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News & Updates
Juliette Cubanski Follow @jcubanski on Twitter, Tricia Neuman Follow @tricia_neuman on Twitter, and Anthony Damico
Published: Aug 21, 2018
Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead
As of 2019, Medicare beneficiaries enrolled in Part D prescription drug plans will no longer be exposed to a coverage gap, sometimes called the “donut hole”, when they fill their brand-name medications. The coverage gap was included in the initial design of the Part D drug benefit in the Medicare Modernization Act of 2003 in order to reduce the total 10-year cost of the benefit. Subsequent legislative changes are phasing out the coverage gap by modifying the share of total costs paid in the gap by Part D enrollees and plans and requiring drug manufacturers to provide a discount on the price of brand-name drugs in the gap. This data note presents trends on the Part D coverage gap and discusses recent and proposed changes affecting out-of-pocket costs for Part D enrollees who reach the coverage gap.
In 2016, the most recent year of available data, more than 5 million Part D enrollees without low-income subsidies (LIS) reached the coverage gap, spending $1,569 out of pocket, on average, and receiving an average manufacturer discount of $1,090. Due to provisions in the Affordable Care Act (ACA) to phase out the coverage gap, average out-of-pocket costs for non-LIS Part D enrollees who reach the coverage gap decreased substantially between 2010 and 2011 but have increased somewhat in recent years.
Under changes made by the Bipartisan Budget Act of 2018 (BBA), Part D enrollees’ out-of-pocket costs for brands in the gap will decline from 35 percent of total costs in 2018 to 25 percent in 2019—rather than in 2020—while plans’ share of costs for brands will decrease to 5 percent and the manufacturer discount will increase from 50 percent to 70 percent. Recent calls to modify the BBA changes to the coverage gap could lead to higher beneficiary out-of-pocket costs and higher Medicare spending.
Published: November 27, 2017 6:01 pm
Intermountain Healthcare changing 'to disrupt ourselves,' CEO says
SALT LAKE CITY — Intermountain Healthcare CEO Dr. Marc Harrison said Monday that a restructuring affecting administrative positions in the hospital system is coming out of a desire to "disrupt ourselves" and that "nothing is already decided" regarding the possibility of other changes.
"Nothing was broken. Our mandate from back in 1975 was to be a model health care system, and I think for 2017 we are, but what we looked at — the question is — 'As we sit in 2017, would that make us a model for 2020 or 2022?' And we didn’t think so," Harrison told the Deseret News and KSL editorial boards.
Last month, Intermountain Healthcare announced it was moving away from its existing reporting structure centered around central, north, south and southwest regions. Intermountain spokesman Daron Cowley confirmed at the time that the jobs of some employees — "all in administrative positions" — would be eliminated and said those affected would have an opportunity to apply for other jobs within the hospital system. The change takes effect Friday.
By: RICARDO ALONSO-ZALDIVAR and MATTHEW PERRONE, Associated Press
Updated: Feb 08, 2018 04:29 PM MST
Trump aims to reduce drug costs under Medicare
WASHINGTON (AP) - President Donald Trump will propose lowering prescription drug costs for Medicare beneficiaries by allowing them to share in rebates that drug companies pay to insurers and middlemen, an administration official said Thursday.
A senior administration official outlined the plan on condition of anonymity ahead of the release of Trump's 2019 budget plan next week.
Pharmaceutical companies now pay rebates to insurers and pharmacy benefit managers to help their medications gain a bigger slice of the market.
Insurers apply savings from rebates to keep premiums more manageable.
Under Trump's proposal, seniors covered by Medicare's popular "Part D" prescription benefit would be able to share in the rebates for individual drugs that they purchase at the pharmacy.
Trump's budget would also expand Medicare's "catastrophic" drug benefit so that many seniors with very high costs would not face copayments. Seniors with high drug bills are currently still responsible for 5 percent of the cost of their medications. With some new drugs costing $100,000 a year or more, patient costs add up quickly.
The White House proposal would put Trump in the middle of a tug-of-war between drug companies on one side and insurers and pharmacy benefit managers on the other, with billions of dollars at stake.