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Medicare Part D 2008 Data Spotlight: Benefit Design

This Medicare Part D data spotlight examines the benefit design of Medicare Part D Prescription Drug Plans (PDP) in 2008, focusing on national plans. It shows that in 2008, as in previous years, only about 10 percent of national prescription drug plans offered the defined standard benefit. The spotlight also…

Medicare Part D 2010 Data Spotlight: Benefit Design and Cost Sharing

The Medicare Modernization Act established a defined standard drug benefit for Part D stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans, while giving plans flexibility to offer alternative benefit designs. Only about one in 10 PDPs offer the standard benefit in 2010. Plan sponsors can offer…

The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States

This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by…

Preventing Chronic Disease: The New Public Health

There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans…

Medicaid Payment for Outpatient Prescription Drugs

This fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide. Fact Sheet (.pdf)

Medicaid Enrollment and Expenditures by Federal Core Requirements and State Options

To receive federal Medicaid matching funds, states that participate in Medicaid must meet federal requirements, which include covering specified “federal core” enrollee groups and mandatory health benefits. States also may choose to cover additional “state expansion” enrollees and optional benefits with federal Medicaid matching funds. The federal core eligibility standards…

Workplace Wellness Programs, Healthy Behaviors and Health Reform

Many large employers offer financial incentives to their employees to exercise regularly, improve their diets, lose weight and quit smoking. Health reform proposals would write some of these incentives into law. But some patient advocates say that, depending on how the incentives are structured, they can make coverage more expensive…

Medicare Prescription Drug Plans in 2009 and Key Changes Since 2006: Summary of Findings

Since 2006, Medicare beneficiaries have had access to prescription drug coverage offered by private plans, either stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug plans (MA-PD plans). Today, more than 26 million Medicare beneficiaries are enrolled in Medicare drug plans, including 17.5 million in stand-alone prescription drug plans…

Uniform Coverage Summaries for Consumers

This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. The rule, which implements a provision in the Affordable Care Act (ACA), is intended to make it simpler for consumers…