Care - December 2008 (Page Cover1) Managed Care - December 2008 - Managed Care - December 2008 (Page Cover2) Managed Care - December 2008 - Managed Care - December 2008 (Page Cover2A) Managed Care - December 2008 - Managed Care - December 2008 (Page Cover2B) Managed Care - December 2008 - Managed Care - December 2008 (Page Cover2C) Managed Care - December 2008 - Managed Care - December 2008 (Page Cover2D) Managed Care - December 2008 - Editor's Memo (Page 1) Managed Care - December 2008 - Contents (Page 2) Managed Care - December 2008 - Contents (Page 3) Managed Care - December 2008 - Contents (Page 4) Managed Care - December 2008 - Legislation & Regulation (Page 5) Managed Care - December 2008 - Legislation & Regulation (Page 6) Managed Care - December 2008 - Legislation & Regulation (Page 7) Managed Care - December 2008 - News and Commentary (Page 8) Managed Care - December 2008 - Medication Management (Page 9) Managed Care - December 2008 - Medication Management (Page 10) Managed Care - December 2008 - Compensation Monitor (Page 11) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 12) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 13) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 14) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 15) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 16) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 17) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 18) Managed Care - December 2008 - ICD-10 Offers Huge Opportunity, Challenge (Page 19) Managed Care - December 2008 - Part D at a Crossroads (Page 20) Managed Care - December 2008 - Part D at a Crossroads (Page 21) Managed Care - December 2008 - Part D at a Crossroads (Page 22) Managed Care - December 2008 - Part D at a Crossroads (Page 23) Managed Care - December 2008 - Plans Can Weather the Financial Crisis (Page 24) Managed Care - December 2008 - Plans Can Weather the Financial Crisis (Page 25) Managed Care - December 2008 - Plans Can Weather the Financial Crisis (Page 26) Managed Care - December 2008 - Plans Can Weather the Financial Crisis (Page 27) Managed Care - December 2008 - DM vs. Medical Home? (Page 28) Managed Care - December 2008 - DM vs. Medical Home? (Page 29) Managed Care - December 2008 - DM vs. Medical Home? (Page 30) Managed Care - December 2008 - DM vs. Medical Home? (Page 31) Managed Care - December 2008 - DM vs. Medical Home? (Page 32) Managed Care - December 2008 - Tackle Prediabetes (Page 33) Managed Care - December 2008 - Tackle Prediabetes (Page 34) Managed Care - December 2008 - Tackle Prediabetes (Page 35) Managed Care - December 2008 - Tackle Prediabetes (Page 36) Managed Care - December 2008 - Tackle Prediabetes (Page 37) Managed Care - December 2008 - Tackle Prediabetes (Page 38) Managed Care - December 2008 - Tackle Prediabetes (Page 39) Managed Care - December 2008 - Tackle Prediabetes (Page 40) Managed Care - December 2008 - Reasonable Approach to Morning Sickness (Page 41) Managed Care - December 2008 - Reasonable Approach to Morning Sickness (Page 42) Managed Care - December 2008 - Reasonable Approach to Morning Sickness (Page 43) Managed Care - December 2008 - Reasonable Approach to Morning Sickness (Page 44) Managed Care - December 2008 - Reasonable Approach to Morning Sickness (Page 45) Managed Care - December 2008 - Formulary Files (Page 46) Managed Care - December 2008 - Tomorrow's Medicine (Page 47) Managed Care - December 2008 - Tomorrow's Medicine (Page 48) Managed Care - December 2008 - Outlook (Page 49) Managed Care - December 2008 - Outlook (Page 50)
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