By Eun Ha Namkung / GWB School of Social Work - Washington University. As the enrollment period for Medicare Part D for the year of 2009 is opened from November 15 to December 31, now is the time for people with Medicare to review and change their current plans. Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), emphasized the importance of reviewing the plan with the following statement. “Plans do change their offerings from year to year. We encourage individual beneficiaries to review how their plans are changing and what other options are available to them."
In 2003, the Medicare Modernization Act Prescription Drug Benefit (Part D) established a prescription drug benefit for all Medicare beneficiaries. This is the largest change to Medicare since the program began several decades ago.
Part D was established to provide protection for people who have very high drug costs or to protect people from unexpected prescription drug bills. It covers both brand-name and generic prescription drugs at participating pharmacies. People have access to two types of prescription drug coverage plans: Stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. PDPs only cover medications while MA-PD plans cover all Medicare benefits including drugs.
After Medicare Part D was implemented in January 2006, it covered 53% of Medicare beneficiaries by mid-2006, and 54% by January 2007. In 2008, more than 25.4 million (57%) Medicare beneficiaries are enrolled in Medicare drug plans.3 In Missouri, 64% of people with Medicare have Part D. In terms of plans, 1,688 PDPs will be offered nationwide in 2009, with monthly premiums from $10.30 to $136.80. In Missouri, 48 PDPs will be available with the lowest being a $14.50 monthly premium.
Yin and his colleagues (2008) examined 5.1 million Part D-eligible seniors’ drug utilization and expenditures during certain periods before and after the enrollment. Their study supported several previous CMS reports and revealed that the Medicare Part D prescription benefit results in modest increases in average drug utilization and decreases average out-of-pocket expenditures by 13.1% among Part D beneficiaries.
However, there is room for improvement of Part D. First, the “doughnut hole”, a well-known coverage gap, should be reduced gradually and covered by many non-expensive plans. If Part D enrollees reach the gap, they are required to pay 100% of total drug costs until they reach the catastrophic coverage level. An estimated 3.4 million (14%) Part D enrollees reached the coverage gap in 2007, and there is growing evidence that some enrollees who reach the gap forgo needed medications because of cost. Second, Part D plans are very different across the 50 states, 34 Medicare regional areas. Furthermore, they are changed yearly. Therefore, annual Part D education sessions for practitioners and consumers should be provided by Medicare community partners, such as Area Agencies on Aging. Last, further research is needed to examine the impact of Medicare Part D on health outcomes, physicians prescribing practices, and drug use patterns among seniors.