The federal government has proposed new rules that aim to make Medicaid outpatient drug reimbursement policies more closely match the cost of obtaining and filling prescriptions. However, the change in policy may have varying effects on reimbursement, depending on the state’s current approach and the type of drug in question. This paper explains current Medicaid pharmacy reimbursement methodology and examines the potential effect of the proposed rule changes.
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The Food and Drug Administration has approved two vaccines against infection by certain strains of human papillomavirus (HPV), the most common sexually transmitted infection in the United States. Initially, the vaccines were recommended only for girls and young women, but in 2011 the Centers for Disease Control and Prevention broadened them to include boys and young men. This fact sheet discusses HPV and cancers related to the virus, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines.
This report presents findings from an analysis of the Medicare Part D marketplace in 2013 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan availability, enrollment, premiums, low-income subsidies, the coverage gap, benefit design, cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by researchers at Georgetown University, the Kaiser Family Foundation and the National Opinion Research Center at the University of Chicago.
This fact sheet includes the latest information and data about the Medicare Part D Prescription Drug Benefit, including current plan information, the standard benefit parameters, updates on additional low-income assistance, and the latest available enrollment data.
The 2014 Part D Data Spotlight analyzes information about the Medicare Part D stand-alone prescription drug plan (PDP) options available to beneficiaries in 2014. The analysis shows that Medicare beneficiaries on average will have a choice of 35 stand-alone prescription drug plans in 2014, and somewhat more “benchmark” plans available to Low-Income Subsidy (LIS) beneficiaries nationwide. The weighted average premium will increase by 5 percent between 2013 and 2014 if enrollees remain in the same plans next year. The analysis also finds more plans are using preferred pharmacy networks and adopting a growing number of cost-sharing formulary tiers for different drugs.
This analysis finds that relatively few Medicare beneficiaries have switched Part D prescription drug plans voluntarily during the annual open enrollment period — even though those who do switch often lower their out-of-pocket costs as a result of changing plans. The vast majority (87% on average between 2006 and 2010) stayed in the same Part D plan, even though the plans can change premiums, deductibles, cost-sharing amounts, and their list of covered drugs each year. Higher rates of plan switching were observed in PDPs that increased premiums, increased deductibles, or dropped coverage of brand-name drugs in the coverage gap.
This annual Employer Health Benefits Survey (EHBS) provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The 2013 EHBS survey finds average family health premiums rose 4 percent in 2013, relatively modest growth by historical standards.
Snapshots: A Comparison of the Availability and Cost of Coverage for Workers in Small Firms and Large Firms
Small and large firms vary substantially on health insurance offer rates and costs. Small firms are less likely to offer coverage, and there are important differences in the health benefits that small and larger firms offer. Workers at small firms are responsible for paying both a larger share of family…
This fact sheet contains 2013 state-specific summary data about available Medicare drug benefit options, including premium ranges and the number of plans available at no cost to qualifying beneficiaries. Fact Sheet (.pdf)
This fact sheet provides a basic overview of the Medicare program, including how it is financed, who is eligible, and what benefits are covered under the program. In addition, it describes supplemental health insurance, out-of-pocket spending by people on Medicare, and data on Medicare expenditures and financing.